| eCQM Title | Retesting of Abnormal Blood Glucose in Patients with Prediabetes |
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| eCQM Identifier (Measure Authoring Tool) | 926 | eCQM Version Number | 2.0.000 |
| NQF Number | Not Applicable | GUID | b72ca317-015f-4b04-8f48-3c1f5ee83cfa |
| Measurement Period | January 1, 20XX through December 31, 20XX | ||
| Measure Steward | PCPI(R) Foundation (PCPI[R]) | ||
| Measure Developer | American Medical Association (AMA) | ||
| Endorsed By | None | ||
| Description |
Percentage of patients aged 18 years and older who had an abnormal fasting plasma glucose, oral glucose tolerance test, or hemoglobin A1c result in the range of prediabetes in the previous year who have a blood glucose test performed in the one-year measurement period |
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| Copyright |
Copyright 2018 American Medical Association. All Rights Reserved. |
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| Disclaimer |
The Measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and American Medical Association (AMA). The AMA shall not be responsible for any use of the Measures. The AMA encourages use of the Measures by other health care professionals, where appropriate. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA disclaims all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. CPT[R] contained in the Measures specifications is copyright 2004-2017 American Medical Association. LOINC[R] copyright 2004-2017 Regenstrief Institute, Inc. SNOMED CLINICAL TERMS (SNOMED CT[R]) copyright 2004-2017 The International Health Terminology Standards Development Organisation (IHTSDO). ICD-10 is copyright 2017 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R]. |
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| Measure Scoring | Proportion | ||
| Measure Type | Process | ||
| Stratification |
None |
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| Risk Adjustment |
None |
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| Rate Aggregation |
None |
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| Rationale |
At least annual glucose testing in patients who were previously found to have lab results in the range of prediabetes is an important aspect of care so that patients can be monitored for improvement or potential transition to Type 2 diabetes. While there are no current studies that show patients with prediabetes do not have follow-up testing completed, the Technical Expert Panel felt that this is a key area in which to have a measure. |
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| Clinical Recommendation Statement |
The following evidence statements are quoted verbatim from the referenced clinical guidelines and other sources, where applicable: At least annual monitoring for the development of diabetes in those with prediabetes is suggested. (ADA, 2018) (E) |
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| Improvement Notation |
Higher score indicates better quality |
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| Reference |
American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. 2018. (41)Supplement 1. Available at: http://care.diabetesjournals.org. |
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| Definition |
Retesting for abnormal blood glucose may include using the following tests: -fasting plasma glucose; -2-h plasma glucose during a 75g oral glucose tolerance test -A1C Abnormal lab result in the range of prediabetes includes: -fasting plasma glucose level between 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L); -2-hour glucose during a 75g oral glucose tolerance test between 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L); -A1C between 5.7-6.4% (39-47 mmol/mol). |
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| Guidance |
None |
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| Transmission Format |
TBD |
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| Initial Population |
All patients aged 18 years and older seen for at least two office visits or at least one preventive visit during the measurement period |
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| Denominator |
Equals initial population who had an abnormal fasting plasma glucose, oral glucose tolerance test, or hemoglobin A1c result in the range of prediabetes in the year prior to the one-year measurement period |
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| Denominator Exclusions |
Patients who are pregnant, patients who have any existing diagnosis of diabetes (Type 1, Type 2, latent autoimmune diabetes of adults [LADA], monogenic diabetes [MODY]), and patients in palliative care/hospice |
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| Numerator |
Patients who had a blood glucose test performed |
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| Numerator Exclusions |
Not Applicable |
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| Denominator Exceptions |
Documentation of patient reasons for exception (eg, patient moved, changed insurance coverage) |
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| Supplemental Data Elements |
For every patient evaluated by this measure also identify payer, race, ethnicity and sex |
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exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18
)
and ( Count("Office Visit During Measurement Period")>= 2
or exists "Preventive Visit During Measurement Period"
)
"Initial Population" and exists "Prediabetes Blood Glucose Test Results Within Year Prior to Measurement Period"
"Patient is Pregnant at Encounter" or "Patient Has Active Diabetes Diagnosis at Encounter" or "Hospice During Measurement Period" or "Palliative Care During Measurement Period" or "Comfort Measures During Measurement Period"
exists "Blood Glucose Test Performed During Measurement Period"
None
exists "Patient Reason for Not Performing Blood Glucose Test"
None
["Laboratory Test, Performed": "HbA1c Laboratory Test"] HbA1CTest
where HbA1CTest.relevantDatetime during "Measurement Period"
and HbA1CTest.result is not null
["Laboratory Test, Performed": "HbA1c Laboratory Test"] PriorHbA1CTest
where PriorHbA1CTest.resultDatetime 12 months or less before start of "Measurement Period"
and PriorHbA1CTest.result included in Interval[5.7 '%', 6.4 '%']
"A1c Test Performed During Measurement Period" union "Two Hour Plasma Glucose During 75 Gram Oral Glucose Tolerance Test Performed During Measurement Period" union "Fasting Plasma Glucose Test Performed During Measurement Period"
exists ( ["Intervention, Order": "Comfort Measures"] ComfortMeasuresOrdered
where ComfortMeasuresOrdered.authorDatetime during "Measurement Period"
)
or exists ( ["Intervention, Performed": "Comfort Measures"] ComfortMeasuresPerformed
where ComfortMeasuresPerformed.relevantPeriod overlaps "Measurement Period"
)
"Initial Population" and exists "Prediabetes Blood Glucose Test Results Within Year Prior to Measurement Period"
exists "Patient Reason for Not Performing Blood Glucose Test"
"Patient is Pregnant at Encounter" or "Patient Has Active Diabetes Diagnosis at Encounter" or "Hospice During Measurement Period" or "Palliative Care During Measurement Period" or "Comfort Measures During Measurement Period"
"Preventive Visit During Measurement Period" union "Office Visit During Measurement Period"
( ["Laboratory Test, Performed": "Fasting Plasma Glucose Lab Test Mass Per Volume"] FastingGlucoseTestMass
where FastingGlucoseTestMass.relevantDatetime during "Measurement Period"
and FastingGlucoseTestMass.result is not null
)
union ( ["Laboratory Test, Performed": "Fasting glucose [Moles/volume] in Serum or Plasma"] FastingGlucoseTestMoles
where FastingGlucoseTestMoles.relevantDatetime during "Measurement Period"
and FastingGlucoseTestMoles.result is not null
)
( ["Laboratory Test, Performed": "Fasting Plasma Glucose Lab Test Mass Per Volume"] PriorFastingGlucoseTestMass
where PriorFastingGlucoseTestMass.resultDatetime 12 months or less before start of "Measurement Period"
and PriorFastingGlucoseTestMass.result included in Interval[100 'mg/dl', 125 'mg/dl']
)
union ( ["Laboratory Test, Performed": "Fasting glucose [Moles/volume] in Serum or Plasma"] PriorFastingGlucoseTestMoles
where PriorFastingGlucoseTestMoles.resultDatetime 12 months or less before start of "Measurement Period"
and PriorFastingGlucoseTestMoles.result included in Interval[5.6 'mmol/L', 6.9 'mmol/L']
)
exists ( ["Encounter, Performed": "Encounter Inpatient"] DischargeHospice
where ( DischargeHospice.dischargeDisposition as Code ~ "Discharge to home for hospice care (procedure)"
or DischargeHospice.dischargeDisposition as Code ~ "Discharge to healthcare facility for hospice care (procedure)"
)
and DischargeHospice.relevantPeriod ends during "Measurement Period"
)
or exists ( ["Intervention, Order": "Hospice care ambulatory"] HospiceOrder
where HospiceOrder.authorDatetime during "Measurement Period"
)
or exists ( ["Intervention, Performed": "Hospice care ambulatory"] HospicePerformed
where HospicePerformed.relevantPeriod overlaps "Measurement Period"
)
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18
)
and ( Count("Office Visit During Measurement Period")>= 2
or exists "Preventive Visit During Measurement Period"
)
exists "Blood Glucose Test Performed During Measurement Period"
( ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Outpatient Consultation"] union ["Encounter, Performed": "Nursing Facility Visit"] ) OfficeEncounter where OfficeEncounter.relevantPeriod during "Measurement Period"
exists ( ["Intervention, Order": "Palliative or Hospice Care"] PalliativeCareOrdered
where PalliativeCareOrdered.authorDatetime during "Measurement Period"
)
or exists ( ["Intervention, Performed": "Palliative or Hospice Care"] PalliativeCarePerformed
where PalliativeCarePerformed.relevantPeriod overlaps "Measurement Period"
)
exists ( ["Diagnosis": "Diabetes"]
union ["Diagnosis": "Diabetes mellitus due to underlying condition without complications"] ) DiabetesDiagnosis
with "Encounter During Measurement Period" VisitDuringMP
such that DiabetesDiagnosis.prevalencePeriod overlaps after VisitDuringMP.relevantPeriod
exists ( ["Diagnosis": "Pregnancy"] PregnancyDiagnosis
with "Encounter During Measurement Period" VisitDuringMP
such that PregnancyDiagnosis.prevalencePeriod overlaps after VisitDuringMP.relevantPeriod
)
( ["Laboratory Test, Not Performed": "HbA1c Laboratory Test"]
union ["Laboratory Test, Not Performed": "Fasting Plasma Glucose Lab Test Mass Per Volume"]
union ["Laboratory Test, Not Performed": "Fasting glucose [Moles/volume] in Serum or Plasma"]
union ["Laboratory Test, Not Performed": "Glucose [Mass/volume] in Serum or Plasma --2 hours post 75 g glucose PO"]
union ["Laboratory Test, Not Performed": "Glucose [Moles/volume] in Serum or Plasma --2 hours post 75 g glucose PO"] ) NoGlucoseTest
with "Encounter During Measurement Period" VisitDuringMP
such that NoGlucoseTest.authorDatetime during VisitDuringMP.relevantPeriod
where NoGlucoseTest.negationRationale in "Patient Reason"
"A1c Test Performed Year Prior to Measurement Period and Results in Prediabetes Range" union "Fasting Plasma Glucose Test Performed Year Prior to Measurement Period and Results in Prediabetes Range" union "Two Hour Plasma Glucose During 75 Grams Oral Glucose Tolerance Test Performed Year Prior to Measurement Period and Results in Prediabetes Range"
( ["Encounter, Performed": "Annual Wellness Visit"] union ["Encounter, Performed": "Preventive Care Services - Established Office Visit, 18 and Up"] union ["Encounter, Performed": "Preventive Care Services - Other"] union ["Encounter, Performed": "Preventive Care Services-Initial Office Visit, 18 and Up"] ) PreventiveVisit where PreventiveVisit.relevantPeriod during "Measurement Period"
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
( ["Laboratory Test, Performed": "Glucose [Mass/volume] in Serum or Plasma --2 hours post 75 g glucose PO"] OralGlucoseTestMass
where OralGlucoseTestMass.relevantDatetime during "Measurement Period"
and OralGlucoseTestMass.result is not null
)
union ( ["Laboratory Test, Performed": "Glucose [Moles/volume] in Serum or Plasma --2 hours post 75 g glucose PO"] OralGlucoseTestMoles
where OralGlucoseTestMoles.relevantDatetime during "Measurement Period"
and OralGlucoseTestMoles.result is not null
)
( ["Laboratory Test, Performed": "Glucose [Mass/volume] in Serum or Plasma --2 hours post 75 g glucose PO"] PriorOralGlucoseTestMass
where PriorOralGlucoseTestMass.resultDatetime 12 months or less before start of "Measurement Period"
and PriorOralGlucoseTestMass.result included in Interval[140 'mg/dL', 199 'mg/dL']
)
union ( ["Laboratory Test, Performed": "Glucose [Moles/volume] in Serum or Plasma --2 hours post 75 g glucose PO"] PriorOralGlucoseTestMoles
where PriorOralGlucoseTestMoles.resultDatetime 12 months or less before start of "Measurement Period"
and PriorOralGlucoseTestMoles.result included in Interval[7.8 'mmol/L', 11.0 'mmol/L']
)
years between ToDate(BirthDateTime)and ToDate(AsOf)
DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
| Measure Set |
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