eCQM Title

Retesting of Abnormal Blood Glucose in Patients with Prediabetes

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
Copyright
Copyright 2018 American Medical Association. All Rights Reserved.
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].
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
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.
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)
Improvement Notation
Higher score indicates better quality
Reference
American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. 2018. (41)Supplement 1. Available at: http://care.diabetesjournals.org.
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).
Guidance
None
Transmission Format
TBD
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
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
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
Numerator
Patients who had a blood glucose test performed
Numerator Exclusions
Not Applicable
Denominator Exceptions
Documentation of patient reasons for exception (eg, patient moved, changed insurance coverage)
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents


Population Criteria

        • 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
         
  • Definitions

    Functions

    Terminology

    • code "Birth date" ("LOINC Code (21112-8)")
    • code "Diabetes mellitus due to underlying condition without complications" ("ICD10CM Code (E08.9)")
    • code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
    • code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
    • code "Fasting glucose [Moles/volume] in Serum or Plasma" ("LOINC Code (14771-0)")
    • code "Glucose [Mass/volume] in Serum or Plasma --2 hours post 75 g glucose PO" ("LOINC Code (1518-0)")
    • code "Glucose [Moles/volume] in Serum or Plasma --2 hours post 75 g glucose PO" ("LOINC Code (14995-5)")
    • valueset "Annual Wellness Visit" (2.16.840.1.113883.3.526.3.1240)
    • valueset "Comfort Measures" (2.16.840.1.113883.17.4077.3.2030)
    • valueset "Diabetes" (2.16.840.1.113883.3.464.1003.103.12.1001)
    • valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
    • valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
    • valueset "Fasting Plasma Glucose Lab Test Mass Per Volume" (2.16.840.1.113883.3.526.3.3003)
    • valueset "HbA1c Laboratory Test" (2.16.840.1.113883.3.464.1003.198.12.1013)
    • valueset "Hospice care ambulatory" (2.16.840.1.113762.1.4.1108.15)
    • valueset "Nursing Facility Visit" (2.16.840.1.113883.3.464.1003.101.12.1012)
    • valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
    • valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
    • valueset "Outpatient Consultation" (2.16.840.1.113883.3.464.1003.101.12.1008)
    • valueset "Palliative or Hospice Care" (2.16.840.1.113883.3.600.1.1579)
    • valueset "Patient Reason" (2.16.840.1.113883.3.526.3.1008)
    • valueset "Payer" (2.16.840.1.114222.4.11.3591)
    • valueset "Pregnancy" (2.16.840.1.113883.3.526.3.378)
    • valueset "Preventive Care Services - Established Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1025)
    • valueset "Preventive Care Services - Other" (2.16.840.1.113883.3.464.1003.101.12.1030)
    • valueset "Preventive Care Services-Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
    • valueset "Race" (2.16.840.1.114222.4.11.836)

    Data Criteria (QDM Data Elements)

    • "Diagnosis: Diabetes" using "Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001)"
    • "Diagnosis: Diabetes mellitus due to underlying condition without complications" using "Diabetes mellitus due to underlying condition without complications (ICD10CM Code E08.9)"
    • "Diagnosis: Pregnancy" using "Pregnancy (2.16.840.1.113883.3.526.3.378)"
    • "Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240)"
    • "Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
    • "Encounter, Performed: Nursing Facility Visit" using "Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012)"
    • "Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
    • "Encounter, Performed: Outpatient Consultation" using "Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008)"
    • "Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up" using "Preventive Care Services - Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025)"
    • "Encounter, Performed: Preventive Care Services - Other" using "Preventive Care Services - Other (2.16.840.1.113883.3.464.1003.101.12.1030)"
    • "Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up" using "Preventive Care Services-Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023)"
    • "Intervention, Order: Comfort Measures" using "Comfort Measures (2.16.840.1.113883.17.4077.3.2030)"
    • "Intervention, Order: Hospice care ambulatory" using "Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15)"
    • "Intervention, Order: Palliative or Hospice Care" using "Palliative or Hospice Care (2.16.840.1.113883.3.600.1.1579)"
    • "Intervention, Performed: Comfort Measures" using "Comfort Measures (2.16.840.1.113883.17.4077.3.2030)"
    • "Intervention, Performed: Hospice care ambulatory" using "Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15)"
    • "Intervention, Performed: Palliative or Hospice Care" using "Palliative or Hospice Care (2.16.840.1.113883.3.600.1.1579)"
    • "Laboratory Test, Not Performed: Fasting glucose [Moles/volume] in Serum or Plasma" using "Fasting glucose [Moles/volume] in Serum or Plasma (LOINC Code 14771-0)"
    • "Laboratory Test, Not Performed: Fasting Plasma Glucose Lab Test Mass Per Volume" using "Fasting Plasma Glucose Lab Test Mass Per Volume (2.16.840.1.113883.3.526.3.3003)"
    • "Laboratory Test, Not Performed: Glucose [Mass/volume] in Serum or Plasma --2 hours post 75 g glucose PO" using "Glucose [Mass/volume] in Serum or Plasma --2 hours post 75 g glucose PO (LOINC Code 1518-0)"
    • "Laboratory Test, Not Performed: Glucose [Moles/volume] in Serum or Plasma --2 hours post 75 g glucose PO" using "Glucose [Moles/volume] in Serum or Plasma --2 hours post 75 g glucose PO (LOINC Code 14995-5)"
    • "Laboratory Test, Not Performed: HbA1c Laboratory Test" using "HbA1c Laboratory Test (2.16.840.1.113883.3.464.1003.198.12.1013)"
    • "Laboratory Test, Performed: Fasting glucose [Moles/volume] in Serum or Plasma" using "Fasting glucose [Moles/volume] in Serum or Plasma (LOINC Code 14771-0)"
    • "Laboratory Test, Performed: Fasting Plasma Glucose Lab Test Mass Per Volume" using "Fasting Plasma Glucose Lab Test Mass Per Volume (2.16.840.1.113883.3.526.3.3003)"
    • "Laboratory Test, Performed: Glucose [Mass/volume] in Serum or Plasma --2 hours post 75 g glucose PO" using "Glucose [Mass/volume] in Serum or Plasma --2 hours post 75 g glucose PO (LOINC Code 1518-0)"
    • "Laboratory Test, Performed: Glucose [Moles/volume] in Serum or Plasma --2 hours post 75 g glucose PO" using "Glucose [Moles/volume] in Serum or Plasma --2 hours post 75 g glucose PO (LOINC Code 14995-5)"
    • "Laboratory Test, Performed: HbA1c Laboratory Test" using "HbA1c Laboratory Test (2.16.840.1.113883.3.464.1003.198.12.1013)"
    • "Patient Characteristic Birthdate: Birth date" using "Birth date (LOINC Code 21112-8)"
    • "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
    • "Patient Characteristic Payer: Payer" using "Payer (2.16.840.1.114222.4.11.3591)"
    • "Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
    • "Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"

    Supplemental Data Elements

    Risk Adjustment Variables


    Measure Set