Childhood immunization Status (NQF 0038)

eMeasure Name Childhood immunization Status eMeasure Id A310F21D-7A80-498A-BA33-8B471F205272
Version number 1 eMeasure Set Id DEEBCF9E-5AF4-476B-BD79-936DCB8584B3
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Endorsed by National Quality Forum
Description The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HIB); three hepatitis B (Hep B), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The percentage of children 2 years of age who had the complete series of vaccines by 2 years of age. There are 12 rates calculated for this measure 10 for the individual immunizations and 2 for the series of immunizations.
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None. (No stratification by age. However, care on how to multiple numerators and exclusions - see HQMF guidance section)
Risk Adjustment
None
Data Aggregation
Rationale
This measure monitors the appropriate and timely use of vaccines for children prior to their second birthday. Pediatric vaccines are responsible for preventing 10.5 million diseases per birth cohort in the U.S. and are a cost-effective preventive measure. For every dollar spent on immunizations, as many as $29 can be saved in direct and indirect costs. With the development and use of vaccines, the prevalence of some infectious diseases has dramatically reduced; since the beginning of the 20th century, there has been a 99% decline in vaccine-preventable disease morbidity. Despite the established guidelines and well-known benefits of vaccination, however, in 2007, 22.5% of children 19–35 months of age had not received the recommended immunizations. General clinical consensus notes that if immunization practices ceased, most infectious diseases currently prevented by vaccinations would reemerge as serious health threats. This measure facilitates efforts toward infectious disease prevention among a vulnerable subgroup of the population.
Clinical Recommendation Statement
Current CDC/ACIP Guidelines recommend infants and toddlers receive the Hepatitis B series, four DTaP vaccinations, four HIB vaccinations, three IPV vaccinations, one MMR vaccination, four pneumococcal conjugate vaccinations, and one varicella vaccination. Some combination products on the market include both the DTaP and HIB vaccines and should only be administered three times. In these cases, children receive three HIB vaccinations instead of the four mentioned above. The recommendation is to receive these vaccinations between birth and 18 months of age. The current HEDIS specifications allow a grace period by measuring compliance with these recommendations between birth and age two.
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
CDC. General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006; 55(RR15);1-48 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5515a1.htm
Definition
Initial Patient Population(s): Children age >2 years of age during the measurement period
Definition
Denominator(s): Patients in the initial population who had an outpatient visit with a primary care physician (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement period This measure is stratified into 12 populations to allow for a different rate calculation for the individual vaccination that children should receive before their second birthday.
	
	Note:  The intent of the measure is to calculate a rate for those children who have received appropriate vaccinations by their second birthday.  The inclusion of vaccine specific rates allows providers an opportunity to identify which vaccinations are not consistently provided to their pediatric patients
Definition
Denominator Exclusion(s): Population 1:Patients with an active diagnosis of encephalopathy or progressive neurologic disorder
Population 2:None
Population 3: Patients with a history of active diagnosis of measles, mumps and rubella; or an active diagnosis of HIV disease, multiple myeloma, leukemia, or immunodeficiency
Population 4: None
Population 5: Patients with a history of active or chronic Hepatitis BPopulation 6: Patients with a history of active diagnosis of chickenpox (varicella), or an active diagnosis of or history of cancer of lymphoreticular or histiocytic tissue, or an active diagnosis of HIV disease, multiple myeloma, leukemia, or immunodeficiency
Population 7: Patients with a history of or an active diagnosis of cancer of lymphoreticular or histiocytic tissue; or patients with an active diagnosis of HIV disease, multiple myeloma, leukemia or immunodeficiency
Population 8: Patients with a history of active or chronic Hepatitis A
Population 9: Patients with a history of active or chronic Rotavirus
Population 10: Patients with a history of or an active diagnosis of cancer of lymphoreticular or histiocytic tissue; or patients with an active diagnosis of HIV disease, multiple myeloma, leukemia or immunodeficiency
Population 11: Patients who have an active diagnosis of encephalopathy, progressive neurologic disease, HIV disease, multiple myeloma, leukemia, immunodeficiency, cancer of lymphoreticular or histiocytic tissue or a history of cancer of lymphoreticular or histiocytic tissuePopulation 12: Patients who have an active diagnosis of encephalopathy, progressive neurologic disease, HIV disease, multiple myeloma, leukemia, immunodeficiency, cancer of lymphoreticular or histiocytic tissue or a history of cancer of lymphoreticular or histiocytic tissue
Definition
Numerator(s): Population 1: diphtheria, tetanus, acellular pertussus (DTaP): At least four DTaP vaccinations, with different dates of service on or before the child’s second birthday. Do not count any vaccination administered prior to 42 days after birth.
Population 2: inactivated polio vaccine (IPV): At least three IPV vaccinations, with different dates of service on or before the child’s second birthday. IPV administered prior to 42 days after birth cannot be counted.
Population 3: measles, mumps and rubella (MMR). At least one MMR vaccination, with the date of service on or before the child’s second birthday.
Population 4: hemophilus influenza b (HiB): At least two HiB vaccinations, with different dates of service on or before the child’s second birthday. Do not count any vaccination administered prior to 42 days after birth.
Population 5: Hepatitis B: At least three Hepatitis B vaccinations, with different dates of service on or before the child’s second birthday. 
Population 6: varicella zoster vaccine (VZV): At least one VZV vaccination, with the date of service on or before the child’s second birthday.
Population 7: Pneumococcal conjugate: At least four pneumococcal conjugate vaccinations, with different dates of service on or before the child’s second birthday. Do not count any vaccination administered prior to 42 days after birth.
Population 8: Hepatitis A: Two Hepatitis A vaccinations, with different dates of service on or before the child’s second birthday.  
Population 9: Rotavirus: The child must receive the required number of rotavirus vaccinations (two doses or three doses, depending on which vaccine is administered), on different dates of service on or before the child’s second birthday. Do not count any vaccination administered prior to 42 days after birth.  The number of rotavirus doses varies based on the vaccine given. There is a two-dose schedule and a three-dose schedule. 
Population 10: Influenza: Two influenza vaccinations, with different dates of service on or before the child’s second birthday. Do not count any vaccination administered prior to six months after birth. 
Population 11: At least  DTaP, IPV, MMR, HiB, Hep B and VZV vaccination. 
Population 12: At least DTaP, IPV, MMR, HiB, Hep B, VZV and Pneumococcal vaccinations
Definition
Denominator Exception(s): Population 1:Patients with an allergy to Dtap vaccine 
Population 2:Patients with an allergy to IPV, neomycin, streptromycin or polymyxin
Population 3: Patients with an allergy to the following vaccines: MMR, mumps, measles, rubella
Population 4: Patients with an allergy to HiB vaccine
Population 5: Patients with an allergy to Baker’s Yeast Substance or Hepatitis B vaccine
Population 6: Patients with an allergy to VZV vaccine
Population 7: Patients with an allergy to pneumococcal vaccine
Population 8: Patients with an allergy to Hepatitis A vaccine 
Population 9: Patients with an allergy to rotavirus vaccine
Population 10: Patients with an allergy to influenza vaccine
Population 11: Patients with an allergy to IPV, neomycin, streptomycin, or polymyxin, Dtap vaccine, MMR vaccine, mumps vaccine, measles vaccine, rubella vaccine, HiB vaccine, Baker’s Yeast Substance, or Hepatitis B vaccine
Population 12: Patients with an allergy to IPV, neomycin, streptomycin, or polymyxin, Dtap vaccine, MMR vaccine, mumps vaccine, measles vaccine, rubella vaccine, HiB vaccine, Baker’s Yeast Substance, Hepatitis B vaccine, or pneumococcal vaccine
Guidance
Measure 0038 lists 12 populations for reporting.  The first ten populations indicate whether any individual has received the appropriate number of a specific immunization by the age of 2.  Note the number of doses of vaccines is specified in the logic; the spacing of vaccines should occur per relevant clinical guidelines. The 11th and 12th populations indicate whether any individual has received all of the expected doses of a group (or bundle) of immunizations.  Note that each of the first 10 populations, referring to a single vaccine (or vaccine combination - MMR) has a specific set of exclusions that apply only to the respective vaccine(s). For populations 11 and 12, if there is an exclusion for any of the individual vaccines, the patient is removed from the denominator. Populations 11 and 12 are intended to show only those patients for whom all of the listed vaccines have been performed.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

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Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012