Diabetes: Urine Screening (NQF 0062)

eMeasure Name Diabetes: Urine Screening eMeasure Id 2380012F-CEAA-4A65-B059-3185B338AA11
Version number 1 eMeasure Set Id DE4053A5-C898-4A11-9DE2-E88A9CB65685
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 patients 18-75 years of age with diabetes (type 1 or type 2) who had a nephropathy screening test or evidence of nephropathy.
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
This measure assesses the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who are susceptible to developing kidney disease as a comorbidity. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin (NIDDK 2007). It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death (NIDDK 2007). Diabetes of either type may cause life-threatening, life-ending or life-altering complications, including end-stage kidney disease. Diabetes is the primary cause of kidney failure, accounting for 44% of newly diagnosed cases in 2005 (NIDDK 2007). Clinical guidelines recommend regular testing to evaluate urine albumin excretions and serum creatinine and the estimated glomerular filtration rate derived from serum creatinine, in addition to comparing measurements when screening for chronic kidney disease (ADA 2009; ACCE 2007). This measure facilitates the prevention and long-term management of kidney disease for patients diagnosed with diabetes.
Clinical Recommendation Statement
American Diabetes Association (ADA), 2009:
. Perform an annual test to assess urine albumin excretion in type 1 diabetic patients with diabetes duration of >=5 years and in all type 2 diabetic patients, starting at diagnosis. (E)
. Measure serum creatinine at least annually in all adults with diabetes regardless of the degree of urine albumin excretion. The serum creatinine should be used to estimate GFR and stage the level of chronic kidney disease (CKD), if present. (E)
. In the treatment of the nonpregnant patient with micro- or macroalbuminuria, either ACE inhibitors or ARBs should be used. (A)

American Association of Clinical Endocrinologists (AACE), 2007: Screen all patients with diabetes mellitus for chronic kidney disease annually; screening should begin 5 years after diagnosis in patients with T1DM and at the time of diagnosis in patients with T2DM. Testing includes:
- Measurement of albumin-to-creatinine ratio in a spot urine specimen and measurement of the estimated glomerular filtration rate derived from serum creatinine
- The following are diagnostic criteria for chronic kidney disease:
. Estimated glomerular filtration rate <60 mL/min/1.73 m2 or albumin-to-creatinine ratio >=30 mg albumin/g creatinine
. Microalbuminuria >=30 mg albumin/g creatinine
. Macroalbuminuria >=300 mg albumin/g creatinine (Grade A)
. Prescribe an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker in the antihypertensive regimen in the absence of contraindications. (Grade A)

American Geriatrics Society (AGS), 2003:  A test for the presence of microalbumin should be performed at diagnosis in patients with type 2 diabetes mellitus.  After the initial screening and in the absence of previously demonstrated macro- or microalbuminuria, a test for the presence of microalbumin should be performed annually. (Level III, Grade A)
Improvement notation
Higher score indicates better quality
Measurement duration
24 month(s)
Reference
American Association of Clinical Endocrinologists and American College of Endocrinology. The American Association of Clinical Endocrinologists Medical Guidelines for the Management of Diabetes Mellitus: The AACE System of Intensive Diabetes Self-Management 2002.
Reference
American Diabetes Association: Clinical Practice Recommendations 2004. Hypertension Management in Adults with Diabetes (Position Statement). Diabetes Care. 2004;27 (suppl 1):65-67.
Reference
California Healthcare Foundation/American Geriatrics Society (AGS) Improving Care of Elders with Diabetes. Guidelines for Improving the Care of the Older Person with Diabetes Mellitus. J Am Geriatr Soc 2003;51:S265-S280. Available at http://ww.americangeriatrics.org/education/diabetes_executive_summary.shtml Accessed September 2004.
Definition
Initial Patient Population(s): All patients 18 to 75 years of age during the measurement period
Definition
Denominator(s): Patients in the initial population with a diagnosis of diabetes and at least 2 non-acute inpatient or outpatient encounters, or currently receiving medications indicative of diabetes during the measurement period or in the 12 months prior to the measurement period
Definition
Denominator Exclusion(s): Patients with a diagnosis of polycystic ovaries, gestational diabetes or steroid-induced diabetes who did not have any face-to-face encounters in any setting, with a diagnosis of diabetes, during the measurement period or the 12 months prior to the measurement period
Definition
Numerator(s): 
The number of patients who had a nephropathy screening test or evidence of nephropathy during the measurement year.
Definition
Denominator Exception(s): N/A
Guidance
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

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012