eMeasure Name | Preventive Care and Screening: Body Mass Index (BMI), Screening and Follow-Up | eMeasure Id | 0beb4703-3e00-4964-be02-40a7ecbf32c9 |
Version number | 2 | eMeasure Set Id | aa066eed-e8f6-4fec-8084-61d3d1e8b6e2 |
Available Date | No information | Measurement Period | January 1, 20xx through December 31, 20xx |
Measure Steward | Quality Insights of Pennsylvania | ||
Endorsed by | National Quality Forum | ||
Description | Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented. Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30 Age 18 – 64 years BMI ≥ 18.5 and < 25 | ||
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Measure scoring | Proportion | ||
Measure type | Process | ||
Stratification | Stratified by (i) age: >=65, (ii) age >=18 and <=64 |
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Risk Adjustment | None |
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Data Aggregation | |||
Rationale | BMI Above Upper Parameter In 2009, no U.S. state met the Healthy People 2010 adult obesity prevalence target of 15 percent, and the number of states with an obesity prevalence ≥30 increased from zero in 2000 to 9 in 2009 (CDC, 2010). Further, the report revealed that the overall self-reported obesity prevalence in the United States was 26.7 percent, an increase of 1.1 percentage points from 2007 to 2009 among adults aged 18 years or older. Obesity continues to be a public health concern in the United States and throughout the world. In the United States, obesity prevalence doubled among adults between 1980 and 2004 (Flegal, et al, 2002; Ogden, et al, 2006). Obesity is associated with increased risk of a number of conditions, including diabetes mellitus, cardiovascular disease, hypertension, and certain cancers, and with increased risk of disability and a modestly elevated risk of all-cause mortality. With obesity on the rise, the medical community anticipates an increase in the complications of obesity, including type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular disease, obstructive sleep apnea, degenerative arthritis, non-alcoholic steatohepatitis, gallbladder disease and others. Results from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) indicate that an estimated 32.7 percent of U.S. adults 20 years and older are overweight, 34.3 percent are obese and 5.9 percent are extremely obese. Although the prevalence of adults in the U.S. who are obese is still high with about one-third of adults obese in 2007-2008, new data suggest that the rate of increase for obesity in the U.S. in recent decades may be slowing (Flegal, et al, 2010). Finkelstein, et al. (2009), found increased prevalence of obesity is responsible for almost $40 billion of increased medical spending through 2006, including $7 billion in Medicare prescription drug costs. We estimate the medical costs of obesity may rise to $147 billion per year by 2008. Ma, et al. (2009) performed a retrospective, cross-sectional analysis of ambulatory visits in the National Ambulatory Medical Care Survey from 2005 and 2006. The study findings on obesity and office-based quality of care concluded the evidence is compelling that obesity is underappreciated in office-based physician practices across the United States. Many opportunities are missed for obesity screening and diagnosis, as well as for the prevention and treatment of obesity and related health risks, regardless of patient and provider characteristics. BMI Below Normal Parameter Poor nutrition or underlying health conditions can result in underweight. Results from the 2003-2006 National Health and Nutrition Examination Survey (NHANES, 2009), using measured heights and weights, indicate an estimated 1.8% of U.S. adults are underweight. A tremendous gap still exists between our knowledge of malnutrition, its sequelae and our actions in preventing and treating malnutrition. To date professionals in various disciplines have applied their own approaches to solving the problem. Yet the causes of malnutrition are multi-factorial and the solutions demand an integration of knowledge and expertise from the many different disciplines involved in geriatric care. Older people have special nutritional needs due to age and disease processes. Elderly patients with unintentional weight loss are at higher risk for infection, depression and death. The leading causes of involuntary weight loss are depression (especially in residents of long-term care facilities), cancer (lung and gastrointestinal malignancies), cardiac disorders and benign gastrointestinal diseases. Medications that may cause nausea and vomiting, dysphagia, dysgeusia and anorexia have been implicated. Polypharmacy can cause unintended weight loss, as can psychotropic medication reduction (e.g., by unmasking problems such as anxiety). In one study it was found that a BMI of less than 22 kg per m2 in women and less than 23.5 in men is associated with increased mortality. The optimal BMI in the elderly is 24 to 29 kg per m2. (In an observational study, Ranhoff, et al. (2005) identified using a BMI< 23, resulted in a positive screen for malnutrition (sensitivity 0.86, specificity 0.71), giving 0.75 correctly classified subjects, thus leading to the recommendation that a score of BMI< 23 should be followed by MNA-SF when the aim is to identify poor nutritional status in elderly. |
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Clinical Recommendation Statement | Although multiple clinical recommendations addressing obesity have been developed by professional organizations, societies and associations, two recommendations, which exemplify the intent of the measure and address the numerator and denominator, have been identified. The US Preventive Health Services Task Force (USPSTF) (2003) recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults (Level Evidence B). Institute for Clinical Systems Improvement (ICSI, 2009) Prevention and Management of Obesity (Mature Adolescents and Adults) provides the following guidance: • Calculate the body mass index; classify the individual based on the body mass index categories. Educate patients about their body mass index and their associated risks. • Weight management requires a team approach. Be aware of clinical and community resources. The patient needs to have an ongoing therapeutic relationship and follow-up with a health care team. • Weight control is a lifelong commitment, and the health care team can assist with setting specific goals with the patient |
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Improvement notation | Higher score indicates better quality |
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Measurement duration | 12 month(s) |
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Reference | |||
Definition | Initial Patient Population(s): All patients greater than or equal to 65 years of age (population 1) or between 18 and 64 years of age (population 2) |
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Definition | Denominator(s): All patients in the initial populations with an outpatient encounter during the measurement period. |
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Definition | Denominator Exclusion(s): Patients are excluded from either population if they have a terminal illness, an active pregnancy, or a patient, medical or system reason. |
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Definition | Numerator(s): Numerator 1 (population 1) = Patients with Body Mass Index (BMI) calculated within the past six months or during the current visit with a normal BMI (less than 30 kg/m² AND greater than or equal to 23 kg/m²) or above or below threshold (greater than or equal to 30 kg/m² or less than 23 kg/m²) with a follow up plan documented during the measurement period Numerator 2 (population 2) =Patients with Body Mass Index (BMI) calculated within the past six months or during the current visit with a normal BMI (less than 25 kg/m² AND greater than or equal to 18.5 kg/m²) or above or below threshold (greater than or equal to 25 kg/m² or less than 18.5 kg/m²) and a follow up plan documented during the measurement period. |
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Definition | Denominator Exception(s): N/A |
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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)". |
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Measure set | CLINICAL QUALITY MEASURE SET 2011-2012 |