Hemoglobin A1c Test for Pediatric Patients (NQF 0060)

EMeasure Name Hemoglobin A1c Test for Pediatric Patients EMeasure Id 02BA6629-ACB9-4A5F-8C02-061BC9A71186
Version number 1 Set Id 593A4765-9B49-4121-B0FD-6B94469591B0
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 Percentage of pediatric patients with diabetes with a HbA1c test in a 12-month measurement period
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Prolonged hyperglycemia causes nonenzymatic glycosylation of proteins in tissue and blood, including hemoglobin in erythrocytes. Similar glycosylation of tissue proteins may be involved in pathologic processes which occur in the microvasculature in diabetes. Measurement of glycated proteins such as hemoglobin or other serum proteins can quantify average levels of blood glucose over a period of weeks to months depending on the component measured. In the case of glycosylated hemoglobin, this corresponds to about the life cycle of a red blood cell, or 120 days (3 months). Other glycated serum proteins, such as fructosamine, represent short term changes in glycemia on the order of one to two weeks. The relationship of glucose levels over time to glycohemoglobin makes it a convenient long-term measure of glycemic control. Considering the interval during which glycosylation of hemoglobin occurs, the American Diabetes Association (ADA) recommends testing frequency from one to four times a year depending on the stability of control (ADA, 1997a).

The measurement of glycohemoglobin levels is therefore an important way to identify and anticipate risk for early microvascular complications which result ultimately in the devastating outcomes of blindness, amputation, and kidney failure. It has now been established that early anticipation of risk allows effective intervention through intensive treatment of diabetes.

Even though most target recommendations for glycemic control have been based on data obtained from studies of adult patients with diabetes, the ideal goal of near-normalization of blood glucose levels in children and adolescents is generally the same as that for adults. However, special consideration must be given to the unique risks of hypoglycemia in young children.
Clinical Recommendation Statement
1. American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE): 
Recommend that a glycosylated hemoglobin be performed during an initial assessment and during follow-up assessments, which should occur at no longer than three-month intervals (AACE/ACE, 2002 and 2000).

2. American Diabetes Association (ADA, 2006): 
Recommends obtaining a glycosylated hemoglobin during an initial assessment and then routinely as part of continuing care. In the absence of well-controlled studies that suggest a definite testing protocol, expert opinion recommends glycosylated hemoglobin be obtained at least twice a year in patients who are meeting treatment goals and who have stable glycemic control and more frequently (quarterly assessment) in patients whose therapy was changed or who are not meeting glycemic goals.
Improvement notation
Higher scores indicate better quality
Measurement duration
24 month(s)
Reference
ADA. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 20(Suppl. 1):S5-S13, 1997.
Reference
ADA. Standards of medical care in Diabetes-2006. Diabetes Care, vol 29, Supplement 1. January 2006.
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 Update. Endocrine Practice. Jan/Feb 2002;8(1)
Definition
Guidance

Table of Contents


Population criteria

Data criteria (QDS Data Elements)

Summary Calculation

Calculation is generic to all measures:



Measure set CLINICAL QUALITY MEASURE SET 2011-2012