Diabetes:HbA1cControl(<8%)(NQF0575)

EMeasureName VersionNumber AvailableDate MeasureSteward Endorsedby Description Measurescoring Measuretype Rationale Diabetes:HbA1cControl< 8% 1 Noinformation EMeasureId Pending

Clinical Recommendation Statement

SetId Pending Measurement January1,20xxthrough Period December31,20xx NationalCommitteeforQualityAssurance NationalQualityForum Thepercentageofpatients1875yearsofagewithdiabetes(type1ortype2) whohadHbA1c<8.0%. Proportion Process Thismeasureevaluatesthepercentageofpatientsinaspecificagedemographic whowerediagnosedwithtype1ortype2diabetesandwhodemonstrate adequatebloodsugarcontrolwithanHbA1clevellowerthan8percent.Diabetes mellitus(diabetes)isagroupofdiseasescharacterizedbyhighbloodglucose levelscausedbythebodysinabilitytocorrectlyproduceorutilizethehormone insulin.ItisrecognizedasaleadingcauseofdeathanddisabilityintheU.S.andis highlyunderreportedasacauseofdeath.Diabetesofeithertypemaycauselife threatening,lifeendingorlifealteringcomplications,includingpoorbloodsugar control.Studieshaveshownthatimprovedglycemiccontroliscorrelatedwitha 40%declineinthedevelopmentofassociatedmicrovascularcomplications(i.e., eye,kidneyandnervediseases)(ADA2009).Clinicalguidelinesrecommend regularHbA1ctestingtofacilitatepatientsabilitytoimproveandsustain acceptablelevels(ADA2009).Thismeasurefacilitatesthemaintenanceandlong termmanagementofadequatebloodsugarlevelsforpatientsdiagnosedwith diabetes. AmericanGeriatricSociety: Forfrailolderadults,personswithlifeexpectancyoflessthan5years, andothersinwhomtherisksofintensiveglycemiccontrolappearto outweighthebenefits,alessstringenttargetsuchas8%isappropriate. (LevelIII,GradeB) Forolderpersons,targethemoglobinA1Cshouldbeindividualized.A reasonablegoalforA1Cinrelativelyhealthyadultswithgoodfunctional statusis7%orlower.(LevelIII,GradeB)

AmericanDiabetesAssociation: LoweringA1Ctobeloworaround7%hasbeenshowntoreduce microvascularandneuropathiccomplicationsoftype1andtype2 diabetes.Therefore,formicrovasculardiseaseprevention,theA1Cgoal fornonpregnantadultsingeneralis<7%.(A) Intype1andtype2diabetes,randomizedcontrolledtrialsofintensive versusstandardglycemiccontrolhavenotshownasignificantreduction

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Definitions TableofContents

inCVDoutcomesduringtherandomizedportionofthetrials.Longterm followupoftheDiabetesControlandComplicationsTrial(DCCT)andUK ProspectiveDiabetesStudy(UKPDS)cohortssuggeststhattreatmentto A1Ctargetsbeloworaround7%intheyearssoonafterthediagnosisof diabetesisassociatedwithlongtermreductioninriskofmacrovascular disease.Untilmoreevidencebecomesavailable,thegeneralgoalof<7% appearsreasonableformanyadultsformacrovascularriskreduction.(B) SubgroupanalysesofclinicaltrialssuchastheDCCTandUKPDSandthe microvascularevidencefromtheADVANCE(ActioninDiabetesand VascularDisease:PreteraxandDiamicronMRControlledEvaluation)trial suggestasmallbutincrementalbenefitinmicrovascularoutcomeswith A1Cvaluesclosertonormal.Therefore,forselectedindividualpatients, providersmightreasonablysuggestevenlowerA1Cgoalsthanthe generalgoalof<7%,ifthiscanbeachievedwithoutsignificant hypoglycemiaorotheradverseeffectsoftreatment.Suchpatientsmight includethosewithshortdurationofdiabetes,longlifeexpectancy,and nosignificantCVD.(B) Conversely,lessstringentA1Cgoalsthanthegeneralgoalof<7%maybe appropriateforpatientswithahistoryofseverehypoglycemia,limited lifeexpectancy,advancedmicrovascularormacrovascularcomplications, andextensivecomorbidconditionsandthosewithlongstandingdiabetes inwhomthegeneralgoalisdifficulttoattaindespitediabetesself managementeducation,appropriateglucosemonitoring,andeffective dosesofmultipleglucoseloweringagentsincludinginsulin.(C) GuidelinesforImprovingtheCareoftheOlderPersonwithDiabetesMellitus. CaliforniaHealthcareFoundation/AmericanGeriatricsSocietyPanelonImproving CareforElderswithDiabetes.AmericanGeriatricsSociety.May2003Vol.51, No.5Supplement,JAGS. StandardsofMedicalCareinDiabetes2009.DiabetesCareJanuary2009 32:S6S12;doi:10.2337/dc09S006

Populationcriteria Datacriteria(QDSDataElements) Summarycalculation

Pleaserefertothespreadsheetforthismeasurefordetailregardingdatacriteriaandcodelists.

Populationcriteria InitialPatientPopulation=

AND:Patientcharacteristic:birthdate(age)>=17yearsand<=74yearstocaptureall patientswhowillreachtheagesbetween18and75yearsduringthemeasurement period;

Denominator= o o AND:Allpatientsintheinitialpatientpopulation; AND: OR:medicationdispensed:medicationsindicativeofdiabetes<=2years beforeorsimultaneouslytomeasurementenddate; OR:medicationorder:medicationsindicativeofdiabetes<=2yearsbeforeor simultaneouslytomeasurementenddate; OR:medicationactive:medicationsindicativeofdiabetes<=2yearsbeforeor simultaneouslytomeasurementenddate; OR: AND:Diagnosisactive:diabetes<=2yearsbeforeorsimultaneouslyto measurementenddate; AND: OR:>=1count(s)ofEncounter:encounteracuteinpatientor ED; OR:>=2count(s)ofEncounter:encounternonacuteinpt, outpatient,orophthalmologyoccurringon2

Numerator= o AND:Laboratorytestresult:HbA1ctest,MOSTRECENTvalue<8.0%;

Exclusions= o OR: AND:Diagnosisactive:polycysticovaries; ANDNOT: AND:Diagnosisactive:diabetes<=2yearsbeforeorsimultaneously tomeasurementenddate; AND: OR:Encounter:encounteracuteinpatientorED<=2years beforeorsimultaneouslytomeasurementenddate; OR:Encounter:encounternonacuteinpt,outpatient,or ophthalmology<=2yearsbeforeorsimultaneouslyto measurementenddate;

OR:

AND: OR:Diagnosisactive:gestationaldiabetes<=2yearsbeforeor simultaneouslytomeasurementenddate; OR:Diagnosisactive:steroidinduceddiabetes<=2yearsbeforeor simultaneouslytomeasurementenddate;

AND: OR:Medicationorder:medicationsindicativeofdiabetes<=2years beforeorsimultaneouslytomeasurementenddate; OR:Medicationdispensed:medicationsindicativeofdiabetes<=2 yearsbeforeorsimultaneouslytomeasurementenddate; OR:Medicationactive:medicationsindicativeofdiabetes<=2years beforeorsimultaneouslytomeasurementenddate;

ANDNOT: AND:Diagnosisactive:diabetes<=2yearsbeforeorsimultaneouslyto measurementenddate; AND: OR:Encounter:EncounteracuteinpatientorED<=2years beforeorsimultaneouslytomeasurementenddate; OR:Encounter:encounternonacuteinpt,outpatient,or ophthalmology<=2yearsbeforeorsimultaneouslyto measurementenddate;

Datacriteria(QDSDataElements) InitialPatientPopulation= o Patientcharacteristic:birthdateusingbirthdatecodelistbeforethemeasurement period

Denominator= o o o Diagnosisactive:diabetesusingdiabetescodelistgroupingbeforeor simultaneouslytothemeasurementenddate; Encounter:encounteracuteinpatientorEDusingencounteracuteinpatientorED codelistgroupingduringthemeasurementperiod; Encounter:encounternonacuteinpt,outpatient,orophthalmologyusingencounter nonacuteinpt,outpatient,orophthalmologycodelistgroupingduringthe measurementperiod; Medicationorder:medicationsindicativeofdiabetesusingmedicationsindicativeof diabetescodelistgroupingbeforeorsimultaneouslytothemeasurementenddate;

Medicationdispensed:medicationsindicativeofdiabetesusingmedications indicativeofdiabetescodelistgroupingbeforeorsimultaneouslytothemeasurement enddate; Medicationactive:medicationsindicativeofdiabetesusingmedicationsindicativeof diabetescodelistgroupingbeforeorsimultaneouslytothemeasurementenddate;

Numerator= o Laboratorytestresult:HbA1ctestusingHbA1ctestcodelistgroupingduringthe measurementperiod;

Exclusions= o o o Diagnosisactive:polycysticovariesusingpolycysticovariescodelistgrouping beforeorsimultaneouslytothemeasurementenddate; Diagnosisactive:gestationaldiabetesusinggestationaldiabetescodelistgrouping beforeorsimultaneouslytothemeasurementenddate; Diagnosisactive:steroidinduceddiabetesusingsteroidinduceddiabetescodelist groupingbeforeorsimultaneouslytothemeasurementenddate;

Summarycalculation Calculationisgenerictoallmeasures: Measureset CLINICALQUALITYMEASURESET20112012 Calculatethefinaldenominatorbyaddingallthatmeetdenominatorcriteria. Subtractfromthefinaldenominatorallthatdonotmeetnumeratorcriteriayetalsomeet exclusioncriteria.Notesomemeasuresdonothaveexclusioncriteria. Theperformancecalculationisthenumbermeetingnumeratorcriteriadividedbythefinal denominator. Formeasureswithmultiplepatientpopulations,repeatthisprocessforeachpatientpopulation andreporteachresultseparately. Formeasureswithmultiplenumerators,calculateeachnumeratorseparatelywithineach populationusingthepairedexclusion.