Controlling the Impact of COPD on Health Status Measure Specifications

Controlling the Impact of COPD on Health Status Measure Specifications Measure # 1 Controlling the Impact of COPD on health status Description The ...
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Controlling the Impact of COPD on Health Status Measure Specifications Measure # 1

Controlling the Impact of COPD on health status

Description

The percentage of patients aged 50 – 80 years whose self-reported impact of COPD on their health status was low, stable or improved, as determined by the COPD Assessment Test (CAT) or Clinical COPD Questionnaire (CCQ).

Measurement Period

January 1, 20xx through December 31, 20xx

Eligible Population

Eligible Specialties

Family Medicine, Internal Medicine, Pulmonary Medicine, Geriatric Medicine

Eligible Providers Medical Doctor (MD), Doctor of Osteopathy (DO), Physician Assistant (PA), Advanced Practice Registered Nurses (APRN) Ages

50 - 80 years of age as of January 1 of the measurement period

Event

Patient had an office visit performed or supervised by an eligible provider in an eligible specialty as an established patient (Established Patient Value Set) for any reason at least once during the measurement period.

Diagnosis

Patient had COPD (COPD, Emphysema, and Chronic Bronchitis Value Set) as a diagnosis on any contact during the current or prior measurement period OR had COPD present on an active problem list at any time during the measurement period.

Denominator

The number of patients in the eligible population who have a diagnosis of COPD that is confirmed with a spirometry result of FEV1/FVC less than 0.7.

Numerator

The number of patients in the denominator whose impact of COPD on their health status was assessed with an allowable tool at least once during the measurement period AND whose impact of COPD on their health status: • Was low. Low impact is demonstrated by a CAT score being less than 10 OR CCQ score being less than 1.0 at any time during the measurement period, OR • Was stable or improved. Stable or improved is demonstrated by a CAT score that did not increase by 2 or more OR a CCQ score that did not increase of 0.4 or more. The CAT/CCQ scores used for calculating a change are the earliest and most recent tool administrations during the measurement period. The timing between the administrations must be at least 90 days.

Required Exclusions

The following exclusions must be applied to the eligible population: •

• Allowable Exclusions

Patients with severe cognitive impairment (Severe Cognitive Impairment Value Set) Patients with cystic fibrosis (Cystic Fibrosis Value Set)

The following exclusions are allowed to be applied to the eligible population: • Patient was a permanent nursing home resident at any time during the measurement period • Patient was in hospice or receiving palliative care at any time during the measurement period • Patient died prior to the end of the measurement period

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Controlling the Impact of COPD on Health Status Measure Specifications Measure Scoring

Rate/Proportion

Interpretation of Score

Higher score indicates better quality

Measure Type

Outcome, Patient Reported

Risk Adjustment

Data elements determined to be useful for assessing risk and predicting future outcomes will be collected as part of the data submission. Proposed elements include: Data elements submitted as part of MNCM standard demographic data elements: • Age • Gender Data elements specific to this patient population: • FEV1/FVC result • Congestive Heart Failure • BMI

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Controlling the Impact of COPD on Health Status Measure Specifications

Data Elements and Field Specifications Use this section to build your data submission. The specifications contain detailed information regarding each column in the submission file that you will need to complete, including column order, definitions, examples, and appropriate formatting. Column

Field Name

Notes

Excel Format

Example

A

Clinic ID

Enter the MNCM Clinic ID for every patient/row submitted. MNCM assigns the clinic ID at the time of registration. Use the MNCM ID listed in the MNCM Data Portal. Do NOT use the Medical Group ID. Blank values will create ERRORs upon submission.

Text

905

B

Patient ID

Enter a unique patient ID to identify each patient.

Text

56609

Keep a “crosswalk” between patient IDs and the patient names/DOBs to help clinic staff locate records during validation audits. • Enter clinic-assigned ID (e.g., MRN, account number). Do NOT enter Social Security Numbers. Blank values will create ERRORs upon submission. •

C

Patient Date of Birth

Enter patient’s date of birth. Quality Check: Verify each date of birth is within the accepted range.

Date (mm/dd/yyyy)

05/08/1985

D

Patient Gender

Enter patient’s gender. Female = F Male = M Unknown = U Blank values will create ERRORs upon submission. Quality Check: Verify each cell has one of the accepted codes.

Text

F

E

Provider NPI Number

Enter the 10 digit NPI number of the eligible provider. Blank values will create ERRORs upon submission. Quality Check: Verify each cell has data.

Text

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1997993992

Controlling the Impact of COPD on Health Status Measure Specifications Column

Field Name

F

Provider Specialty Code

Notes Enter the code for the specialty of the eligible provider. 1 = Family Medicine 2 = Internal Medicine 5 = Geriatric Medicine 26 = Pulmonology 99 = Other

Excel Format

Example

Number

26

Blank values will create ERRORs upon submission. Quality check: Verify each cell has an accepted code. G

Spirometry Date

Enter the date of the most recent spirometry result (FEV1/FVC) recorded in the medical record.

Date (mm/dd/yyyy)

5/10/2015

H

Spirometry Result

Enter the FEV1/FVC result of the most recent spirometry test performed.

Number, decimal value

0.6

I

Congestive Heart Failure

Enter the code that corresponds to whether or not the patient has a diagnosis of Congestive Heart Failure (Congestive Heart Failure Value Set) on an active problem list or coded on any prior contact.

Number; Whole numbers only

1

0 = no, the patient does not have a diagnosis of CHF 1 = yes, the patient does have a diagnosis of CHF Enter the patient’s height in inches. Use the most recently recorded height during the measurement period.

Number, decimal value

68.5

J

Height

K

Weight

Enter the patient’s weight in pounds. Use the most recently recorded weight during the measurement period.

Number, decimal value

132.4

L

COPD PROM test name

Enter the code that corresponds to the COPD patient reported outcome tool administered during the measurement period.

Number; Whole numbers only

1

1 = COPD Assessment Test (CAT) 2 = Clinical COPD Questionnaire (CCQ)

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Controlling the Impact of COPD on Health Status Measure Specifications Column

Field Name

Notes Enter the date of the most recent COPD patient reported outcome tool administered during the measurement period.

Excel Format

Example

M

COPD PROM test date, most recent

Date (mm/dd/yyyy)

5/10/2015

N

COPD PROM test score, most recent

Enter the score of the most recent COPD patient reported outcome tool administered during the measurement period.

Number

2

O

COPD PROM test date, earliest

Enter the date of the earliest COPD patient reported outcome tool administered during the measurement period. If only one PROM test was administered during the measurement period, leave blank.

Date (mm/dd/yyyy)

5/10/2015

P

COPD PROM test score, earliest

Enter the score of the earliest COPD patient reported outcome tool administered during the measurement period. If only one PROM test was administered during the measurement period, leave blank.

Number

2

Q

COPD PROM test date, lowest

Enter the date of the lowest scoring COPD patient reported outcome tool administered during the measurement period. If the lowest scoring COPD patient reported outcome tool is reported in fields M through P, leave blank.

Date (mm/dd/yyyy)

5/10/2015

R

COPD PROM test score, lowest

Enter the score of the lowest scoring COPD patient reported outcome tool administered during the measurement period. If the lowest scoring COPD patient reported outcome tool is reported in fields M through P, leave blank.

Number

2

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Controlling the Impact of COPD on Health Status

Was the patient 50 - 80 years of age on the first day of the measurement period?

No

No

Yes

Did the patient have at least one Established Patient office visit with an eligible provider in an eligible specialty during the measurement period?

PATIENT NOT INCLUDED IN DATA SUBMISSION

No

Additional optional exclusions include: permanent nursing home residents, hospice or palliative care, and death Yes

Did the patient have a diagnosis of COPD, emphysema or chronic bronchitis on any contact during the current or prior measurement period OR on their active problem list during the measurement period?

Yes

Yes

Did the patient have cystic fibrosis or a severe cognitive impairment?

No

PATIENT NOT INCLUDED IN DENOMINATOR

No

Did the patient have spirometry testing performed at any time and was the most recent spirometry FEV1/FVC result less than 0.7?

PATIENT INCLUDED IN ELIGIBLE POPULATION

Yes

PATIENT INCLUDED IN DENOMINATOR

During the measurement period, did the patient complete at least one allowable COPD PROM?

Yes

Was the lowest COPD PROM result a CAT < 10 or a CCQ < 1.0?

No

No

PATIENT NOT INCLUDED IN NUMERATOR

During the measurement period, did the patient complete at least two allowable COPD PROM’s with at least 90 days in between completion?

No

PATIENT INCLUDED IN NUMERATOR

Yes

Yes

Yes

Did the CAT increase by 2 or more, or did the CCQ increase by 0.4 or more between the earliest and latest tool administrations during the measurement period?

No

Value Set Code COPD-01 COPD-01 COPD-01 COPD-01 COPD-01 COPD-01 COPD-01 COPD-01 COPD-01 COPD-01 COPD-01 COPD-01 COPD-01 COPD-01 COPD-01 EPOV-01 EPOV-01 EPOV-01 EPOV-01 EPOV-01 EPOV-01 EPOV-01 CF-01 CF-01 CF-01 CF-01 CF-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01 COGN-01

Value Set Name COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis COPD, Emphysema and Chronic Bronchitis Established Patient Established Patient Established Patient Established Patient Established Patient Established Patient Established Patient Cystic Fibrosis Cystic Fibrosis Cystic Fibrosis Cystic Fibrosis Cystic Fibrosis Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment Severe Cognitive Impairment

COPD Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Eligible Population Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion Exclusion

Code System ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM CPT CPT CPT CPT CPT CPT CPT ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM

Code J41.0 J41.1 J41.8 J42 J44.0 J44.1 J44.9 J43.0 J43.1 J43.2 J43.8 J43.9 J68.4 J98.2 J98.3 99211 99212 99213 99214 99215 99396 99397 E84.8 E84.19 E84.9 E84.11 E84.0 A52.17 F01.50 F01.51 F02.80 F02.81 F03.90 F03.91 F04 F05 F71 F72 F73 G30.0 G30.1 G30.8 G30.9 G31.0 G31.01 G31.09 G31.1 G31.2 G31.81 G31.82 G31.83

Code Description Simple chronic bronchitis Mucopurulent chronic bronchitis Mixed simple and mucopurulent chronic bronchitis Unspecified chronic bronchitis Chronic obstructive pulmonary disease with acute lower respiratory infection Chronic obstructive pulmonary disease with (acute) exacerbation Chronic obstructive pulmonary disease, unspecified Unilateral pulmonary emphysema [MacLeod's syndrome] Panlobular emphysema Centrilobular emphysema Other emphysema Emphysema, unspecified Chronic respiratory conditions due to chemicals, gases, fumes and vapors Interstitial emphysema Compensatory emphysema Office or other outpt visit evaluation & management of established pt (10 min) Office or other outpt visit evaluation & management of established pt (20 min) Office or other outpt visit evaluation & management of established pt (30 min) Office or other outpt visit evaluation & management of established pt (45 min) Office or other outpt visit evaluation & management of established pt (60 min) Periodic comprehensive preventive medicine established pt; ages 40 to 64 Periodic comprehensive preventive medicine established pt; ages 65 and older Cystic fibrosis with other manifestations Cystic fibrosis with other intestinal manifestations Cystic fibrosis, unspecified Meconium ileus in cystic fibrosis Cystic fibrosis with pulmonary manifestations General paresis Vascular dementia without behavioral disturbance Vascular dementia with behavioral disturbance Dementia in other diseases classified elsewhere without behavioral disturbance Dementia in other diseases classified elsewhere with behavioral disturbance Unspecified dementia without behavioral disturbance Unspecified dementia with behavioral disturbance Amnestic disorder due to known physiological condition Delirium due to known physiological condition Moderate intellectual disabilities Severe intellectual disabilities Profound intellectual disabilities Alzheimer's disease with early onset Alzheimer's disease with late onset Other Alzheimer's disease Alzheimer's disease, unspecified Frontotemporal dementia Pick's disease Other frontotemporal dementia Senile degeneration of brain, not elsewhere classified Degeneration of nervous system due to alcohol Alpers disease Leigh's disease Dementia with Lewy bodies

COGN-01 CHF-01 CHF-01 CHF-01 CHF-01 CHF-01 CHF-01 CHF-01 CHF-01 CHF-01 CHF-01 CHF-01 CHF-01

Severe Cognitive Impairment Congestive Heart Failure Congestive Heart Failure Congestive Heart Failure Congestive Heart Failure Congestive Heart Failure Congestive Heart Failure Congestive Heart Failure Congestive Heart Failure Congestive Heart Failure Congestive Heart Failure Congestive Heart Failure Congestive Heart Failure

Exclusion Patient Factor Patient Factor Patient Factor Patient Factor Patient Factor Patient Factor Patient Factor Patient Factor Patient Factor Patient Factor Patient Factor Patient Factor

ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM ICD10CM

G31.85 I50.20 I50.21 I50.22 I50.23 I50.30 I50.31 I50.32 I50.33 I50.40 I50.41 I50.42 I50.43

Corticobasal degeneration Unspecified systolic (congestive) heart failure Acute systolic (congestive) heart failure Chronic systolic (congestive) heart failure Acute on chronic systolic (congestive) heart failure Unspecified diastolic (congestive) heart failure Acute diastolic (congestive) heart failure Chronic diastolic (congestive) heart failure Acute on chronic diastolic (congestive) heart failure Unspecified combined systolic (congestive) and diastolic (congestive) heart failure Acute combined systolic (congestive) and diastolic (congestive) heart failure Chronic combined systolic (congestive) and diastolic (congestive) heart failure Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure

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