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