Continuous Improvement and the Expansion of Quality ... - NCQA

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yEAR T H E S TAT E o f H E A l T H C A R E Q U A l I T y 2 0 1 1 • H E D I S M E A S U R E S o f C A R E 5–11 yEars CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 96.7 97.0 NA NA 91.8 2009 96.6 97.0 NA NA 91.8 yEAR 12–50 yEars CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 91.8 91.8 NA NA 85.8 2009 91.4 91.6 NA NA 86.0 yEAR ovErall ratE 61 CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 92.9 93.0 NA NA 88.4 2009 92.7 92.8 NA NA 88.6 2008 92.4 92.7 NA NA 88.7 2007 92.3 92.9 NA NA 86.9 2006 91.6 92.7 NA NA 87.1 2005 89.9 91.6 NA NA 85.7 2004 72.9 NA NA NA 64.5 2003 71.4 NA NA NA 64.1 2002 67.9 NA NA NA 62.5 2001 65.6 NA NA NA 60.1 2000 62.6 NA NA NA NA 1999 57.7 NA NA NA NA C H R o N I C D I S E A S E M A N A G E M E N T
C H R o N I C D I S E A S E M A N A G E M E N T 62 USE of SPIRoMETRy TESTING IN THE ASSESSMENT AND DIAGNoSIS of CoPD Chronic obstructive pulmonary disease (CoPD), characterized by blocked airflow and diminished capacity to breathe, is a major health problem in the U.S. The most significant risk factor is long-term cigarette smoking. 1,2 other factors include old age and exposure to occupational and environmental pollutants. The Use of Spirometry Testing in the Assessment and Diagnosis of COPD measure evaluates whether adults with a new CoPD diagnosis received a spirometry test, which helps in early diagnosis and enables appropriate treatment planning. • CoPD ranks as the fourth leading cause of death in the United States. 3 • According to the Global Initiative for Chronic obstructive lung Disease guidelines, the spirometry test is an effective and objective screening tool. 4 It measures how much and how fast one can breathe air in and out to assess how well oxygen is delivered to the lungs. • Early detection of CoPD is crucial for promoting smoking cessation and instituting appropriate pharmacological and nonpharmacological therapy before patients reach more costly stages of the disease. 3,4 N AT I o N A l C o M M I T T E E f o R Q U A l I T y A S S U R A N C E the Case for Improvement • In 2010, total annual costs were estimated to exceed $50 billion—$29.5 billion of this was for direct health care costs, including hospitalizations, drugs and physician office and emergency department visits. 1,6 of direct costs, 40–65-year-old patients represented 67 percent of physician office visits and 43 percent of hospitalizations. • Disability and premature death from CoPD cost an additional $14.1 billion in lost income. 1 • In 2008, 13.1 million adults over 18 were estimated to have CoPD, 1,5 but close to 24 million U.S. adults have evidence of impaired lung function, which indicates underdiagnosis 1,5
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128 N AT I o N A l C o M M I T T E
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130 APPENDIx 1: HEDIS EffECTIVENESS
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134 APPENDIx 2: HEDIS EffECTIVENESS
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172 MEASURE N AT I o N A l C o M M
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184 REfERENCES N AT I o N A l C o M
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ACkNoWlEDGMENTS Health Plans The 20
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