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

Recommendations

Info

HEdIs Measure definition 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 The percentage of adults 40 years and older who experience an CoPD exacerbation event and who were given appropriate medication therapy to manage an exacerbation. As identified by claims, a CoPD exacerbation is an inpatient or ED visit with a primary discharge diagnosis of CoPD. results CoPD medications aimed at controlling symptoms have been shown to increase exercise capacity, improve health status and reduce exacerbations. 5,7 Decreasing the frequency of an exacerbation has shown to slow the progression of CoPD and should be a critical goal of care management. 2,5 yEAR bronCHodIlators CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 77.8 73.5 78.2 76.1 82.1 2009 78.0 75.0 76.2 74.9 80.7 2008 76.1 68.1 74.1 71.3 78.2 yEAR 65 systEMIC CortICostEroIds CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 69.8 66.2 66.6 69.6 65.3 2009 66.1 64.1 60.9 64.2 61.8 2008 67.0 58.2 60.0 60.8 61.7 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 66 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 ANNUAl MoNIToRING foR PATIENTS oN PERSISTENT MEDICATIoNS Adverse drug events trigger 700,000 emergency department (ED) visits a year. A quarter of those visits come from adults 65 years and older. Approximately 120,000 hospital visits a year are attributable to adverse drug events, and older adults are seven times more likely to be hospitalized after an ED visit compared to the rest of the population. 1 The Annual Monitoring for Patients on Persistent Medications measure assesses whether adults were properly monitored for selected medications usually prescribed for long-term use. • Adults over 65 consume more health care than any other age group, and prescribing medications to the elderly is the most common clinical decision doctors make. 2 • Allergic reactions and unintentional overdoses are two of the most common adverse drug reactions that cause hospitalization. Rates may improve with ongoing monitoring and quality improvement. 3 the Case for Improvement • Adverse drug events are responsible for $4 billion dollars of extra medical costs annually. 4 • Adverse drug events present a public health concern as over-the-counter drugs become more available and more drugs are prescribed in an outpatient setting. • In one study, patients brought to the ED with adverse drug events caused by outpatient medications were shown to spend between three and eight more days in the hospital in the six-month period post ED visit, compared with patients admitted to the ED for other reasons. 5 better methods to identify and monitor adverse drug events may reduce avoidable hospitalizations. 3,6 HEdIs Measure definition This measure assesses the percentage of adults 18 years of age and older who received at least 180 treatment days of ambulatory medication therapy for the following therapeutic agents during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. • Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARb) • Digoxin • Diuretics • Anticonvulsants A combined rate is also reported. results When patients do not adhere to a drug regimen, they have high rates of inpatient and outpatient health resource use. 7 Continued
Page 1 and 2:
Continuous Improvement and the Expa
Page 3 and 4:
2 This Report and the data containe
Page 5 and 6:
4 N AT I o N A l C o M M I T T E E
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
top 10 and bottom 10 states “loca
Page 15 and 16: 14 N AT I o N A l C o M M I T T E E
Page 17 and 18: 16 this measure has shown steady ga
Page 25 and 26: 24 HEDIS MEASURES of CARE about HEd
Page 27 and 28: S A f E T y A N D P o T E N T I A l
Page 37 and 38: W E l l N E S S A N D P R E V E N T
Page 49 and 50: C H R o N I C D I S E A S E M A N A
Page 65: C H R o N I C D I S E A S E M A N A
Page 73 and 74: M E A S U R E S T A R G E T E D A T
Page 117 and 118:
M E A S U R E S T A R G E T E D A T
Page 119 and 120:
M E A S U R E S T A R G E T E D A T
Page 121 and 122:
C o N S U M E R A N D P A T I E N T
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
128 N AT I o N A l C o M M I T T E
Page 131 and 132:
130 APPENDIx 1: HEDIS EffECTIVENESS
Page 133 and 134:
Page 135 and 136:
134 APPENDIx 2: HEDIS EffECTIVENESS
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
142 APPENDIx 4b: ACCREDITED VS. NoN
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
148 APPENDIx 6A: ACCREDITED VS. NoN
Page 151 and 152:
150 APPENDIx 6b: ACCREDITED VS. NoN
Page 153 and 154:
152 APPENDIx 7A: PUblICly REPoRTING
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
158 APPENDIx 8: PUblICly REPoRTING
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
172 MEASURE N AT I o N A l C o M M
Page 175 and 176:
174 APPENDIx 14b: VARIATIoN IN PlAN
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
180 APPENDIx 16A: VARIATIoN IN PlAN
Page 183 and 184:
182 APPENDIx 16b: VARIATIoN IN PlAN
Page 185 and 186:
184 REfERENCES N AT I o N A l C o M
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 200 and 201:
ACkNoWlEDGMENTS Health Plans The 20
show all

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

Create successful ePaper yourself

Delete template?

Save as template?