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Clinical Measure Descriptions

The clinical performance results displayed in the CCHRI Report on Quality use NCQA HEDIS Performance measures to evaluate four important components of quality medical care:

The use of preventive services and routine screening tests, such as immunizations and mammograms, that help patients stay healthy;
The utilization of the most up-to-date medical treatment and medication for the treatment of sudden illnesses and mental health issues such as heart attacks and depression, that help patients get better;
The medical care for patients with chronic conditions, such as asthma and diabetes, that help patients cope with their illness.
The members’ ability to access needed care or services.

To find out more about the clinical measures select from the measure categories listed below:

Access and Availability of Care

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Measure	Description	Products
Call Abandonment		HMO/PPO/Medicare
Call Answer Timeliness		HMO/PPO/Medicare
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment	Initiation of AOD Treatment - Total	HMO/PPO/Medicare
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment	Initiation of AOD Treatment - Age 13 - 17	HMO/PPO/Medicare
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment	Initiation of AOD Treatment - Age 18+	HMO/PPO/Medicare
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment	Engagement of AOD Treatment - Total	HMO/PPO/Medicare
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment	Engagement of AOD Treatment - Age 13-17	HMO/PPO/Medicare
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment	Engagement of AOD Treatment - Age 18+	HMO/PPO/Medicare
Prenatal and Postpartum Care	Timely Initiation of Prenatal Care	HMO
Prenatal and Postpartum Care	Postpartum Care	HMO

Behavioral Health

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Measure	Description	Products
Antidepressant Medication Management	Effective Acute Phase Treatment	HMO/PPO/Medicare
Antidepressant Medication Management	Effective Continuation Phase Treatment	HMO/PPO/Medicare
Follow-up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder	Initiation Phase	HMO/PPO
Follow-up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder	Continuation and Maintenance (C&M) Phase	HMO/PPO
Follow-up After Hospitalization for Mental Illness	Follow-up within 30 days of hospital discharge	HMO/PPO/Medicare
Follow-up After Hospitalization for Mental Illness	Follow-up within 7 days of hospital discharge	HMO/PPO/Medicare

Cardiovascular Conditions

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Measure	Description	Products
Cholesterol Management for Patients with Cardiovascular Conditions	LDL-C Screening	HMO/PPO/Medicare
Cholesterol Management for Patients with Cardiovascular Conditions	LDL-C Level of <100 mg/dL	HMO/Medicare
Controlling High Blood Pressure		HMO/Medicare
Persistence of Beta-Blocker Treatment After a Heart Attack		HMO/PPO/Medicare

Diabetes

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Measure	Description	Products
Comprehensive Diabetes Care	HbA1c Test	HMO/PPO/Medicare
Comprehensive Diabetes Care	HbA1c level <=9.0 percent	HMO/Medicare
Comprehensive Diabetes Care	Retinal Exam	HMO/Medicare
Comprehensive Diabetes Care	LDL-C Screening	HMO/PPO/Medicare
Comprehensive Diabetes Care	LDL-C Level of <100 mg/dL	HMO/Medicare
Comprehensive Diabetes Care	Medical Attention for Nephropathy	HMO/PPO/Medicare
Comprehensive Diabetes Care	Blood Pressure Control (<130/80)	HMO/Medicare
Comprehensive Diabetes Care	Blood Pressure Control (<140/90)	HMO/Medicare

Medication Management

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Measure	Description	Products
Annual Monitoring for Patients on Persistent Medications	Total	HMO/PPO/Medicare
Annual Monitoring for Patients on Persistent Medications	ACE Inhibitors or ARBs	HMO/PPO/Medicare
Annual Monitoring for Patients on Persistent Medications	Digoxin	HMO/PPO/Medicare
Annual Monitoring for Patients on Persistent Medications	Diuretics	HMO/PPO/Medicare
Annual Monitoring for Patients on Persistent Medications	Anticonvulsants	HMO/PPO/Medicare
Potentially Harmful Drug-Disease Interactions in the Elderly	Total	Medicare
Potentially Harmful Drug-Disease Interactions in the Elderly	Falls + Tricyclic Antidepressants or Antipsychotics	Medicare
Potentially Harmful Drug-Disease Interactions in the Elderly	Dementia + Tricyclic Antidepressants or Anticholinergic Agents	Medicare
Potentially Harmful Drug-Disease Interactions in the Elderly	Chronic Renal Failure + Nonaspirin NSAIDs or Cox-2 Selective NSAIDs	Medicare
Use of High-Risk Medications in the Elderly	One Prescription	Medicare
Use of High-Risk Medications in the Elderly	Two or More Prescriptions	Medicare

Musculoskeletal Conditions

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Measure	Description	Products
Osteoporosis Management in Women Who had a Fracture		Medicare
Use of Imaging Studies for Low Back Pain		HMO/PPO
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis		HMO/PPO/Medicare

Prevention and Screening

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Measure	Description	Products
Breast Cancer Screening	Total	HMO/PPO/Medicare
Cervical Cancer Screening		HMO/PPO
Childhood Immunizations	Combo 3	HMO
Childhood Immunizations	Combo 2	HMO
Childhood Immunizations	MMR	HMO
Childhood Immunizations	HiB	HMO
Childhood Immunizations	VZV	HMO
Childhood Immunizations	HepB	HMO
Childhood Immunizations	DTaP	HMO
Childhood Immunizations	IPV	HMO
Childhood Immunizations	Pneumococcal Conjugate	HMO
Chlamydia Screening in Women	Total	HMO/PPO
Chlamydia Screening in Women	Age 16-20	HMO/PPO
Chlamydia Screening in Women	Age 21-24	HMO/PPO
Colorectal Cancer Screening		HMO/Medicare
Flu Shots for Adults Ages 50 - 64		HMO/PPO

Respiratory Conditions

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Measure	Description	Products
Appropriate Testing for Children with Pharyngitis		HMO/PPO
Appropriate Treatment for Children with Upper Respiratory Infection		HMO/PPO
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis		HMO/PPO
Pharmacotherapy Management of COPD Exacerbation	Dispensed systemic corticosteroid within 14 days of event	HMO/PPO/Medicare
Pharmacotherapy Management of COPD Exacerbation	Dispensed a bronchodilator with 30 days of event	HMO/PPO/Medicare
Use of Appropriate Medications for People with Asthma	Age 5-9	HMO/PPO
Use of Appropriate Medications for People with Asthma	Age 10-17	HMO/PPO
Use of Appropriate Medications for People with Asthma	Age 18-56	HMO/PPO
Use of Appropriate Medications for People with Asthma	Total	HMO/PPO
Use of Spirometry Testing in the Assessment and Diagnosis of COPD		HMO/PPO/Medicare

CCHRI Senior Manager
Cathie Markow, PBGH
cmarkow@pbgh.org

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Clinical Measure Descriptions