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Measure: CMS122

Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS122v12 2024 12.0.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v11 2023 11 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v10 2022 10.0.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v9 2021 9.3.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v8 2020 8.4.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v7 2019 7.4.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v6 2018 6.1.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v5 2017 5.0.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)

Description

Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period

Guidance

Patient is numerator compliant if most recent HbA1c level >9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period. If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance. Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.

Patient Group Definitions

Group Description Instructions Links
Initial PopulationPatients 18-75 years of age with diabetes with a visit during the measurement periodWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsExclude patients whose hospice care overlaps the measurement periodWebchart Instructions
NumeratorPatients whose most recent HbA1c level (performed during the measurement period) is >9.0%Webchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS122v7 122 2019 7.4.000 0059 F2986519-5A4E-4149-A8F2-AF0A1DC7F6BC
Steward Developer Endorsed By
National Committee for Quality Assurance National Committee for Quality Assurance National Quality Forum
Scoring Method Measure Type Stratification Risk Adjustment
Proportion OUTCOME None None

Rate Aggregation

None

Improvement Notation

Lower score indicates better quality

Rationale

As the seventh leading cause of death in the U.S., diabetes kills approximately 79,500 people a year (CDC Health 2017). Diabetes is a long lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC About Diabetes 2017). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. (CDC At a Glance 2016). In 2012, diabetes cost the U.S. an estimated $245 billion: $176 billion in direct medical costs and $69 billion in reduced productivity. This is a 41 percent increase from the estimated $174 billion spent on diabetes in 2007 (ADA Economic 2013). Reducing A1c blood level results by 1 percentage point (eg, from 8.0 percent to 7.0 percent) helps reduce the risk of microvascular complications (eye, kidney and nerve diseases) by as much as 40 percent (CDC Estimates 2011).

Clinical Recommendation Statement

American Diabetes Association (2017):

- A reasonable A1C goal for many nonpregnant adults is <7%. (Level of evidence: A)

- Providers might reasonably suggest more stringent A1C goals (such as <6.5% [48 mmol/mol]) for selected individual patients if this can be achieved without significant hypoglycemia or other adverse effects of treatment (i.e. polypharmacy). Appropriate patients might include those with short duration of diabetes, type 2 diabetes treated with lifestyle or metformin only, long life expectancy, or no significant cardiovascular disease (CVD). (Level of evidence: C)

- Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid
 conditions, or long-standing diabetes in whom the goal is difficult to achieve despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin. (Level of evidence: B)

Definition

None

Transmission Format

TBD

Applicable Value Sets

Category Value Set OID
Diagnosis Diabetes 2.16.840.1.113883.3.464.1003.103.12.1001
Encounter, Performed Annual Wellness Visit 2.16.840.1.113883.3.526.3.1240
Encounter, Performed Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Encounter, Performed Home Healthcare Services 2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed Preventive Care Services - Established Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed Preventive Care Services-Initial Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1023
Intervention, Order Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Intervention, Performed Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Laboratory Test, Performed HbA1c Laboratory Test 2.16.840.1.113883.3.464.1003.198.12.1013
Patient Characteristic Ethnicity Ethnicity 2.16.840.1.114222.4.11.837
Patient Characteristic Payer Payer 2.16.840.1.114222.4.11.3591
Patient Characteristic Race Race 2.16.840.1.114222.4.11.836
Patient Characteristic Sex ONC Administrative Sex 2.16.840.1.113762.1.4.1

References

American Diabetes Association. Glycemic targets. Sec. 6. In Standards of Medical Care in Diabetes-2017. Diabetes Care 2017;40(Suppl. 1):S48-S56
American Diabetes Association (ADA). April 2013. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care. Vol. 36 no. 41033-46. http://care.diabetesjournals.org/content/36/4/1033.full
Centers for Disease Control and Prevention (CDC). 2017. Health, United States, 2016: With Chartbook on Long-term Trends in Health.  https://www.cdc.gov/nchs/data/hus/hus16.pdf#019
Centers for Disease Control and Prevention (CDC). 2011. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf
Center for Disease Control and Prevention (CDC). 2017. About Diabetes. https://www.cdc.gov/diabetes/basics/diabetes.html.
Centers For Disease Control and Prevention (CDC). 2016. At a Glance 2016, Diabetes Working to Reverse the US Epidemic. https://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2016/diabetes-aag.pdf.

Disclaimer

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Copyright

This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure.   The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. 

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.

Source: https://ecqi.healthit.gov/ecqm/measures/cms122v7