Measure: CMS122
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
Measure Versions
| eMeasure Code |
Measure Year |
Full Version Number |
Title |
| 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.
This eCQM is a patient-based measure.
This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Patient Group Definitions
| Group |
Description |
Instructions Links |
| Initial Population | Patients 18-75 years of age with diabetes with a visit during the measurement period | Webchart Instructions |
| Denominator | Equals Initial Population | Webchart Instructions |
| Denominator Exclusions | Exclude patients whose hospice care overlaps the measurement period.
Exclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.
Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured. | Webchart Instructions |
| Numerator | Patients whose most recent HbA1c level (performed during the measurement period) is >9.0% | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| Denominator Exceptions | None | |
Details
| Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
| CMS122v9 |
|
2021 |
9.3.000 |
Not Applicable |
f2986519-5a4e-4149-a8f2-af0a1dc7f6bc |
| Steward |
Developer |
Endorsed By |
| National Committee for Quality Assurance |
National Committee for Quality Assurance |
|
| Scoring Method |
Measure Type |
Stratification |
Risk Adjustment |
| Proportion |
Intermediate 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 and affects more than 30 million Americans (9.4 percent of the U.S. population) (Centers for Disease Control and Prevention [CDC], 2017a, 2017b). 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, 2019). 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, 2016).
In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (American Diabetes Association, 2018).
Controlling A1c blood levels help reduce the risk of microvascular complications (eye, kidney and nerve diseases) (CDC, 2014).
Clinical Recommendation Statement
American Diabetes Association (2019):
- 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 |
| Diagnosis |
Frailty Diagnosis |
2.16.840.1.113883.3.464.1003.113.12.1074 |
| Encounter, Performed |
Acute Inpatient |
2.16.840.1.113883.3.464.1003.101.12.1083 |
| Encounter, Performed |
Annual Wellness Visit |
2.16.840.1.113883.3.526.3.1240 |
| Encounter, Performed |
Care Services in Long-Term Residential Facility |
2.16.840.1.113883.3.464.1003.101.12.1014 |
| Encounter, Performed |
ED |
2.16.840.1.113883.3.464.1003.101.12.1085 |
| Encounter, Performed |
Encounter Inpatient |
2.16.840.1.113883.3.666.5.307 |
| Encounter, Performed |
Frailty Encounter |
2.16.840.1.113883.3.464.1003.101.12.1088 |
| Encounter, Performed |
Home Healthcare Services |
2.16.840.1.113883.3.464.1003.101.12.1016 |
| Encounter, Performed |
Nonacute Inpatient |
2.16.840.1.113883.3.464.1003.101.12.1084 |
| Encounter, Performed |
Nursing Facility Visit |
2.16.840.1.113883.3.464.1003.101.12.1012 |
| Encounter, Performed |
Observation |
2.16.840.1.113883.3.464.1003.101.12.1086 |
| Encounter, Performed |
Office Visit |
2.16.840.1.113883.3.464.1003.101.12.1001 |
| Encounter, Performed |
Outpatient |
2.16.840.1.113883.3.464.1003.101.12.1087 |
| 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 |
| Medication, Active |
Dementia Medications |
2.16.840.1.113883.3.464.1003.196.12.1510 |
| 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 |
| Symptom |
Frailty Symptom |
2.16.840.1.113883.3.464.1003.113.12.1075 |
References
American Diabetes Association. (2018). Economic costs of diabetes in the U.S. in 2017. Diabetes Care, 41, 917-928. Retrieved from http://care.diabetesjournals.org/content/early/2018/03/20/dci18-0007
American Diabetes Association. (2019). 6. Glycemic targets: Standards of medical care in diabetes—2019. Diabetes Care, 42(Suppl. 1), S61-S70. https://doi.org/10.2337/dc19-S006
Centers for Disease Control and Prevention. (2014). National diabetes statistics report, 2014. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Retrieved from http://www.thefdha.org/pdf/diabetes.pdf
Centers for Disease Control and Prevention. (2016). At a glance 2016: Diabetes—Working to reverse the U.S. epidemic. Atlanta, GA: Author. Retrieved from https://upcap.org/admin/wp-content/uploads/2016/06/Diabetes-at-a-Glance.pdf
Centers for Disease Control and Prevention. (2017a). Health, United States, 2016: With chartbook on long-term trends in health. Retrieved from https://www.cdc.gov/nchs/data/hus/hus16.pdf
Centers for Disease Control and Prevention. (2017b). National diabetes statistics report, 2017. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
Centers for Disease Control and Prevention. (2019). About diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html
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Source:
https://ecqi.healthit.gov/ecqm/measures/cmsv9