Measure: CMS127
Pneumococcal Vaccination Status for Older Adults
Measure Versions
| eMeasure Code |
Measure Year |
Full Version Number |
Title |
| CMS127v11 |
2023 |
11 |
Pneumococcal Vaccination Status for Older Adults |
| CMS127v10 |
2022 |
10.0.000 |
Pneumococcal Vaccination Status for Older Adults |
| CMS127v9 |
2021 |
9.2.000 |
Pneumococcal Vaccination Status for Older Adults |
| CMS127v8 |
2020 |
8.1.000 |
Pneumococcal Vaccination Status for Older Adults |
| CMS127v7 |
2019 |
7.2.000 |
Pneumococcal Vaccination Status for Older Adults |
| CMS127v6 |
2018 |
6.1.000 |
Pneumococcal Vaccination Status for Older Adults |
| CMS127v5 |
2017 |
5.1.000 |
Pneumococcal Vaccination Status for Older Adults |
Description
Percentage of patients 66 years of age and older who have ever received a pneumococcal vaccine
Guidance
Patient self-report for procedures as well as immunizations should be recorded in 'Procedure, Performed' template or 'Immunization, Administered' template in QRDA-1.
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 66 years of age and older with a visit during the measurement period | Webchart Instructions |
| Denominator | Equals Initial Population | Webchart Instructions |
| Denominator Exclusions | Exclude patients who are in hospice care for any part of the measurement period. | Webchart Instructions |
| Numerator | Patients who received a pneumococcal vaccination on or after their 60th birthday and before the end of the measurement period; or ever had an adverse reaction to the vaccine before the end of the measurement period | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| Denominator Exceptions | None | |
Details
| Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
| CMS127v10 |
|
2022 |
10.0.000 |
Not Applicable |
59657b9b-01bf-4979-a090-8534da1d0516 |
| Steward |
Developer |
Endorsed By |
| National Committee for Quality Assurance |
National Committee for Quality Assurance |
|
| Scoring Method |
Measure Type |
Stratification |
Risk Adjustment |
| Proportion |
PROCESS |
None |
None |
Rate Aggregation
None
Improvement Notation
Higher score indicates better quality
Rationale
Pneumococcal disease is a common cause of illness and death in older adults and in persons with certain underlying conditions. The major clinical syndromes of pneumococcal disease include pneumonia, bacteremia and meningitis, with pneumonia being the most common (CDC 2015a). Pneumonia symptoms generally include fever, chills, pleuritic chest pain, cough with sputum, dyspnea, tachypnea, hypoxia tachycardia, malaise and weakness. There are an estimated 400,000 cases of pneumonia in the U.S. each year and a 5%–7% mortality rate, although it may be higher among older adults and adults in nursing homes (CDC 2015b; Janssens and Krause 2004).
Pneumococcal infections result in significant health care costs each year. Geriatric patients with pneumonia require hospitalization in nearly 90 percent of cases, and their average length of stay is twice that of younger adults (Janssens and Krause 2004). Pneumonia in the older adult population is associated with high acute-care costs and an overall impact on total direct medical costs and mortality during and after an acute episode (Thomas et al. 2012). Total medical costs for Medicare beneficiaries during and one year following a hospitalization for pneumonia were found to be $15,682 higher than matched beneficiaries without pneumonia (Thomas et al. 2012). It was estimated that in 2010, the total annual excess cost of hospital-treated pneumonia in the fee-for-service Medicare population was approximately $7 billion (Thomas et al. 2012).
Pneumococcal vaccines have been shown to be highly effective in preventing invasive pneumococcal disease. Studies show that at least one dose of pneumococcal polysaccharide vaccine protects between 50-85 in 100 healthy adults against invasive pneumococcal disease (CDC 2019). When comparing costs, outcomes and quality adjusted life years, immunization with recommended pneumococcal vaccines was found to be more economically efficient than no vaccination, with an incremental cost-effectiveness ratio of $25,841 per quality-adjusted life year gained (Chen et al. 2014).
Clinical Recommendation Statement
The Advisory Committee on Immunization Practices (ACIP) recommends a routine single dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults age 65 years and older. The 13-valent pneumococcal conjugate vaccine (PCV13) is no longer routinely recommended for all adults age 65 years and older. Instead, shared clinical decision-making for PCV13 use is recommended for persons age 65 years and older who do not have an immunocompromising condition, CSF leak, or cochlear implant and who have not previously received PCV13. When patients and vaccine providers engage in shared clinical decision-making for PCV13 use to determine whether PCV13 is right for the specific individual, considerations may include the individual patient’s risk for exposure to PCV13 serotypes and the risk for pneumococcal disease for that person as a result of underlying medical conditions.
If a decision to administer PCV13 is made, it should be administered at least 12 months before PPSV23 (Matanock et al. 2019).
Definition
None
Transmission Format
TBD
Applicable Value Sets
| Category |
Value Set |
OID |
| 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 |
Discharge Services - Nursing Facility |
2.16.840.1.113883.3.464.1003.101.11.1065 |
| 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 |
Nursing Facility Visit |
2.16.840.1.113883.3.464.1003.101.12.1012 |
| Encounter, Performed |
Office Visit |
2.16.840.1.113883.3.464.1003.101.12.1001 |
| Encounter, Performed |
Online Assessments |
2.16.840.1.113883.3.464.1003.101.12.1089 |
| 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 |
| Encounter, Performed |
Telephone Visits |
2.16.840.1.113883.3.464.1003.101.12.1080 |
| 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 |
| 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
CITATIONCenters for Disease Control and Prevention. (2015a, June 10). Pneumococcal disease: Symptoms and complications. Retrieved from https://www.cdc.gov/pneumococcal/about/symptoms-complications.html
CITATIONCenters for Disease Control and Prevention. (2015b, June 19). Pneumococcal vaccination: Clinical Features. Retrieved from https://www.cdc.gov/pneumococcal/clinicians/clinical-features.html#pneumonia
CITATIONChen, J., O’Brien, M. A., Yang, H. K., et al. (2014). Cost-effectiveness of pneumococcal vaccines for adults in the United States. Advances in Therapy, 31(4), 392-409.
CITATIONJanssens, J. P., & Krause, K. H. (2004). Pneumonia in the very old. Lancet Infectious Diseases, 4(2), 112-124.
CITATIONMatanock, A., G. Lee, R. Gierke, M. Kobayashi, A. Leidner, T. Pilishvili. 2019. “Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ?65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices.” MMWR Morb Mortal Wkly Rep 68:1069–75.
CITATIONThomas, C.P., M. Ryan, J.D. Chapman, et al. 2012. “Incidence and cost of pneumonia in Medicare beneficiaries.” Chest 142(4): 973–81.
CITATIONCenters for Disease Control and Prevention. (2019, November 21). Pneumococcal Vaccination: What Everyone Should Know. Retrieved from https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html.
CITATIONCenters for Disease Control and Prevention. (2015a, June 10). Pneumococcal disease: Symptoms and complications. Retrieved from https://www.cdc.gov/pneumococcal/about/symptoms-complications.html
CITATIONCenters for Disease Control and Prevention. (2015b, June 19). Pneumococcal vaccination: Clinical Features. Retrieved from https://www.cdc.gov/pneumococcal/clinicians/clinical-features.html#pneumonia
CITATIONChen, J., O’Brien, M. A., Yang, H. K., et al. (2014). Cost-effectiveness of pneumococcal vaccines for adults in the United States. Advances in Therapy, 31(4), 392-409.
CITATIONJanssens, J. P., & Krause, K. H. (2004). Pneumonia in the very old. Lancet Infectious Diseases, 4(2), 112-124.
CITATIONMatanock, A., G. Lee, R. Gierke, M. Kobayashi, A. Leidner, T. Pilishvili. 2019. “Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ?65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices.” MMWR Morb Mortal Wkly Rep 68:1069–75.
CITATIONThomas, C.P., M. Ryan, J.D. Chapman, et al. 2012. “Incidence and cost of pneumonia in Medicare beneficiaries.” Chest 142(4): 973–81.
CITATIONCenters for Disease Control and Prevention. (2019, November 21). Pneumococcal Vaccination: What Everyone Should Know. Retrieved from https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html.
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Source:
https://ecqi.healthit.gov/ecqm/measures/cmsv1