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  • Measure Summary
  • NQMC:010612
  • Oct 2015

Adolescent well-care visits: percentage of enrolled members 12 to 21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.

National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.
National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

This is the current release of the measure.

This measure updates previous versions:

  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.
  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

Primary Measure Domain

Related Health Care Delivery Measures: Use of Services

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of enrolled members 12 to 21 years of age who had at least one comprehensive well-care visit with a primary care practitioner (PCP) or an obstetrics and gynecology (OB/GYN) practitioner during the measurement year.

Note: This measure is based on the Centers for Medicare & Medicaid Services (CMS) and American Academy of Pediatrics (AAP) guidelines for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) visits.

Note from the National Quality Measures Clearinghouse (NQMC): For this measure, there are both Administrative and Hybrid Specifications. This NQMC measure summary is based on the Administrative Specification. Refer to the original measure documentation for details pertaining to the Hybrid Specification. Only the Administrative Method of data collection may be used when reporting this measure for the commercial population.

    Rationale

    This measure looks at the use of regular check-ups by adolescents. It reports the percentage of adolescents 12 to 21 years of age who had one or more well-care visits with a primary care provider (PCP) or obstetrics and gynecology (OB/GYN) practitioner during the measurement year. Adolescents benefit from an annual preventive health care visit that addresses the physical, emotional and social aspects of their health.

    Adolescence is a time of transition between childhood and adult life and is accompanied by dramatic changes. Accidents, homicide and suicide are the leading causes of adolescent deaths. Sexually transmitted diseases, substance abuse, pregnancy and antisocial behavior are important causes of—or result from—physical, emotional and social adolescent problems.

    The American Medical Association (AMA) Guidelines for Adolescent Preventive Services (n.d.), the federal government's Bright Futures (1994; 2000; 2002) program and the American Academy of Pediatrics (AAP) (2000) guidelines all recommend comprehensive annual check-ups for adolescents.

    Evidence for Rationale

    American Academy of Pediatrics. Committee on practice and ambulatory medicine: recommendations for preventive pediatric health care. Pediatrics. 2000;105:645-6.

    American Medical Association. Guidelines for adolescent preventive health services. Recommendations for physicians and other health professionals. Chicago (IL): American Medical Association; various p.

    Bright futures: guidelines for health supervision of infants, children, and adolescents. 2nd ed. 1994; 2000; 2002.

    National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

    Primary Health Components

    Primary care; well-care visit

    Denominator Description

    Members age 12 to 21 years as of December 31 of the measurement year (see the related "Denominator Inclusions/Exclusions" field)

    Numerator Description

    At least one comprehensive well-care visit with a primary care practitioner (PCP) or an obstetrics and gynecology (OB/GYN) practitioner during the measurement year (see the related "Numerator Inclusions/Exclusions" field)

    Type of Evidence Supporting the Criterion of Quality for the Measure

    • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
    • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences

    Additional Information Supporting Need for the Measure

    • Assessing physical, emotional and social development is important at every stage of life, particularly with children and adolescents (Child Trends, 2012). Behaviors established during childhood or adolescence, such as eating habits and physical activity, often extend into adulthood (Kann et al., 2014). A health care provider's advice or guidance pertaining to health behaviors can have a significant impact.
    • Studies show that children with delayed development who receive early intervention are more likely to graduate high school, hold a job, live independently and avoid teen pregnancy, delinquency and violent crimes—representing a saved cost to society of between $30,000 and $100,000 per child (Glascoe & Shapiro, 2007).
    • Among adolescents, the primary causes of morbidity and mortality tend to result from engaging in risky behaviors. In 2013, about 40 percent of high school students had tried cigarettes and 66 percent had had at least one drink of alcohol (Centers for Disease Control and Prevention [CDC], 2013).
    • The 2011/2012 National Survey of Children's Health showed that an estimated 11 million children 0 to 17 years of age did not have any preventive medical care visits in the past year (Child and Adolescent Health Measurement Initiative [CAHMI], n.d.).
    • Well-care visits provide an opportunity for providers to influence health and development. A well-care visit is a critical opportunity for screening and counseling. Assessing changes in physical and social circumstances can help lessen the risk of serious and long-term health effects.

    Evidence for Additional Information Supporting Need for the Measure

    Centers for Disease Control and Prevention (CDC). Youth Risk Behavior Survey fact sheets. [internet]. Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2013 [accessed 2014 Jun 01].

    Child and Adolescent Health Measurement Initiative (CAHMI). The Data Resource Center for Child and Adolescent Health: 2011/12 National Survey of Children’s Health. [internet]. Portland (OR): Oregon Health and Science University (OHSU); [accessed 2014 Jun 01].

    Child Trends. Well-child visits. Bethesda (MD): Child Trends; 2012 Sep. 11 p.

    Glascoe FP, Shapiro HL. Introduction to developmental and behavioral screening. Dev Behav Pediatr Online. 2007;:various.

    Kann L, Kinchen S, Shanklin SL, Flint KH, Kawkins J, Harris WA, Lowry R, Olsen EO, McManus T, Chyen D, Whittle L, Taylor E, Demissie Z, Brener N, Thornton J, Moore J, Zaza S, Centers for Disease Control and Prevention (CDC). Youth risk behavior surveillance--United States, 2013. Morb Mortal Wkly Rep Surveill Summ. 2014 Jun 13;63 Suppl 4:1-168. PubMed External Web Site Policy

    National Committee for Quality Assurance (NCQA). The state of health care quality 2015. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. 205 p.

    Extent of Measure Testing

    All HEDIS measures undergo systematic assessment of face validity with review by measurement advisory panels, expert panels, a formal public comment process and approval by the National Committee for Quality Assurance's (NCQA's) Committee on Performance Measurement and Board of Directors. Where applicable, measures also are assessed for construct validity using the Pearson correlation test. All measures undergo formal reliability testing of the performance measure score using beta-binomial statistical analysis.

    Evidence for Extent of Measure Testing

    Rehm B. (Assistant Vice President, Performance Measurement, National Committee for Quality Assurance, Washington, DC). Personal communication. 2015 Mar 16.  1 p.

    State of Use

    Current routine use

    Current Use

    Accreditation

    External oversight/Medicaid

    External oversight/State government program

    Monitoring and planning

    Measurement Setting

    Ambulatory/Office-based Care

    Managed Care Plans

    Professionals Involved in Delivery of Health Services

    Advanced Practice Nurses

    Physician Assistants

    Physicians

    Least Aggregated Level of Services Delivery Addressed

    Single Health Care Delivery or Public Health Organizations

    Statement of Acceptable Minimum Sample Size

    Specified

    Target Population Age

    Age 12 to 21 years

    Target Population Gender

    Either male or female

    IOM Care Need

    Not within an IOM Care Need

    IOM Domain

    Not within an IOM Domain

    Case Finding Period

    December 31 of the measurement year

    Denominator Sampling Frame

    Enrollees or beneficiaries

    Denominator (Index) Event or Characteristic

    Patient/Individual (Consumer) Characteristic

    Denominator Time Window

    Time window brackets index event

    Denominator Inclusions/Exclusions

    Inclusions
    Members age 12 to 21 years as of December 31 of the measurement year

    Note:

    • Members must have been continuously enrolled during the measurement year.
    • Allowable Gap: No more than one gap in enrollment of up to 45 days during the measurement year. To determine continuous enrollment for a Medicaid member for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage.

    Exclusions
    Unspecified

    Value Set Information
    Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site External Web Site Policy to purchase HEDIS Volume 2, which includes the Value Set Directory.

    Exclusions/Exceptions

    Does not apply to this measure

    Numerator Inclusions/Exclusions

    Inclusions
    At least one comprehensive well-care visit (Well-Care Value Set) with a primary care practitioner (PCP) or an obstetrics and gynecology (OB/GYN) practitioner during the measurement year. The practitioner does not have to be the practitioner assigned to the member.

    Exclusions
    Unspecified

    Value Set Information
    Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site External Web Site Policy to purchase HEDIS Volume 2, which includes the Value Set Directory.

    Numerator Search Strategy

    Fixed time period or point in time

    Data Source

    Administrative clinical data

    Paper medical record

    Type of Health State

    Does not apply to this measure

    Instruments Used and/or Associated with the Measure

    Unspecified

    Measure Specifies Disaggregation

    Does not apply to this measure

    Scoring

    Rate/Proportion

    Interpretation of Score

    Does not apply to this measure (i.e., there is no pre-defined preference for the measure score)

    Allowance for Patient or Population Factors

    Analysis by subgroup (stratification by individual factors, geographic factors, etc.)

    Description of Allowance for Patient or Population Factors

    This measure requires that separate rates be reported for commercial and Medicaid product lines.

    Standard of Comparison

    External comparison at a point in, or interval of, time

    External comparison of time trends

    Internal time comparison

    Original Title

    Adolescent well-care visits (AWC).

    Measure Collection Name

    HEDIS 2016: Health Plan Collection

    Measure Set Name

    Utilization and Risk Adjusted Utilization

    Measure Subset Name

    Utilization

    Submitter

    National Committee for Quality Assurance - Health Care Accreditation Organization

    Developer

    National Committee for Quality Assurance - Health Care Accreditation Organization

    Funding Source(s)

    Unspecified

    Composition of the Group that Developed the Measure

    National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.

    Financial Disclosures/Other Potential Conflicts of Interest

    In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.

    Adaptation

    This measure was not adapted from another source.

    Date of Most Current Version in NQMC

    2015 Oct

    Measure Maintenance

    Unspecified

    Date of Next Anticipated Revision

    Unspecified

    Measure Status

    This is the current release of the measure.

    This measure updates previous versions:

    • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.
    • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

    Source(s)

    National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

    National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

    Measure Availability

    Source available for purchase from the National Committee for Quality Measurement (NCQA) Web site External Web Site Policy.

    For more information, contact NCQA at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

    Companion Documents

    The following are available:

    • National Committee for Quality Assurance (NCQA). The state of health care quality 2015. Washington (DC): National Committee for Quality Assurance (NCQA); 2015 Oct. 205 p.
    • National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 2, technical update. Washington (DC): National Committee for Quality Assurance (NCQA); 2015 Oct 1. 12 p.

    For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

    NQMC Status

    This NQMC summary was completed by ECRI on August 7, 2003. The information was verified by the measure developer on December 1, 2003.

    This NQMC summary was updated by ECRI Institute on June 16, 2006, and on August 11, 2008. The information was verified by the measure developer on September 26, 2008.

    This NQMC summary was updated by ECRI Institute on March 27, 2009. The information was verified by the measure developer on May 29, 2009.

    This NQMC summary was updated by ECRI Institute on February 8, 2010 and on June 10, 2011.

    This NQMC summary was retrofitted into the new template on July 1, 2011.

    This NQMC summary was updated by ECRI Institute on October 5, 2012, August 5, 2013, March 3, 2014, April 10, 2015, and again on March 29, 2016.

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    This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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