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  • Measure Summary
  • NQMC:010004
  • Oct 2014

Preventive services: percentage of adult enrolled members age 19 years and older who are up-to-date for all appropriate preventive services (combination 3).

Bussey S, Warner K. 2014 clinical indicators report: 2013/2014 results. Minneapolis (MN): HealthPartners; 2014 Oct. 131 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: Wehrle D, Bussey S. 2013 clinical indicators report: 2012/2013 results. Minneapolis (MN): HealthPartners; 2013 Oct. 134 p.

The measure developer reaffirmed the currency of this measure in November 2015.

Measure Hierarchy

HealthPartners Clinical Indicators > Preventive Services

Age Group

UMLS Concepts (what is this?)

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of enrolled members age 19 years and older who are up-to-date for all appropriate preventive services (combination 3) based on age and gender.

Rationale

Appropriate and timely preventive care significantly reduces morbidity and mortality. Preventive service rates improve if every patient encounter is seen as an opportunity to address preventive care needs. Looking at the member's up-to-date status as inclusive of all required preventive services, rather than individual, discrete services is more meaningful and patient centered.

Evidence for Rationale

Institute for Clinical Systems Improvement (ICSI). Preventive services for adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2010 Sep. 79 p. [167 references]

Primary Health Components

Preventive services (cholesterol, cancer screening [breast, cervical, colorectal], chlamydia screening, pneumococcal vaccine, blood pressure, tobacco assessment)

Denominator Description

Members age 19 years and older as of December 31 of the measurement year who were continuously enrolled from January 1 to December 31 of the measurement year, with not more than a 45 day break in coverage and who had a clinic visit (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Members from the denominator who have had appropriate preventive services (combination 3) based on age and gender (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

Additional Information Supporting Need for the Measure

Refer to the 2014 Clinical Indicators Report, which features comparative provider performance on measures of clinical quality, patient experience and affordability related to preventive and chronic care, behavioral health, pharmacy, specialty care, hospital care and total cost of care. A technical supplement to the 2014 Clinical Indicators Report is also available and includes measurement detail, optimal component rates, trended plan rates over time and external benchmarks.

Evidence for Additional Information Supporting Need for the Measure

Bussey S, Warner K. 2014 clinical indicators report: 2013/2014 results. Minneapolis (MN): HealthPartners; 2014 Oct. 131 p.

Bussey S, Warner K. 2014 clinical indicators report: 2013/2014 results. Technical supplement. Minneapolis (MN): HealthPartners; 141 p.

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

National reporting

Pay-for-performance

Measurement Setting

Ambulatory/Office-based Care

Managed Care Plans

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 19 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Case Finding Period

January 1 to December 31 of the measurement year

Denominator Sampling Frame

Enrollees or beneficiaries

Denominator (Index) Event or Characteristic

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Time window brackets index event

Denominator Inclusions/Exclusions

Inclusions
Members age 19 years and older as of December 31 of the measurement year who were continuously enrolled from January 1 to December 31 of the measurement year, with not more than a 45 day break in coverage and who had a clinic visit

Exclusions

  • Members can be validly excluded from the measure if they died, or resided in a nursing home, or were a hospice patient.
  • Members can be validly excluded from a component if there is a contraindication.

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Members from the denominator who have had appropriate preventive services (combination 3)* based on age and gender

*Preventive services, timeframes and ages audited for each component for combination 3 include:

  • Cholesterol, total and high-density lipoprotein (HDL) (last 5 years) (females greater than or equal to 50 [age 45 + 5 year look back period]; males greater than or equal to 40)
  • Colorectal cancer screening (colonoscopy last 10 years, flexible sigmoidoscopy last 5 years or fecal occult blood test [FOBT] in reporting year) (females greater than or equal to 51 and less than or equal to 75 [age 50 + 1 year look back period]; males greater than or equal to 51 and less than or equal to 75)
  • Breast cancer screening (mammography last 2 years) (females greater than or equal to 52 and less than or equal to 75 [age 50 + 2 year look back period])
  • Cervical cancer screening (Pap test last 3 years) (females greater than or equal to 24 and less than or equal to 64 [age 21 + 3 year look back period])
  • Chlamydia screening (in reporting year) (sexually active women per Health Effectiveness Data and Information Set [HEDIS] specifications, age greater than or equal to 16 and less than or equal to 24)
  • Pneumococcal vaccine (age greater than or equal to 65 years) (greater than or equal to 66 [age 65 + the year to get the immunization])
  • Blood pressure (last 2 years) (greater than or equal to 19)
  • Tobacco assessment (in reporting year) (greater than or equal to 19)

Exclusions
Unspecified

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

Measure is disaggregated into categories based on different definitions of the denominator and/or numerator

Basis for Disaggregation

This measure is disaggregated based on different definitions of the numerator. Report the rate for members who are up-to-date (UTD) for all appropriate preventive services and the percent UTD rate by each service type:

  • Cholesterol, total and high-density lipoprotein (HDL) (last 5 years) (females greater than or equal to 50 [age 45 + 5 year look back period]; males greater than or equal to 40)
  • Colorectal cancer screening (colonoscopy last 10 years, flexible sigmoidoscopy last 5 years or fecal occult blood test [FOBT] in reporting year) (females greater than or equal to 51 and less than or equal to 75 [age 50 + 1 year look back period]; males greater than or equal to 51 and less than or equal to 75)
  • Breast cancer screening (mammography last 2 years) (females greater than or equal to 52 and less than or equal to 75 [age 50 + 2 year look back period])
  • Cervical cancer screening (Pap test last 3 years) (females greater than or equal to 24 and less than or equal to 64 [age 21 + 3 year look back period])
  • Chlamydia screening (in reporting year) (sexually active women per Health Effectiveness Data and Information Set [HEDIS] specifications, age greater than or equal to 16 and less than or equal to 24)
  • Pneumococcal vaccine (age greater than or equal to 65 years) (greater than or equal to 66 [age 65 + the year to get the immunization])
  • Blood pressure (last 2 years) (greater than or equal to 19)
  • Tobacco assessment (in reporting year) (greater than or equal to 19)

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

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

External comparison of time trends

Internal time comparison

Prescriptive standard

Prescriptive Standard

Percent reaching all targets* - 2013 Goal:

  • Silver--90%
  • Gold--93%

*Targets: patients receiving all appropriate services (refer to the "Numerator Inclusions/Exclusions" field).

Evidence for Prescriptive Standard

Bussey S, Warner K. 2014 clinical indicators report: 2013/2014 results. Minneapolis (MN): HealthPartners; 2014 Oct. 131 p.

Original Title

Preventive services—adult primary care (combination 3).

Measure Collection Name

HealthPartners Clinical Indicators

Measure Set Name

Preventive Services

Submitter

HealthPartners - Managed Care Organization

Developer

HealthPartners - Managed Care Organization

Funding Source(s)

HealthPartners

Composition of the Group that Developed the Measure

  • Provider Measurement Committee
  • Preventive Services Quality Committee

Financial Disclosures/Other Potential Conflicts of Interest

None

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2014 Oct

Measure Maintenance

Annual

Date of Next Anticipated Revision

2015 Oct

Measure Status

This is the current release of the measure.

This measure updates a previous version: Wehrle D, Bussey S. 2013 clinical indicators report: 2012/2013 results. Minneapolis (MN): HealthPartners; 2013 Oct. 134 p.

The measure developer reaffirmed the currency of this measure in November 2015.

Source(s)

Bussey S, Warner K. 2014 clinical indicators report: 2013/2014 results. Minneapolis (MN): HealthPartners; 2014 Oct. 131 p.

Measure Availability

Source available from the HealthPartners Web site External Web Site Policy.

For more information, contact the HealthPartners Quality Measurement and Improvement Department at 8170 33rd Ave S., Bloomington, MN 55425; Phone: 952-883-5777; E-mail: quality@healthpartners.com; Web site: https://www.healthpartners.com/provider-public/quality-and-measurement/ External Web Site Policy.

Companion Documents

The following are available:

  • HealthPartners. National Quality Measures Clearinghouse (NQMC) measure submission form: Preventive services: percentage of adult enrolled members ages 19 years and older who are up-to-date for all appropriate preventive services. 2012 Oct. 9 p.
  • Institute for Clinical Systems Improvement (ICSI). Preventive services for adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2010 Sep. 79 p.
  • Bussey S, Warner K. 2014 clinical indicators report: 2013/2014 results. Technical supplement. Minneapolis (MN): HealthPartners; 141 p. This document is available from the HealthPartners Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on November 22, 2013. The information was verified by the measure developer on February 24, 2014.

This NQMC summary was updated by ECRI Institute on April 22, 2015.

The information was reaffirmed by the measure developer on November 27, 2015.

Copyright Statement

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

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