| REQUIRED MEASURES |
Measure
|
Definition
|
Data Gathering Plan
|
Goal
|
Notes/Comments |
| 1. Hypertensive Patients with appropriate
BP control |
The number of CVD patients with a
1. diagnosis of hypertension (but not DM) whose last BP (taken
with the last 12 months) was less than 140/90 OR
2. diagnosis of hypertension AND DM whose last BP was less
than 130/80
DIVIDED by the total of CVD patients with hypertension in
the clinical information system. Multiply by 100 to get a
percentage. |
On the last workday of each month, search
the clinical information system for all CVD patients with
a
1. diagnosis of hypertension (but not DM) whose last BP (taken
with the last 12 months) was less than 140/90 OR
2. diagnosis of hypertension AND DM whose last BP was less
than 130/80
Also, count the number of CVD patients with hypertension in
the clinical information system. |
>50% |
JNC-VII
Ref. 1
PECS 3.0 will report separately on the BP results of all CVD
patients with DM using the 130/80 limit. We will also consider
an index measure that will appear on the Clinical information
system Summary Report called “Patients with appropriate
BP control” that combines results for patients with
hypertension or DM.
Note that CVD patients with renal disease should have a BP
goal < 130/80. |
| 2. CVD Patients with 2 BP’s in Last Year |
The number of CVD patients in
the clinical information system who have had two BP’s
in the last 12 months, divided by the total number of CVD
patients in the clinical information system. Multiply by 100
to get a percentage |
On the last workday of each month, search
the clinical information system for all patients with CVD
who have had two BP’s within the last 12 months. At
the same time, count the number of CVD patients. |
>90% |
JNC-VII
Ref. 1 |
| 3. Documentation of Self-management Goal
Setting |
The number of CVD patients in the clinical
information system with documented self-management goals in
the last 12 months divided by the total number of CVD patients
in the clinical information system. Multiply by 100 to get
a percentage. |
On the last workday of each month, search
the clinical information system for all patients with a diagnosis
of CVD who have documented self-management goals set with
a clinician in the past 12 months. At the same count the number
of CVD patients. |
>70% |
JNC-VII, American Society of Hypertension
Guidelines, Lorig et al.
Ref. 1, 3, 4 |
| 4. Patients with appropriate fasting lipid
profile documented |
The number of CVD patients in the clinical
information system with a documented fasting lipid profile
within the condition appropriate time frame (1 year for patients
with CAD or CAD risk equivalent by ATP III guidelines; 1 year
for patients with dyslipidemia and 5 years for patients with
hypertension only who are not in high risk category) divided
by the total number of CVD patients in the clinical information
system. Multiply by 100 to get a percentage. |
On the last workday of each month, search
the clinical information system for all CVD patients with
a documented fasting lipid profile within the condition appropriate
time frame (1 year for patients with CAD or CAD risk equivalent
by ATP III guidelines; 1 year for patients with dyslipidemia
and 5 years for patients with hypertension only who are not
in high risk category). At the same time count the total number
of patients with a diagnosis of CVD. |
>80% |
ATP-III
Ref. 2
NOTE: This measure definition has changed slightly from previous
years to align with the measure used in the DM collaborative. |
| 5. Patients with LDL Cholesterol level
treated to goal |
The number of CVD patients with fasting
LDL documented in the appropriate time range and whose last
fasting LDL is in appropriate range:
1. LDL < 100 if CAD or CAD risk equivalent – high
risk
2. LDL < 130 if 2 or more risk factors without CAD or CAD
risk equivalent – moderate risk
3. LDL < 160 if 0-1 risk factor without CAD or CAD risk
equivalent – low risk
Divided by the number of CVD patients in the clinical information
system with fasting LDL documented in the appropriate time
range (measure 3). Multiply by 100 to get a percentage |
On the last workday of each month, search
the clinical information system for all CVD patients with
fasting LDL documented in the appropriate time range whose
last fasting LDL is in appropriate range. At the same time
count the number of CVD patients with fasting LDL documented
in the appropriate time range (measure 3). |
>60% |
ATP-III
Ref. 2
CAD Risk factors (at least one):
1. Symptomatic carotid artery disease
2. Peripheral arterial disease
3. Abdominal aortic aneurysm.
CAD-equivalent Risk factors:
4. DM
OR
5. > 20% ten-year risk (Framingham risk calculation) with
2 or more risk factors listed below
Risk factors:
1. Cigarette smoking
2. Hypertension (BP >140/90 mmHg or on antihypertensive
medication)
3. Low HDL cholesterol (<40 mg/dL)
4. Family history of premature CAD (CAD in male first degree
relative <55 years;
5. CAD in female first degree relative <65 years)
6. Age (men >45 years; women >55 years)
If HDL cholesterol >=60 mg/dl, you subtract a risk factor
from the total count.
More aggressive treatment goals are clinical options for high-risk
and medium risk patients based on recent evidence, reference
15. |
| 6. Aspirin or Other Antithrombotic Agent
Use |
The number of CVD patients with CAD (no
age limit) in the clinical information system who have a current
prescription for aspirin or other antithrombotic agent divided
by the number of CVD patients with CAD in the clinical information
system. Multiply by 100 to get a percentage. |
On the last workday of each month, search
the clinical information system for all patients with CAD
who have a current prescription for aspirin or other antithrombotic
agent. At the same time count the number of patients with
a diagnosis of CAD. |
>90% |
AHA/ACC guidelines for secondary prevention
Ref. 5;
Suitable agents include Warfarin/Coumadin, Plavix (clopidogrel),
Ticlid (ticlopidine), low molecular weight heparin, and any
newer agents that may become available that are shown to be
equivalent or superior to the existing medications. |
| ADDITIONAL RECOMMENDED
MEASURES: Your team must choose at least one of these to track
and report on. You will find that they can be used to enhance
care and increase the ability to achieve the required measures
above. |
Measure
|
Definition
|
Data Gathering Plan
|
Goal
|
Notes/Comments |
| 7. ACE Inhibitor /ARB Use |
The number of CVD patients, age > 55, with CAD or DM
in the clinical information system who have been prescribed
ACE inhibitors or ARBS, divided by the total number of CVD
patients, age > 55, with CAD or DM in the clinical information
system. Multiply by 100 to get a percentage. |
On the last workday of each month, search the clinical information
system for all CVD patients, age > 55, with CAD or DM in
the clinical information system who have been prescribed ACE
inhibitors or ARBs.. At the same time count the total number
of CVD patients, age > 55, with CAD or DM. |
>70% |
AHA/ACC guidelines for secondary prevention
Ref. 5
HOPE Study
Ref. 6
We believe usual practice ought to be a test of an ACE and
if ACE is not tolerated, then try an ARB. In some cases, ARB
will be first choice but because of cost of medication, ACEs
ought to be a common starting point. |
| 8. Beta Blocker Use |
The number of patients with CAD in the clinical information
system who have a prescription for a beta blocker, divided
by the number of patients with CAD. Multiply by 100 to get
a percentage. |
On the last workday of each month, search the clinical information
system for all patients with CAD in the clinical information
system who have a prescription for a beta blocker. At the
same time, count the number of patients with a diagnosis of
CAD. |
>70% |
AHA/ACC guidelines for secondary prevention
Ref. 5 |
| 9. Depression Screening (12 months) |
The number of CVD patients in the clinical information system
who have been screened for depression in the past 12 months,
divided by the total number of CVD patients in the clinical
information system. Multiply by 100 to get a percentage. |
On the last workday of each month, search the clinical information
system for all CVD patients in the clinical information system
who have been screened for depression in the past 12 months.
At the same time count the total number of CVD patients. |
>50% |
Depression in Primary Care: Clinical Practice Guideline
Ref. 7 |
| 10. Patients with 2 HbA1c’s in Last Year (at Least
3 Months Apart) |
The number of patients with CVD and DM in the clinical information
system who have had two HbA1c’s (at least 91 days apart)
in the last 12 months, divided by the total number of patients
with CVD and DM in the clinical information system. Multiply
by 100 to get a percentage |
On the last workday of each month, search the clinical information
system for all patients with a diagnosis of CVD and DM who
have had two HbA1c’s within the last 12 months (at least
91 days apart). At the same time, count the number of patients
with both CVD and DM. |
>90% |
ADA Clinical Practice Recommendations 2004
Ref. 8 |
| 11. Weight Reduction |
The number of CVD patients with a BMI >25 at any time
in the last 12 months who have lost 10 pounds (by comparing
their maximum recorded weight in the 12 months period to their
latest recorded weight), divided by the total number of CVD
patients who have or had a BMI > 25 at any time in the
last 12 months. Multiply by 100 to get a percentage. |
On the last workday of each month, search the clinical information
system for all CVD patients with a BMI >25 at any time
in the last 12 months who have lost 10 pounds (by comparing
their maximum recorded weight in the 12 months period to their
latest recorded weight). At the same time count the total
number of CVD patients who have or had a BMI > 25 at any
time in the last 12 months. |
>30% |
Clinical Guidelines on the Identification, Evaluation, and
Treatment of Overweight and Obesity in Adults
Ref. 9-11
The weight reduction measure needs alignment across conditions.
We will consider specific tests with teams in 2005 to guide
us to better alignment. |
| 12. Exercise |
The number of CVD patients whose last documented exercise
rate (within the last 12 months) was 3Xweek @ least 20 minutes,
divided by the total number of CVD patients. Multiply by 100
to get a percentage. |
On the last workday of each month, search the clinical information
system for all CVD patients whose last documented exercise
rate (within the last 12 months) was 3Xweek @ least 20 minutes.
At the same time count the total number of CVD patients. |
>60% |
AHA/ACC guidelines for secondary prevention, Ref. 5; Exercise
and physical activity in the prevention and treatment of atherosclerotic
cardiovascular disease, Ref. 12; Behavioral counseling in
primary care promote physical activity, .Ref. 13.
The exercise measure needs alignment across conditions. We
will consider a specific test with teams in 2005 to guide
us to better alignment. |
| 13. Patients who are current smokers |
The number of patients in the registry who are current smokers
(documented within the last 12 months), divided by the total
number of CVD patients in the registry with smoking status
documented within the last 12 months. Multiply by 100 to get
percentage. |
On the last workday of each month, search the registry for
all patients with CVD who are current smokers (documented
within the last 12 months). At the same time count the total
number of patients with CVD in the registry with smoking status
documented within the last 12 months. |
<12% |
Healthy People 2010
Clinical Practice Guideline for treating tobacco use and dependence
Ref. 14
(Note: PECS versions 2.x reported “current smokers”
on registry summary reports but in fact based calculations
on tobacco use. PECS version 3 will align calculation with
the label on the registry summary report.) |
