1. Warfarin Use in Atrial Fibrillation / ICD-9 427.31 / GI bleeding, Gastritis & duodenitis
Alcoholism/drug abuse, Gait abnormality
Alzheimer disease, Cerebral hemorrhage
Seizure disorder, CNS tumors, Renal insufficiency,
Thrombocytopenia / Non-adherence, fall risk / Warfarin, Heparin, Enoxaparin,
Dicumarol, Clopidogel, Anisindione / Past Stroke, CHF
2. ACE inhibitors in Heart Failure / ICD-9 428, 398.91, 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93
RFV 2520.0 / Hyperkalemia / Allergy /
ACEI
Benazepril HCL, Captopril, Enalaprilat/enalapril, maleate, Fosinopril sodium, Quinapril HCL, Ramipril, Lisinopril, Perindopril erbumine, Moexipril, TrandolaprilARB
Losartan Potassium, Irbesartan, Valsartan / CAD, DM, HTN3. Diuretics or Beta blockers in uncomplicated hypertension / ICD-9 401-405
RFV 2505.0, 2510.0 / DM, CAD, CHF / Failure of previous trials /
DIURETICS
Isosorbide, Torsemide, Bendroflumethiazide,Benzthiazide, Chlorothiazide, Chlorthalidone,
Cyclothiazide, Hydrochlorothiazide,
Hydroflumethiazide, Indapamide, Methyclothiazide, Metolazone, Polythiazide,
Quinethazone, Trichlormethiazide, Bumetanide,
Ethacrynic acid/ethacrynate sodium, Furosemide,
BB
Timolol, Nadolol, Propranolol, Penbutolol sulfate, Metoprolol, Labetalol HCL, Atenolol,Pindolol, Acebutolol HCL, Sotalol HCL,
Esmolol HCL, Carvedilol, Bisoprolol fumarate,
Betaxolol HCL, Levobunolol HCL
4. Aspirin in CAD / ICD-9 410-414
429.0, 429.1, 429.2, 429.5, 429.6, 429.7 RFV 2515.0 / GI bleeding, Gastritis & duodenitis,
Cerebral hemorrhage, Alcoholism/drug abuse / Allergy / Aspirin, Warfarin, Heparin, Enoxaparin,
Dicumarol, Clopidogel, Anisindione / Hyperlipidemia, HTN
5. Beta blockers in CAD / As above in #4. / Heart block, Asthma, COPD / Intolerance to previous trial / Timolol, Nadolol, Propranolol, Penbutolol sulfate, Metoprolol, Labetalol HCL, Atenolol,
Pindolol, Acebutolol HCL, Sotalol HCL,
Esmolol HCL, Carvedilol, Bisoprolol fumarate,
Betaxolol HCL, Levobunolol HCL / HTN, past MI
6. Antibiotic use in uncomplicated UTI / ICD-9 595.0, 595.9, 599.0 in females with acute visits
RFV 1665.2, 1675.0, 2700.0 / Infections of bacterial origin, Other infections (Skin infections, Vaginitis/cervicitis, Infections of kidney, Sexually transmitted disease), Nephrolithiasis, DM, Cancer, HIV/AIDS, Urological procedures, Urological structural/functional abnormality, Pregnancy / Allergy, recurrent UTI / SMX/TMP, TMP, Ciprofloxacin, Ofloxacin,
Norfloxacin, Amoxicillin, Nitrofurantoin
7. Antibiotic use in uncomplicated sore throat / ICD-9 034.0 / DM, HIV/AIDS, Cancer, Infections of bacterial origin, Complicated sore throat, Pre-/postoperative visits, Injury-induced visits / Allergy, recurrent sore throat / Penicillin, Erythromycin
8. No antibiotics in uncompli-cated URI / ICD-9 79.99, 460, 465, 487.1
RFV 1445.0, 1450.0, 2600.0 / Bronchospasm, DM, HIV/AIDS, Other sexually transmitted disease, Cancer, Infections of bacterial origin, Potential bacterial infections of respiratory system / Antibiotics not listed as medication (LIST TO BE PROVIDED BY RANDY) / Chronic conditions
9. Antibiotics in otitis media / ICD-9 381.0, 382
RFV 2450.0 / Age > 18, Infections of bacterial origin / Recurrence / Amoxicillin, Cefuroxime, Ceftriaxone, Cefprozil,
Loracarbef, Cefixime, Cefpodoxime
10. Inhaled steroids in asthma / ICD-9 493
RFV 2625.0 / COPD, No beta agonist listed / Mild asthma /
Inhaled Steroids
Beclomethasone dipropionate, Budesonide,Flunisolide, Fluticasone propionate,
Triamcinolone acetonide
Beta2-agonists
Salmeterol, Albuterol, Bitolterol, Pirbuterol,Terbutaline, Metaproterenol sulfate, Levalbuterol HCL, Isoproterenol
11. Anxiolytics in depression / ICD-9 296.2, 296.3, 300.4, 309.0, 309.1, 311.0
RFV 1110.0 / Anxiety disorder /
Benzodiazepines
Alprazolam, Chlordiazepoxide, Clorazepate dipotassium, Clonazepam, Diazepam, Estazolam,Flurazepam, Halazepam, Lorazepam, Oxazepam,
Prazepam, Quazepam, Temazepam, Triazolam
12. Depression treatment / As above in #11 /
Tricyclics & Tetrac
Amitriptyline Hcl, Nortriptyline Hcl, Doxepin,Imipramine Hcl, Desipramine Hcl, Amoxapine
Maprotiline Hcl, Trimipramine Maleate
SSRI/SNRI
Fluoxetine Hcl, Paroxetine Hcl, Sertraline Hcl,Citalopram Hcl, Venlafaxine Hcl
NEW GEN ANTI-DEP
Bupropion Hcl, Nefazodone Hcl, Trazodone Hcl,Mirtazapine
Monoamine Oxidase Inhibitors
Tranylcypromine, Phenelzine, Isocarboxazid14. Diet advice in hyper-lipidemia with comorbidities / ICD-9 272.0-272.4 with DM, CAD or Obesity / Age > 85 years / Visit with advice provided or dietician care / Diet/nutrition advice provided
15. Diet advice in obesity with co-morbidities / ICD-9 278.0
RFV 1040.0 with DM, HTN, CHF / None / Visit with advice provided or dietician care / Diet/nutrition advice provided / CAD, COPD, CHF, DM
16. Smoking cessation advice in smoking with co-morbidities / Smoker with CAD, COPD, Asthma, CHF, DM, others / Non-smokers / Visit with advice provided / Smoking cessation advice provided / CAD, COPD, Pregnancy
17. Adolescent prevention / Age 12 to 17 years / None / Recent visit with prevention / Advice on diet, exercise or weight / Asthma, other conditions
18. Dietary advice in diabetes with co-morbidities / ICD-9 250, RFV 2205.0 with HTN, CAD, hyperlipidemia / None / Visit with advice provided or dietician care / Dietary advice provided / HTN, CAD, obesity, hyperlipidemia, renal disease
19. Management of self-inflicted injuries / Reported intentional, self-inflicted injury / None / Specific follow-up visit planned or hospitalized / Depression, schizoprenia
20. Smoking status assessment / All / None / None / Determination smoker/non-smoker / CAD, COPD, Pregnancy, DM
21. Hypertension screening / All / None / Visit with BP measurement / Blood pressure measurement done / CAD,
22. Appropriate HIV screening follow-up / HIV serology ordered /
None
/ Specific follow-up visit planned23. Appropriate Screening ECG use / All / Cardiac disease, Chest pain, HTN, Palpitations,
Dysnea, Syncope, Hemoptysis, Chest trauma,
Renal failure / Pre-op visit, need for job clearance / Avoidance of ECG screening except where indicated / General exam, DM, smoking
24. Appropriate Screening U/A use / All / Urologic disease, pregnancy, relevant diseases of genital organs / None / No urinalysis performed / General exam
25. Appropriate Screening CBC use / All / Hematologic, oncologic, infecection, fatigue / None / Avoidance of CBC use except in indicated patients / General exam
26. High risk drug-drug interactions / All with 2+ medications / None / Close monitoring in unusual cases / Avoidance of drug combinations posing a high risk for adverse drug events / Multiple chronic conditions
27. High risk drug-patient interactions / All with 1+ medications / None / Close monitoring in unusual cases / Avoidance of drugs contraindicated in specific conditions / Multiple chronic conditions
28. Strep test among patients diagnosed with sore throat / ICD-9 034.0 / % of patients diagnosed with sore throat for whom a strep test was ordered
29. Appropriate follow-up in AOM / ICD-9 381.0, 382
RFV 2450.0 in children 5 y with acute visits / Specific follow-up visit planned
30. Lipid-lowering meds in CAD
31. Pharmacotherapy in DM
1In calculating each quality indicator, the denominator is a specific group of patient visits for which the quality indicator would apply (refer to population definitions) excluding certain visits where contraindications exist for the application of the quality indicator (refer to prominent exclusions). In most cases, population definitions and prominent exclusions are identified by specific ICD-9-CM and reason-for-visit (RFV) codes. An attempt was made to list other conditions that are potentially contraindicative of the application of the quality indication but are measured in N(H)AMCS (refer to unmeasured exceptions). These unmeasured exceptions should not affect the results so long as there is no reason to believe they are of significant frequency or not randomly distributed among the predictor variables of interest.
2In calculating each quality indicator, the numerator is to define specific physician actions that indicate performance of high quality care according to evidence-base clinical guidelines. In cases where medication use is the performance measure, please note that medications were listed as of 2000.
3Comorbidities are confounders that could influence the performance of the quality indicator. These conditions will be used as case-mix variables in risk adjustment for assessing the performance of the quality indicator.