Below is the most recently endorsed version of the measure specifications:
Measure Description:
The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) whose most recent HbA1c level is >9.0% during the measurement year.
Numerator Statement:
Patients whose most recent HbA1c level is greater than 9.0% or is missing a result, or for whom an HbA1c test was not done during the measurement year.
Numerator Details:
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Denominator Statement:
Patients 18-75 years of age by the end of the measurement year who had a diagnosis of diabetes (type 1 and type 2) during the measurement year or the year prior to the measurement year.
Denominator Details:
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Exclusions:
This measure excludes adults in hospice. It also excludes adults with advanced illness and frailty, as well as Medicare adults 65 years of age and older enrolled in an I-SNP or living long-term in institutional settings.
Additionally, exclude patients who had a diagnosis of gestational diabetes or steroid-induced diabetes, in any setting during the measurement year or the year prior to the measurement year and who did NOT have a diagnosis of diabetes. These patients are sometimes pulled into the denominator via pharmacy data. They are then removed once no additional diagnosis of diabetes (Type 1 or Type II) is found.
Exclusion Details:
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Risk Adjustment:
No risk adjustment or risk stratification
Classification:
Measure Type:
Outcome: Intermediate Clinical Outcome
Measure Format:
measure
Condition:
Diabetes, Endocrine
Non-Condition Specific:
Care Setting:
Outpatient Services
National Quality Strategy Priorities:
Effective Communication and Care Coordination
Current Use:
Payment Program, Professional Certification or Recognition Program, Public Reporting, Quality Improvement with Benchmarking (external benchmarking to multiple organizations), Regulatory and Accreditation Programs
Planned Use:
Data Source:
Claims, Electronic Health Data, Electronic Health Records: Electronic Health Records, Paper Medical Records
Level of Analysis:
Health Plan
Target Population:
Populations at Risk
Outcome-Focused, Highest Opportunity for Improvement, Highly Prevalent Conditions
Measure Steward Contact Information:
For additional measure specification information, please contact the Measure Steward.
Measure Steward Organization:
National Committee for Quality Assurance
Primary Measure Steward Contact:
Measure Disclaimer:
This HEDIS® performance measure is not a clinical guideline and does not establish a standard of medical care and has not been tested for all potential applications.
THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.
Measure Steward Copyright:
The HEDIS® measures and specifications were developed by and are owned by the National Committee for Quality Assurance (NCQA). The HEDIS measures and specifications are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in these materials and can rescind or alter these materials at any time. These materials may not be modified by anyone other than NCQA. Anyone desiring to use or reproduce the materials without modification for a non-commercial purpose may do so without obtaining any approval from NCQA. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA.
©2019 NCQA, all rights reserved.
Calculated measure results, based on unadjusted HEDIS specifications, may not be termed “Health Plan HEDIS rates” until they are audited and designated reportable by an NCQA-Certified Auditor. Such unaudited results should be referred to as “Unaudited Health Plan HEDIS Rates.” Accordingly, “Heath Plan HEDIS rate” refers to and assumes a result from an unadjusted HEDIS specification that has been audited by an NCQA-Certified HEDIS Auditor.
Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. NCQA disclaims all liability for use or accuracy of any coding contained in the specifications.
Content reproduced with permission from HEDIS, Volume 2: Technical Specifications for Health Plans. To purchase copies of this publication, including the full measures and specifications, contact NCQA Customer Support at 888-275-7585 or visit
www.ncqa.org/publications.
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