North Carolina Local Public Health · health (panel) management, health directors and clinical managers need access to trends and analytics across their clinical programs and some

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North Carolina Local Public Health

Key Performance Indicators (KPI) Requirements

May 2014

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Key Performance Indicators

Table of Contents:

Introduction

Key Performance Indicator Details

Appointments by Visit Type

No Shows by Visit Type

Program Enrollment

Percentage of No Shows

Visits by Program

Average Visit Time by Provider

Chronic Condition Percentage

Number of Obese Patients

Charge by Program

Charge by Payor

Number of Visits by Payor

Monthly Charges

Quarterly Charge by Payor

Average Charge per Visit by Payor

Meaningful Use Performance

Program Enrollment by Age Range

Percent with Action Plan

Percent of Asthma Patients with Beta Agonist Overuse

Asthma ED Visits

Asthma inpatient visits

Percent of asthma patients with symptom assessment or continued care visit

Percent with assessment of environmental triggers

Breast cancer screening-rate for women ages 50-69

Cervical cancer screening - rate for women ages 21-64

Colorectal screening- rate for ages 50-75

Percent with Ischemic Vascular Disease (IVD) using Aspirin

Percent with Blood Pressure less than 140/90

Percent with IVD or Diabetes Mellitus (DM) with LDL < 100

Percent with Ischemic Vascular Disease (IVD) and lipid testing

Percent with smoking status documented or advice given

Percent with annual visit age 2-3 met




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Percent with annual visit age 19-21


Percent with 3 or more varnishing by 3.5

Percent with 4 or more varnishing by 3.5

Percent with A1C result < 8.0

Percent with A1C result > 9.0

Percent with A1C testing in past year

Percent with BP < 130/80

Percent with BP > 140/90

Percent with cholesterol screen in past year

Percent of Diabetes Mellitus (DM) and Hypertension (HTN) on ACE/ARB therapy

Percent with foot exam in previous year

Percent with LDL < 100

Percent with LDL > 130

Percent with neuropathy screening/treatment in past year

Percent with retinal eye exam in past 15 months

Inpatient (IP) visit rate per 1,000 heart failure member-months

Percent with adolescent well child visit in previous year met

Percent with adolescent well child in prior 3 years met

Percent well child visits- 6 in first 15 months met

Percent well child visits- between ages 3-6 met

Percent well child visits- between ages 7-11 met

Controlling High Blood Pressure

Use of High-Risk Medications In the Elderly

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Use of Imaging Studies For Low Back Pain

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Introduction North Carolina Local Health Departments (LHDs) have adopted Electronic Health Records

(EHR) at a rapid pace in the last 2 years. Electronic Health Records enable capturing structured

data, which can be easily reported on. This data is useful for Meaningful Use reports, Clinical

Quality Measures (CQM), PQRI and others measuring patient level outcomes. For population

health (panel) management, health directors and clinical managers need access to trends and

analytics across their clinical programs and some comparative analytics across comparable

local health departments.

PIs documented here are a result of feedback collected with health directors, clinical managers,

and public health informatics specialists. Initially a pilot project was undertaken with the Stokes

and Richmond County Health Departments. The indicators and findings from this pilot were

then reviewed by a working group of LHD health directors, clinical staff, and informatics

specialists. Follow up discussion were also held with selected working group members. Actual

documentation was prepared by staff and students from Patagonia Health, UNC School of

Information and Library Sciences, and the North Carolina Institute for Public Health.

These PIs are intended to aggregate data to be used by health directors and their authorized

staff. They do not contain identifiable patient information. These PIs may be used for

understanding trends, watching cause-effect, better explaining value proposition of the LHDs

and grant writing.

Key Performance Indicator Details

KPI Title Appointments by Visit Type

KPI Description This graph displays the number of

non-deleted appointments that were

scheduled during the fiscal year (July

1 – June 30) according to the visit

type.

KPI Calculation Sum of all scheduled appointments

(including missed appointments) with

a specific visit type within the given

date range

Data Source(s) Appointments

Minimum Data Set Patient ID, Appointment Date, Visit

Type

Dashboard Update Frequency Weekly

KPI Reporting Aggregation LHD

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KPI is reported in which reports Appointments-Demo

Comments

KPI Title No Shows by Visit Type


non-deleted appointments that were

scheduled during the fiscal year (July

1 – June 30) according to the visit

type. It displays the number of no

shows according to the visit type.

KPI Calculation Sum of all missed appointments with

a specific visit type within the given

date range


Minimum Data Set Patient ID, Appointment Date,

Appointment Status, Visit Type




Comments

KPI Title Program Enrollment


unduplicated patients who visited the

practice for a specific program in the

practice/health department during the

fiscal year (July 1 – June 30). If a

patient had multiple visits for different

programs, they are grouped into the

program according to the most recent

visit.

KPI Calculation Sum of all unduplicated patients who

visited the practice for a specific

program within the given date range


Minimum Data Set Patient ID, Program, Appointment Date



KPI is reported in which reports Program Breakdown-Demo

Comments

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KPI Title Percentage of No Shows

KPI Description This graph displays the percentage of

no shows compared to the total

number of scheduled visits during the

fiscal year (July 1 - June 30) according

to the visit type.

KPI Calculation Numerator divided by denominator

expressed as a percentage

Numerator: Sum of all missed

appointments with a specific visit type

within the given date range

Denominator:Sum of all scheduled

appointments (including missed

appointments) with a specific visit type



Minimum Data Set Patient ID, Appointment Date,

Appointment Status, Visit Type




Comments

KPI Title Visits by Program


visits to the practice/health department

during the fiscal year (July 1 - June 30)

according to the type of program the

visit was for.

KPI Calculation Sum of all visits for a specific program







Comments

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KPI Title Average Visit Time by Provider

KPI Description This graph displays the average visit

time for an appointment by provider

based on the check-in and check-out

time (only entries with a check-in and

check-out time are included in the

average).



Numerator: Sum of the visit times of

all visits to a specific provider within

the given date range (visit time

calculated by the difference between

check-in and check-out time, where

both values are present)

Denominator: Total number of visits to

a specific provider within the given

date range where a check-in and

check-out time were given


Minimum Data Set Patient ID, Check-in Time, Check-out

Time, Appointment Date, Provider




Comments

KPI Title Chronic Condition Percentage

KPI Description This graph displays the percentage of

patients with a specific chronic

condition as a percentage of the total

number of patients that visited the

practice during the fiscal year (July 1 -

June 30). The chronic conditions for

this graph are asthma, diabetes,

hypertension, obesity and smoking.

Obesity is defined as patients who

have a BMI greater than 25. Smokers

defined as those who smoke currently,

either every day or some days.

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Numerator: Sum of all patients

diagnosed with a specific condition that

were enrolled in the practice within the

given date range

Denominator: Sum of all patients that

were enrolled in the practice within the

given date range

Data Source(s) Encounter note, Social History

Minimum Data Set Patient ID, Encounter/Assessment

Date



KPI is reported in which reports Clinical Reports-Demo

Comments

KPI Title Number of Obese Patients


obese patients who visited the

practice/health department during the

fiscal year (July 1-June 30). Obesity is

defined as patients who have a BMI

greater than 25.

KPI Calculation Sum of all patients with a BMI greater

than 25 that were enrolled in the

practice within the given date range

Data Source(s) Encounter note

Minimum Data Set Patient ID, Encounter Date



KPI is reported in which reports Clinical Reports-Demo

Comments

KPI Title Charge by Program

KPI Description This graph displays the total amount

charged by the type of program the

charge was associated with during the

fiscal year (July 1 - June 30).

KPI Calculation Sum of all charges attributed to a

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specific program within the given date

range

Data Source(s) Billing

Minimum Data Set Patient ID, Billing Date



KPI is reported in which reports Financial Reports-Demo

Comments

KPI Title Charge by Payor


charged by insurance type the charge

was associated with during the fiscal

year (July 1 - June 30).

KPI Calculation Sum of all charges attributed to a specific

payor within the given date range


Minimum Data Set Patient ID, Billing Date




Comments

KPI Title Number of Visits by Payor

KPI Description This graph displays the total number of

visits based on the payor during the

fiscal year (July 1 - June 30).

KPI Calculation Sum of all visits for patients with a

specific payor within the given date

range


Minimum Data Set Patient ID, Visit Date, Payor



KPI is reported in which reports Financial Reports

Comments

KPI Title Monthly Charges


charged for each month during the fiscal

10

year (July 1 - June 30).

KPI Calculation Sum of all charges for a specific month



Minimum Data Set Patient ID, Visit Date




Comments

KPI Title Quarterly Charge by Payor


charged for each quarter during the fiscal

year (July 1 - June 30). This amount is

then divided into slices, reflecting the total

amount during a specific quarter charged

to each payor.

KPI Calculation Sum of all charges attributed to a specific

payor for a specific quarter within the

given date range






Comments

KPI Title Average Charge per Visit by

Payor

KPI Description This graph displays the average charge

per visit for each payor during the fiscal

year (July 1 - June 30), determined by

dividing the total charge during that period

for each payor by the total number of

visits for each payor.



Numerator: Sum of all charges attributed

to a specific payor within the given date

range

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Denominator: Sum of all visits for

patients with a specific payor within the

given date range (where a charge was

attributed to that visit)






Comments

http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-

quality-measures

http://www.athenahealth.com/_doc/pdf/whitepapers/Paid-MU.pdf

KPI Title Meaningful Use Performance

KPI Description This graph displays the names of each

physician as well as spark bars displaying

how well each physician is meeting their

meeting their meaningful use goals, as

well as a link to jump to a page with more

detailed information. Physician names

have either green, orange or red circles

next to their names, indicating they have

either met all of their meaningful use goals

(green), failed to meet one to seven of

their goals (orange), or failed to meet eight

or more of their goals (red).

KPI Rationale From cdc.gov: the 5 purposes of

meaningful use are:

1. Improving quality, safety, efficiency,

and reducing health disparities

2. Engage patients and families in their

health

3. Improve care coordination

4. Improve population and public health

5. Ensure adequate privacy and security

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protection for personal health

information

http://www.cdc.gov/ehrmeaningfuluse/intro

duction.html

KPI Calculation Meaningful Use measures are calculated

from a variety of sources, including

encounter notes, history, diagnoses,

medication and allergies.

These measures follow the ONC specified

calculations to match the required

thresholds

Data Source(s) Encounter note, medications, history,

assessment, procedure, allergy

Minimum Data Set Meaningful Use Performance Data



KPI is reported in which reports Meaningful Use-Demo

Comments Meaningful Use Measures provides a

concise summary of provider completed

operations compared with threshold

requirements laid out by ONC.

For Stage 1 (2011 edition), following

measures are listed:

KPI Title Program Enrollment by Age

Range

KPI Description

KPI Calculation Sum of all unduplicated patients who

visited the practice for a specific

program within a specific age range






KPI is reported in which reports Program Breakdown-Demo

Comments

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KPI Title Percent with Action Plan

KPI Description Relative frequency of asthma patients

have specified an action plan on their

medical chart



Numerator: number of asthma patients

with an action plan specified on their

medical chart

Denominator: total number of patients

with asthma

Data Source(s) Medicaid Manual Chart Abstraction

Minimum Data Set N/A

Dashboard Update Frequency N/A


KPI is reported in which reports NOT REPORTED ON DASHBOARD

Comments Action plan is a checkbox or some other

code in the system to indicate action

plan is setup

Probably not useful for dashboard

KPI Title Percent of Asthma Patients with

Beta Agonist Overuse

KPI Description Relative frequency of beta agonist

overuse in asthma patients



Numerator: Total number of asthma

patients with 4 or more prescription fill

dates in any 90-day window

Denominator: Total number of asthma

patients having a prescription for a beta

agonist

Data Source(s) Medicaid Paid Claims





Comments

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KPI Title Asthma ED Visits

KPI Description Frequency of emergency department

visits for patients with asthma in specified

time period (1000 asthma member-

months)



Numerator: # of emergency department

visits for asthma patients

Denominator: 1000 asthma member

months






Comments This is important, but may not be able to

track this. EHR does not have ED visit

information

KPI Title Asthma inpatient visits

KPI Description Hospital admissions with asthma as

primary diagnosis per 1000 asthma

member-months



Numerator: Hospital admissions with

asthma as primary diagnosis

Denominator: 1000 asthma member-

months






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Comments This is important, but may not be able to

track this. EHR does not have ED visit

informatio

KPI Title Percent of asthma patients with

symptom assessment or

continued care visit

KPI Description Continued care visit with assessment of

asthma symptoms. Symptom assessment

determined from review of progress notes

or completed patient questionnaires.

Continued care visit defined as one with a

listed diagnosis of asthma.



Numerator: Number of asthma patients

with symptom assessment or continued

care visit


patients






Comments put this in the report, not dashboard

KPI Title Percent with assessment of

environmental triggers

KPI Description Environmental trigger assessment may

include documentation of tobacco use or

exposure. Documentation was collected

from review of progress notes, action

plans and patient questionnaires.



Numerator: Percent of asthma patients

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with records indicating an environmental

trigger


patients






Comments Report. Not dashboard

KPI Title Breast cancer screening-rate for

women ages 50-69

KPI Description Rate of breast cancer screening for

women between 50-69 within the past two

years



Numerator: Number of women with one

or more mammograms over prior two

years

Denominator: Number of women (ages

52-69) at end of measurement period


Minimum Data Set PatientID, Date of Birth, Encounter Date,

ICD-9 Code



KPI is reported in which reports Clinical Reports

Comments Must be CA enrolled 11+ months during

the measurement year and the year prior

to measurement year. Women with

bilateral mastectomy are excluded.

KPI Title Cervical cancer screening - rate

for women ages 21-64

KPI Description Rate that women between 21-64 received

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screening for cervical cancer in the last 3

years



Numerator: Number of women ages with

one or more pap smears over prior 3

years

Denominator: Number of women ages

24-64 at end of measurement period



ICD-9 Code




Comments Women with prior hysterectomy are

excluded.

KPI Title Colorectal screening- rate for

ages 50-75

KPI Description How often were women ages 50-75

receiving colorectal screening procedures



Numerator: Number of patients with

either: FOBT within 1 year OR flex sig

within 5 years OR colonoscopy within 10

years

Denominator: Number of patients (ages

51-75) at the end of the measurement

period



ICD-9 Code




Comments Patients with diagnosis of colon cancer

are excluded

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KPI Title Percent with Ischemic Vascular

Disease (IVD) using Aspirin

KPI Description Among patients with IVD, what percent of

them use aspirin



Numerator: number of patients with

Ischemic Vascular Disease using Aspirin

Denominator: total number of patients

with IVD






Comments Aspirin use addressed, based on:

● Aspirin or other antiplatelet

therapy on med list or flowsheet

● Contraindication or allergy noted

● Documented discussion of

risks/benefits

KPI Title Percent with Blood Pressure less

than 140/90

KPI Description Based on most recent blood pressure

measurement (BP) documented in charts

among patients ages 18-85.



Numerator: Number of patients with BP <

140/90 based on most recent BP in chart

Denominator: Total number of patients in

population





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Comments

KPI Title Percent with IVD or Diabetes

Mellitus (DM) with LDL < 100

KPI Description An LDL measurement of less than 100

among qualifying patients (All IVD/CVD,

DM patients ages 18-75).



Numerator: Number of patients with LDL

< 100mg/dl

Denominator: Total number of patients in

population






Comments

KPI Title Percent with Ischemic Vascular

Disease (IVD) and lipid testing

KPI Description Lipid Panel or LDL within the past year

among qualifying patients (All IVD/CVD,

DM patients ages 18-75).



Numerator: Number of patients with lipid

panel or LDL within past year

Denominator: Total number of patients

screened






Comments Among all ischemic vascular

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disease/cardiovascular disease

(IVD/CVD) and Diabetes Mellitus (DM)

patients

KPI Title Percent with smoking status

documented or advice given

KPI Description Documentation that patient is non-smoker

OR documentation of cessation advice or

treatment within past year among

qualifying patients




documentation that he/she is a non-

smoker or documentation of cessation

advice/treatment within past year


screened






Comments Among all patients with diabetes (ages

10-75) and all patients with IVD, CVD,

hypertension or heart failure (ages 18-75)

KPI Title Percent with annual visit age 2-3

met

KPI Description The percentage of patients with at least

one dental visit with a dental practitioner




Numerator:

Number of patients ages 2-3 with at least



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Comments

KPI Title Percent with annual visit age 4-6

met






Numerator: Number of patients ages 4-6

with at least one dental visit with a dental

practitioner







Comments

KPI Title Percent with annual visit age 7-

10 met

KPI Description The percentage patients with at least one

dental visit with a dental practitioner




Numerator: Number of patients with at

least one dental visit with a dental

practitioner





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Comments


14 met






Numerator: Number of patients ages 11-

14 with at least one dental visit with a

dental practitioner







Comments


18 met








dental practitioner

Denominator: Total Number of Patients






Comments

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21








dental practitioner







Comments


21 met








dental practitioner







Comments

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KPI Title Percent with 3 or more

varnishing by 3.5

KPI Description Percent of patients with at least 3 dental

fluoride varnishing claims during first 42

months of life



Numerator: Number of patients in their

first 42 months of life with at least 3 dental

fluoride varnishing claims







Comments Among patients who turned 3.5 years old

during the measurement year and were

enrolled 36+ months since birth

KPI Title Percent with 4 or more

varnishing by 3.5

KPI Description Percent of patients with at least 4 dental

fluoride varnishing claims during first 42

months of life



Numerator: Number of patients in first 42

months of life with at least 4 dental

varnishing claims







Comments Among patients who turned 3.5 years old

during the measurement year and were

enrolled 36+ months since birth

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KPI Title Percent with A1C result < 8.0

KPI Description Percent of patients with most recent

HbA1c < 8.0% (good control)



Numerator: Number of patients with last

A1C result < 8.0%


with A1C screening






Comments

KPI Title Percent with A1C result > 9.0

KPI Description Percent of patients with most recent

HbA1c > 9.0% (poor control)



Numerator: Number of patients with last

A1C result > 9.0%


screened for A1C






Comments Patients with no test are counted as “poor

control”

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KPI Title Percent with A1C testing in past

year

KPI Description Percent of patients with claim for A1c test

during the past 12 months



Numerator: Number of patients with a

claim for an A1C testing in last 12 months


with claims for an A1C test






Comments

KPI Title Percent with BP < 130/80

KPI Description Percent of patients with most recent BP <

130 systolic and < 80 diastolic (good

control)



Numerator: Number of patients with most

recent systolic < 130 and diastolic < 80


with BP screening






Comments

KPI Title Percent with BP > 140/90

KPI Description Percent of patients with most recent BP >

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140 systolic or < 90 diastolic (poor

control)




recent BP > 140 or < 90 diastolic


with BP screening







control”

KPI Title Percent with cholesterol screen

in past year

KPI Description Percent of patients with claim for LDL or

lipid panel test during past 12 months




claim for LDL or lipid panel test in last

twelve months


with claim for LDL or lipid panel test






Comments

KPI Title Percent of Diabetes Mellitus (DM)

and Hypertension (HTN) on

ACE/ARB therapy

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KPI Description Percent of patients who are receiving

ACE inhibitor or ARB therapy



Numerator: Number of DM and HTN

patients on ACE inhibitor or ARB therapy

Denominator: Total number of DM and

HTN patients

Data Source(s)

Minimum Data Set Medicaid Paid Claims




Comments Among patients diagnosed with HTN and

DM

KPI Title Percent with foot exam in

previous year

KPI Description Patients with any foot exam



Numerator: Number of patients with foot

exam

Denominator:






Comments

KPI Title Percent with LDL < 100

KPI Description Percent of patients with most recent LDL-

C <100 mg/dl. (Good Control)




recent LDL C < 100 mg/dl


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with LDL C screening in past year






Comments

KPI Title Percent with LDL > 130

KPI Description Percent of patients with most recent LDL-

C > 130 mg/dl. (Poor Control)




recent LDL-C > 130 mg/dl.


with recent LDL C screening







control”

KPI Title Percent with neuropathy

screening/treatment in past year

KPI Description Percent of patients screened for or

evidence of nephropathy, based on one of

the following:

● Diagnosis or treatment for

nephropathy using specific CPT

codes and ICD-9 codes

● Urine microalbumin test during

year

● ACE inhibitor/ARB therapy during

year


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evidence of nephropathy within past year







Comments

KPI Title Percent with retinal eye exam in

past 15 months

KPI Description Percent of patients with claim for eye

exam during the past 15 months




retinal eye exam in past 15 months


measured


Minimum Data Set Clinical Reports




Comments

KPI Title Inpatient (IP) visit rate per 1,000

heart failure member-months

KPI Description Hospital admissions with CHF primary or

secondary diagnosis per 1000 asthma

member-months



Numerator: Number of hospital

admissions with CHF as primary or

secondary diagnosis

Denominator: 1000 member months

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Data Source(s)





Comments

KPI Title Percent with adolescent well

child visit in previous year met

KPI Description Percent of patients who had at least one

well-care visit with a PCP or OB/GYN

practitioner in the last year




least one well-care visit in last year


measured


Minimum Data Set Patient ID, Encounter Date, CPT Code,

Date of Birth



KPI is reported in which reports Appointments

Comments

KPI Title Percent with adolescent well

child in prior 3 years met

KPI Description Number of patients who had at least one

well-care visit with a PCP or OB/GYN

practitioner in the last 3 years




least one well-care visit with a PCP or

OB/GYN in last 3 years



Minimum Data Set Patient ID, Encounter Date, CPT Code,

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Date of Birth



KPI is reported in which reports Appointments

Comments

KPI Title Percent well child visits- 6 in first

15 months met

KPI Description Number of patients who had 6 or more

well-child visits during the first 15 months

of life



Numerator:

Denominator:

Data Source(s)





Comments

KPI Title Percent well child visits-

between ages 3-6 met

KPI Description Number of patients who received one or

more well-child visits with a PCP

practitioner



Numerator:

Denominator:

Data Source(s)



KPI Reporting Aggregation


Comments

33

KPI Title Percent well child visits-

between ages 7-11 met

KPI Description



Numerator:

Denominator:

Data Source(s)





Comments

KPI Title Controlling High Blood Pressure

KPI Description Percentage of patients 18-85 years of

age who had a diagnosis of

hypertension and whose blood pressure

was adequately controlled

(<140/90mmHg) during the

measurement period.

KPI Rationale This measure assesses the percentage

of patients demonstrating adequate

control of systolic and diastolic blood

pressure levels. Over 50 million

Americans warrant treatment for high

blood pressure, according to the

NHANES survey (JNC 7 2003).

Financially, hypertension and

associated disorders and heath

complications, such as coronary heart

disease and congestive heart failure,

cost the U.S. economy more than $100

billion each year. The United States

Preventive Services Task Force

(USPSTF) recommends that clinicians

screen adults 18 and older for high

blood pressure (2007). This guideline is

further endorsed by research studies

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and clinical trials that have

demonstrated decline in costly health

outcomes as a direct result of improved

blood pressure control. This measure is

important in efforts to promote blood

pressure control and improve quality of

life.



Numerator:

Denominator:

Data Source(s)





Comments

KPI Title Use of High-Risk Medications In

the Elderly

KPI Description Percentage of patients 66 years of age

and older who were ordered high-risk

medications. Two rates are reported.

● Percentage of patients who were

ordered at least one high-risk

medication.

● Percentage of patients who were

ordered at least two different

high-risk medications.

KPI Rationale Certain medications are associated with

increased risk of harms from drug side-

effects and drug toxicity and pose a

concern for patient safety. There is

clinical consensus that these drugs

pose increased risks in the elderly.

Studies link prescription drug use by the

elderly with adverse drug events that

contribute to hospitalization, increased

length of hospital stay, increased

duration of illness, nursing home

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placement and falls and fractures that

are further associated with physical,

functional and social decline in the

elderly.



Numerator:

Denominator:

Data Source(s)





Comments

Rationale from qualityforum.org

KPI Title Preventive Care and Screening:

Tobacco Use: Screening and

Cessation Intervention

KPI Description Percentage of patients aged 18 years

and older who were screened for

tobacco use one or more times within 24

months AND who received cessation

counseling intervention if identified as a

tobacco user.

KPI Rationale There is good evidence that tobacco

screening and brief cessation

intervention (including counseling and

pharmacotherapy) in the primary care

setting is successful in helping tobacco

users quit. Tobacco users who are able

to stop smoking lower their risk for heart

disease, lung disease and stroke.



Numerator:

Denominator:

Data Source(s)





36

Comments

https://www.auanet.org/common/pdf/practices-resources/quality/pqrs-

toolkit/2013TobaccoUse.pdf

KPI Title Use of Imaging Studies For Low

Back Pain

KPI Description Percentage of patients 18-50 years of

age with a diagnosis of low back pain

who did not have an imaging study (plain

X-ray, MRI, CT scan) within 28 days of

the diagnosis.

KPI Rationale This measure assesses the percentage of

patients in a specific age demographic

who did not receive an imaging study

(i.e., x-ray, MRI, CT scan) in the 28 days

following a new episode of low back pain.

Low back pain is the second most

frequently listed reason for physician

office visits. It is a common cause of lost

productivity and absenteeism from work

in the United States. The general

consensus from literature reviews

indicates that nearly half of American

adults will experience low back pain in a

year, and about two-thirds will suffer from

it in their lifetime. Low back pain is

particularly prevalent among men and

women between 30 and 50 years of age,

and most likely results from aging and an

inactive lifestyle. Low back pain has a

significant financial impact, costing an

average of $8,000 per claim (Atlas, Devo

2001). This measure facilitates efforts

toward improved musculoskeletal

condition and individual quality of life.



Numerator:

Denominator:

Data Source(s)


37




Comments

KPI Title Payor Mix by Program

KPI Description



Numerator: Charges assigned to a

specific Payor within each Program

Denominator: Total Charges within each

Program


Minimum Data Set Insurance Type, Encounter Date, Units,

Charges, Program




Comments

Asthma-

● Percent with action plan

● % with beta agonist overuse

● Emergency Department (ED) visits per asthma member-months

● Inpatient (IP) visits per 1,000 asthma member-months

● % with Symptom assessment/continuous care visit

● % with assessment of triggers

Cancer Screening

● Cervical cancer screening rate for females ages 21-64

● Colorectal screening rate for ages 50-75

Cardiovascular

● % with Ischemic Vascular Disease (IVD) taking Aspirin

● % with Blood Pressure (BP) < 140/90

● % Ischemic Vascular Disease (IVD) or Diabetes mellitus (DM) with LDL < 100

● % with Ischemic Vascular Disease (IVD) and lipid testing

● % with smoking status documented or advice given

Dental Care

● % with annual visit age 2-3 met

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● % with annual visit 11-14 met


● % with annual visit 19-21 net


● % with 3 or more varnishing by 3.5

● % with 4 or more varnishing by 3.5

Diabetes

● % with A1C result < 8.0

● % with A1C result > 9.0

● % with A1C testing in past year

● % Blood Pressure (BP) < 130/80

● % Blood Pressure (BP) > 140/90

● % with cholesterol screen in past year

● % of Diabetes mellitus (DM) and Hypertension (HTN) on ACE/ARB therapy

● % with foot exam in previous year

● % with LDL < 100

● % with LDL > 130

● % with neuropathy screening/treatment in past year

● % with retinal eye exam in past 15 months

Heart Failure

● Inpatient (IP) Visit rate per 1,000 heart failure member-months

Pediatric

● % with adolescent well child visit in previous year met

● % with adolescent well child visit in prior 3 years met

● % with well child visits – 6 in first 15 months met

● % with well child visits – between ages 3-6 met

● % with well child visits – between ages 7-11 met

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http://www.cms.gov/Regulations-and-

Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_AdultRecommend_Core

SetTable.pdf

Documents

North Carolina Local Public Health · health (panel) management, health directors and clinical managers need access to trends and analytics across their clinical programs and some