Proportion of patients with a chronic condition that have a potentially avoidable complication during a calendar year.

Percent of adult population aged 18+ years who were identified as having at least one of the following six chronic conditions: Asthma, Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease (CAD), Heart Failure (HF), Hypertension (HTN), or Diabetes Mellitus (DM), were followed for at least one-year, and had one or more potentially avoidable complications (PACs) during the most recent 12 months. Please reference attached document labeled NQF_Chronic_Care_PACs_01_24_17.xls, in the tabs labeled PACs I-9 & I-10 for a list of code definitions of PACs relevant to each of the above chronic conditions.

We define PACs as one of two types:
(1) Type 1 PACs - PACs related to the index condition: Patients are considered to have a PAC, if they receive services during the episode time window for any of the complications directly related to the chronic condition, such as for acute exacerbation of the index condition, respiratory insufficiency in patients with Asthma or COPD, hypotension or fluid and electrolyte disturbances in patients with CAD, HF or diabetes etc.
(2) Type 2 PACs - PACs related to Patient Safety or broader System Failures: Patients are also considered to have a PAC, if they receive services during the episode time window for any of the complications related to patient safety or health system failures such as for sepsis, infections, phlebitis, deep vein thrombosis, pressure sores etc.

All relevant hospitalizations for patients with chronic conditions are considered potentially avoidable and flagged as PACs. This particularly applies to hospitalizations due to acute exacerbations of the index condition. For example, a hospitalization for diabetic emergency in a diabetic patient, or a hospitalization for acute pulmonary edema in a heart failure patient is considered a PAC.

PACs are counted as a dichotomous (yes/no) outcome. If a patient had one or more PACs, they get counted as a “yes” or a 1. The summary tab in the enclosed workbook labeled NQF_Chronic_Care_PACs_01_24_17.xls gives the overview of the frequency and costs associated with each of these types of PACs for each of the six chronic conditions. Detailed drill-down tabs with graphs are also provided in the same workbook for each of the six chronic conditions to highlight high-frequency PACs. The Decision Tree tabs in the same workbook highlight the flow diagrams for the selection of patients into each chronic condition episode.

The information is based on a two-year claims database from a commercial insurer with 3,258,706 covered lives and $25.9 billion in “allowed amounts” for claims costs. The database is an administrative claims database with medical as well as pharmacy claims.

It is important to note that while the overall frequency of PAC hospitalizations is low (for all chronic care conditions summed together, PAC frequency was 1.6% for all PAC occurrences), they amount to over 52% of the PAC medical costs.