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Physician Feedback/Quality and Resource Use Reports (QRUR)

Adherence to Antipsychotic Medications for Individuals with Schizophrenia

  • Percentage of individuals at least 18 years of age as of the beginning of the measurement period with schizophrenia or schizoaffective disorder who had at least two prescription drug claims for antipsychotic medications and had a Proportion of Days Covered (PDC) of at least 0.8 for antipsychotic medications during the measurement period (12 consecutive months).

    CBE ID

Advance Care Plan

  • Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.

    CBE ID

Age-Related Macular Degeneration: Dilated Macular Examination

  • Type of Score: Proportion

    Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage AND the level of macular degeneration severity during one or more office visits within 12 months

    CBE ID

Antidepressant Medication Management (AMM)

  • The percentage of members 18 years of age and older who were treated antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported.

    a) Effective Acute Phase Treatment. The percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks).
    b) Effective Continuation Phase Treatment. The percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

    CBE ID

Appropriate Treatment for Children With Upper Respiratory Infection (URI)

  • The Appropriate Treatment for Upper Respiratory Infection (URI) measure assesses whether members 3 months of age and older with a diagnosis of upper respiratory infection were not dispensed an antibiotic prescription. The measure includes patients enrolled in commercial, Medicaid, and Medicare health plans.

    CBE ID