No risk adjustment or risk stratification

Percentage of healthcare personnel (HCP) who receive the influenza vaccination.

Percent of nursing home/ skilled nursing facility residents given the influenza vaccination during the flu season.

Improved measurement of the continuity of insurance coverage in the Medicaid and CHIP population is needed to help maximize insurance continuity and coverage for vulnerable children. To further this goal, the AHRQ-CMS CHIPRA PQMP Center of Excellence at the Children’s Hospital of Philadelphia developed the metric Informed Coverage.

The measure is derived from patient responses to the Hip or Knee Decision Quality Instruments. Participants who have a passing knowledge score (60% or higher) and a clear preference for surgery are considered to have met the criteria for an informed, patient-centered decision.
The target population is adult patients who had a primary hip or knee replacement surgery for treatment of hip or knee osteoarthritis.

Percentage of pneumonia patients 18 years of age and older who receive their first dose of antibiotics within 6 hours after arrival at the hospital

Percentage of Immunocompetent patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines

The percentage of individuals 18 years of age and older with one or more initial opioid prescriptions for >7 cumulative days’ supply.

This measure assesses the degree to which the organization initiates and engages members identified with a need for alcohol and other drug (AOD) abuse and dependence services and the degree to which members initiate and continue treatment once the need has been identified. Two rates are reported:

Percentage of episodes with an International Normalized Ratio (INR) test performed three to seven days after a newly started interacting anti-infective medication for individuals receiving warfarin

Percentage of individuals at least 18 years of age as of the end of the measurement period with at least 56 days of warfarin therapy who receive at least one International Normalized Ratio (INR) test during each 56-day interval with active warfarin therapy.