Quality Improvement (Internal to the specific organization)

To ensure that members who are taking statins to treat hyperlipidemia filled sufficient medication to have at least 80% coverage during the measurement year.

The measure addresses adherence to statins. The measure is reported as the percentage of eligible individuals with diabetes mellitus who had at least two prescriptions for statins and who have a Proportion of Days Covered (PDC) of at least 0.8 during the measurement period (12 consecutive months).

Percentage of patients, age = 18 and < 80 at diagnosis, who have their first diagnosis of cancer (epithelial malignancy) that is lymph node positive and at AJCC stage III, whose primary tumor is of the colon and chemotherapy was recommended or administered within 4 months (120 days) of diagnosis

Percentage of female patients, age = 18 at diagnosis, who have their first diagnosis of cancer (epithelial malignancy), at AJCC T1cN0M0 or stage IB to IIIC, whose primary tumor is of the breast, and is progesterone or estrogen receptor positive with adjuvant hormonal therapy (recommended or administered) within 1 year (365 days) of diagnosis

Median time from admit decision time to time of departure from the emergency department for emergency department patients admitted to inpatient status

The Adolescent Assessment of Preparation for Transition (ADAPT) to Adult-Focused Health Care measures the quality of preparation for transition from pediatric-focused to adult-focused health care as reported in a survey completed by youth ages 16-17 years old with a chronic health condition. The ADAPT survey generates measures for each of the 3 domains: 1) Counseling on Transition Self-Management, 2) Counseling on Prescription Medication, and 3) Transfer Planning.

Documents whether provider has adopted and is using health information technology. To qualify, the provider must have adopted and be using a certified/qualified electronic health record (EHR).

Documents whether provider has adopted a qualified e-Prescribing system and the extent of use in the ambulatory setting.

The percentage of adults 19 years of age and older who are up-to-date on Advisory Committee on Immunization Practice (ACIP) recommended routine vaccines for influenza, tetanus and diphtheria (Td) or tetanus, diphtheria and acellular pertussis (Tdap), zoster and pneumococcal.

Annual risk adjusted inpatient mortality rate for adult patients (aged 18 and over) admitted to acute care hospitals with diagnosis of severe sepsis or septic shock. The measure includes patients in acute care hospital settings over one year timeframe who had, either on admission, or during their hospital stay, a clinical diagnosis of severe sepsis (now referred to as ´sepsis´) or septic shock using criteria described in the International Sepsis Definitions (Sepsis-2)