Claims Data

Percentage of vaginal deliveries (excluding those coded with shoulder dystocia) during which an episiotomy is performed.

This measure assesses the number of patients with confirmed venous thromboembolism (VTE) during hospitalization (not present at admission) who did not receive VTE prophylaxis between hospital admission and the day before the VTE diagnostic testing order date.

Percent of elderly cases with intra-abdominal procedure with an incidental appendectomy.

Inpatients age 6 months and older discharged during October, November, December, January, February or March who are screened for influenza vaccine status and vaccinated prior to discharge if indicated.

Percentage of patients aged 18 years and older with a diagnosis of ESRD and receiving dialysis who received the influenza immunization during the flu season (September through February)

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 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.