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Highest Opportunity for Improvement

Diagnostic Imaging: Stenosis Measurement in Carotid Imaging Reports

  • Percentage of final reports for carotid imaging studies (neck magnetic resonance angiography (MRA), neck computerized tomographic angiography (CTA), neck duplex ultrasound, carotid angiogram) performed that include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement

    CBE ID
    0507

Excess days in acute care (EDAC) after hospitalization for acute myocardial infarction (AMI)

  • This measure assesses days spent in acute care within 30 days of discharge from an inpatient hospitalization for acute myocardial infarction (AMI) to provide a patient-centered assessment of the post-discharge period. This measure is intended to capture the quality of care transitions provided to discharged patients hospitalized with AMI by collectively measuring a set of adverse acute care outcomes that can occur post-discharge: emergency department (ED) visits, observation stays, and unplanned readmissions at any time during the 30 days post-discharge.

    CBE ID
    2881

Excess days in acute care (EDAC) after hospitalization for pneumonia

  • This measure assesses days spent in acute care within 30 days of discharge from an inpatient hospitalization for pneumonia, including aspiration pneumonia or for sepsis (not severe sepsis) with a secondary discharge diagnosis of pneumonia coded in the claim as present on admission (POA) and no secondary diagnosis of severe sepsis coded as POA.

    CBE ID
    2882

Falls: Screening, Risk-Assessment, and Plan of Care to Prevent Future Falls

  • This is a clinical process measure that assesses falls prevention in older adults. The measure has three rates:

    A) Screening for Future Fall Risk:
    Percentage of patients aged 65 years and older who were screened for future fall risk at least once within 12 months



    B) Falls Risk Assessment: 
    Percentage of patients aged 65 years and older with a history of falls who had a risk assessment for falls completed within 12 months

    C) Plan of Care for Falls: 

    CBE ID
    0101

Flu Vaccinations for Adults Ages 18 and Older

  • The percentage of adults 18 years of age and older who self-report receiving an influenza vaccine within the measurement period. This measure is collected via the CAHPS 5.0H adults survey for Medicare, Medicaid, and commercial populations. It is reported as two separate rates stratified by age: 18-64 and 65 years of age and older.

    CBE ID
    0039

Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence

  • The percentage of emergency department (ED) visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence, who had a follow up visit for AOD. Two rates are reported:
    - The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
    - The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).

    CBE ID
    3488

Follow-Up After Emergency Department Visit for Mental Illness

  • The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness or intentional self-harm, who had a follow-up visit for mental illness. Two rates are reported:
    - The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
    - The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).

    CBE ID
    3489

Follow-Up After Emergency Department Visit for Mental Illness or Alcohol and Other Drug Abuse or Dependence

  • The percentage of discharges for patients 18 years of age and older who had a visit to the emergency department with a primary diagnosis of mental health or alcohol or other drug dependence during the measurement year AND who had a follow-up visit with any provider with a corresponding primary diagnosis of mental health or alcohol or other drug dependence within 7- and 30-days of discharge.

    Four rates are reported:
    - The percentage of emergency department visits for mental health for which the patient received follow-up within 7 days of discharge.

    CBE ID
    2605

Gastroenteritis Admission Rate (PDI 16)

  • Admissions for a principal diagnosis of gastroenteritis, or for a principal diagnosis of dehydration with a secondary diagnosis of gastroenteritis per 100,000 population, ages 3 months to 17 years. Excludes cases transferred from another facility, cases with gastrointestinal abnormalities or bacterial gastroenteritis, and obstetric admissions.

    CBE ID
    0727