Table 1.
Definitions of Clinical Performance Measures
| Measure | Denominator | Numerator |
|---|---|---|
| Breast cancer screening | • Females 52–64 years old | • Receipt of mammogram within the prior 2 years |
| • ≥2 outpatient visits within the past 3 years | • Refusal of exam within the prior 12 months | |
| • No history of bilateral mastectomy or two separate unilateral mastectomies. | ||
| Influenza vaccination | • ≥65 years old | • Receipt of vaccine within the prior 12 months |
| • ≥2 outpatient visits within the past 3 years | • Refusal of vaccination within the prior 12 months | |
| Pneumococcal vaccination | • ≥65 years old | • Receipt of vaccine at any time prior to current reporting year |
| • ≥2 outpatient visits within the past 3 years | • Refusal of vaccination within the prior 12 months | |
| Cholesterol screening | • 35–75 years old | • Receipt of total cholesterol exam within the prior 5 years |
| • ≥2 outpatient visits within the past 3 years | ||
| Diabetes | • 18–75 years old | • Receipt of retinal exam within the prior 12 months (including office visits in ophthalmology, optometry or tele-ophthalmology retinal evaluation clinics) |
| • ≥2 outpatient visits within the past year | • Receipt of LDL cholesterol exam within the prior 12 months | |
| • ≥2 outpatient diagnoses of diabetes ever, with the first diagnosis occurring at least 12 months prior | • Receipt of HbA1c exam within the prior 12 months | |
| • LDL < 100 mg/dL based on most recent value (missing values for current reporting year considered ≥100 mg/dL) | ||
| • HbA1c < 7% based on most recent value (missing values for current reporting year considered >7%) | ||
| • Blood pressure < 130/80 mmHg based on average of three (or two) most recent non-emergency room blood pressures during the reporting period (if zero or one blood pressures available, blood pressure assumed to be ≥130/80 mmHg) | ||
| • Receipt of LDL cholesterol exam within the prior 12 months | ||
| Cardiovascular disease | • 18–75 years old | • LDL < 100 mg/dL (missing values for current reporting year considered >100 mg/dL) |
| • ≥2 outpatient visits within the past 3 years | ||
| • Diagnosis of acute myocardial infarction, coronary angioplasty, coronary artery bypass graft, coronary artery disease, stable angina, peripheral arterial disease, stroke, abdominal aortic aneurysm at least 12 months prior |