Table 2.
Definitions of Quality of Care Indicators
| Quality Indicator | Numerator (visits by adults with) | Denominator (visits by adults with) | Quality Indicator Source | Strength of Recommendation/Level of Evidence |
|---|---|---|---|---|
| Hypertension | ||||
| Controlled Hypertension |
Systolic BP < 140 and Diastolic BP < 90 or Systolic BP < 130 and Diastolic BP < 80 |
Hypertension (physician-reported or ICD-9 code or receipt of antihypertensive) | JNC 7 [17] (2003) and JNC 8 [18] (2014) | Ea |
| Diabetes | ||||
| Controlled Diabetes |
HbA1c < 7% or HbA1c < 8% |
Diabetes (physician-reported or ICD-9 code or receipt of anti-diabetic agent) | ADA [23] (2012) | Bb |
| ACEi/ARB use | ACEi/ARB listed or dispensed during visit |
1) Diabetes (physician-reported or ICD-9 code or receipt of anti-diabetic agent) and 2) Hypertension (physician-reported or ICD-9 code or receipt of antihypertensive) |
ADA [23] (2012) | Cc |
| Statin use | Statin listed or dispensed during visit |
1) Diabetes (physician-reported or ICD-9 code or receipt of anti-diabetic agent) and 2) Age 40–75 |
ACC/AHA [21] (2013) |
IAd |
| Chronic Kidney Disease | ||||
| Controlled Hypertension |
Systolic BP < 130 and Diastolic BP < 80 or Systolic BP < 140 and Diastolic BP < 90 |
1) CKD (physician-reported or ICD-9 code) and 2) Hypertension (physician-reported or ICD-9 code or receipt of antihypertensive) |
JNC 7 [17] (2003) and ACC/AHA [25] (2017) | Ea |
| Controlled Diabetes |
HbA1c < 7% or HbA1c < 8% |
1) CKD (physician-reported or ICD-9 code) and 2) Diabetes (physician-reported or ICD-9 code or receipt of anti-diabetic agent) |
KDOQI [19] (2012) ADA [23] (2012) |
1Ae |
| ACEi/ARB use | ACEi/ARB listed or dispensed during visit |
1) CKD (physician-reported or ICD-9 code) and 2) Hypertension (physician-reported or ICD-9 code or receipt of antihypertensive) |
KDIGO CKD [20] (2012) |
1Bf, 2Dg |
| Statin use | Statin listed or dispensed during visit |
1) CKD (physician-reported or ICD-9 code) and 2) Age ≥ 50 |
KDIGO Lipid [22] (2013) |
1Ae, 1Bf |
CKD chronic kidney disease, ACEi Angiotensin converting enzyme inhibitor, ARB angiotensin receptor blocker, NSAID nonsteroidal anti-inflammatory drug, HbA1c Hemoglobin A1c, ICD International Classification of Diseases, JNC Joint National Committee, KDOQI Kidney Disease Outcomes Quality Initiative, ADA American Diabetes Association, KDIGO Kidney Disease Improving Global Outcomes
a E - Expert Opinion
b B - Supportive evidence from well-conducted cohort or case-control studies
c C - Supportive evidence from poorly controlled or uncontrolled studies or conflicting evidence with the weight of evidence supporting the recommendation
d IA – Procedure/treatment should be performed/administered, data derived from multiple randomized clinical trials or meta-analyses
e 1A - Level 1 “We recommend,” High quality of evidence
f 1B - Level 1 “We recommend,” Moderate quality of evidence
g 2D - Level 2 “We suggest,” Very low quality of evidence