2012 HEDIS^® measures

Human Papillomavirus (HPV) for Female Adolescents

Series begins on or after the 9th birthday and must be completed by the 13th birthday

Three doses of HPV vaccine on or between the 9th and 13th birthday

Medication Management
for People with Asthma

Ages 5-64

Age stratifications

5-11 years
12-18 years
19-50 years
51-64 years
Total rate

Exclusions:

Emphysema, COPD, cystic fibrosis, acute respiratory failure or no dispensed medications

The percentage of members 5-64 years of age during the measurement year who were identified as having persistent asthma and were dispensed appropriate medications that they remained on during the treatment period.  Two rates are reported:

• The percentage of members who remained on an asthma controller medication for at least 50% of their treatment period
• The percentage of members who remained on an asthma controller medication for at least 75% of their treatment period

Weight assessment and counseling for nutrition and physical activity for children and adolescents.

Patients 3 - 17 who had evidence of body mass index (BMI) percentile including height and weight, counseling for nutrition and counseling for physical activity documented during an outpatient visit either by a claim or as a medical record entry during the measurement year.

Well-child exams

Ages 0-15 months

6 well-care visits (at least 2 weeks apart) with a PCP. Must show evidence of all of the following:

• Health and development history (physical and mental)
• Physical exam
• Health education/anticipatory guidance

Well-child exams

Ages 3-6 years

Annual well-care visit with a PCP each year. Must show evidence of all of the following:

• Health and development history (physical and mental)
• Physical exam
• Health education/anticipatory guidance

Well-child exams

Ages 12-21 years

Annual well-care visit with a PCP or OB/GYN. Must show evidence of all of the following:

• Health and development history (physical and mental)
• Physical exam
• Health education/anticipatory guidance

Childhood immunization

Series must be completed by the 2nd birthday

• 4 DTaP/DT (none prior to 42 days of age)
• 3 IPV (none prior to 42 days of age)
• 1 MMR
• 3 HIB (none prior to 42 days of age)
• 3 hepatitis B
• 2 hepatitis A
• 1 VZV, or documented chicken pox disease (or positive serology) occurring prior to 2nd birthday
• 4 pneumococcal conjugate (none prior to 42 days of age
• 2-3 rotavirus (none prior to 42 days of age)
• 2 influenza

Immunizations for Adolescents

• 1 meningococcal vaccine on or between the member’s 11th or 13th birthday
• 1 Tdap or 1 Td on or between the member’s 10th or 13th birthday

Exclusions: contraindication to either vaccine

Lead screening in children (Medicaid only)

Children aged 2

Children who received at least one capillary or venous lead screening test on or before their second birthday.

Treatment of children with upper respiratory infections

Ages 3 months-
18 years

Children 3 months to 18 years who were given a diagnosis of upper respiratory infection (URI) and were NOT dispensed an antibiotic prescription within 3 days of the URI diagnosis.

Exclusions:

• Encounters with > 1 diagnosis
• Children with a history of antibiotic Rx within 30 days of encounter

Appropriate testing of children with pharyngitis

Ages 2-18 years

Children who had an outpatient visit or ED encounter with only a diagnosis of pharyngitis who were dispensed an antibiotic and also received a Group A streptococcus test 3 days before or 3 days after the prescription.

Exclusions:

• Encounters with > 1 diagnosis
• Children with a history of antibiotic Rx within 30 days of encounter

Follow-up care for children prescribed ADHD medication

Ages 6-12 years

Children who received an initial prescription for ADHD medication and:

• Received at least one follow-up visit with a prescriber within 30 days of initiation of medication
• Remained on the medication for at least 210 days and who, in addition to the visit in the initiation phase, had at least two more follow-up visits between four weeks and 9 months

Chlamydia screening

Age 16-24 and sexually active

Women identified as presumed sexually active by pharmacy Rx data, or claims data indicating potential sexual activity

• Screening test for chlamydia yearly

Exclusions:

• Women who had a pregnancy test followed within 7 days by either a prescription for Accutane (isotretinoin) or an X-ray.

Cervical cancer screening

Age 21-64

PAP test within the measurement year or prior 2 years.

Exclusions:

• Women who have had a complete hysterectomy with no residual cervix.

Breast cancer screening

Age 40-69

*****

Mammogram in the measurement year or one year prior.

Exclusions:

• Women who have had bilateral mastectomy (may occur on the same or separate dates)

Prenatal/
postpartum care

Pregnant women

Prenatal visit within first trimester (or within 42 days of enrollment)

Postpartum visit between 21 and 56 days after delivery

Adults’ Access to Preventive/ambulatory Health Services

Ages 20 and older

*****

Adult BMI assessment

Ages 18-74

*****

Patients 18-74 who had their body mass index (BMI) and weight documented during an outpatient visit either by a claim or as a medical record entry during the measurement year or year prior

Avoidance of antibiotic treatment for adults with acute bronchitis

Ages 18-64

Adults diagnosed with acute bronchitis who did not receive an antibiotic Rx on or within 3 days of diagnosis

Colorectal cancer screening

Ages 50-75

*****

One or more of the following screenings:

• Fecal occult blood test yearly
• Flexible sigmoidoscopy every five years
• Colonoscopy every 10 years

Exclusions:

• Colorectal cancer
• Total colectomy

Annual monitoring for patients on persistent medications

Ages 18 and older

Patients 18 and older on persistent medications (at least 180 days) who received annual monitoring.

Exclusion:

• Anyone with a hospitalization in the measurement year

Plan All-Cause Readmissions

*****

Percentage of acute inpatient stays followed by an acute readmission for any cause within 30 days for 18 years and older

Care for older adults

Age 65 years and older

*****

Adults aged 65 and older who had each of the following during the measurement year:

• Advance care planning
• Medication review
• Functional status assessment
• Pain screening

Glaucoma screening in older adults

Ages 65 and older

*****

Medicare members without a prior diagnosis of glaucoma or glaucoma suspect who received a glaucoma eye exam by an ophthalmologist or optometrist.

Osteoporosis management in women who had a fracture

Age 67 and older

*****

Women who received the following within 6 months of suffering a fracture:

• Bone mineral density (BMD) test
• Prescription for a drug to treat or prevent osteoporosis in six months after the fracture

Exclusions:

• Women who received screening and/or treatment in the year prior to the fracture.
• Fractures of the finger, toe, face and skull are not included in this measure.

Initiation and engagement of alcohol and other drug dependence treatment

Ages 13 and older

Patients diagnosed with alcohol and other drug dependence who:

• initiate treatment within 14 days
• receive two additional AOD services within 30 days of initiation

Use of appropriate medications for people with asthma

Ages 5-56 years

Children and adults identified with asthma who received Rx for long term control of asthma (inhaled corticosteroids, cromolyn sodium, nedocromil, leokotriene modifiers, methylxanthines).

Exclusions:

• Patients with diagnosis of emphysema, COPD, cystic fibrosis, or acute respiratory failure

Note: Long-acting beta-2 agonists do not count by themselves. They are considered add-on therapy.

Presistence of beta-blocker treatment after heart attack

Age 18 and older

Patients who were hospitalized and discharged alive after an acute MI who:

• Received treatment with beta-blockers for six months after discharge

Exclusions:

• Patients identified as having a contraindication to beta-blocker therapy
• Patients with a history of adverse reaction to beta-blocker therapy

Cholesterol management for patients with cardiovascular condition

Ages 18-75

*****

Patients who were discharged alive for any of the following:

• Acute myocardial infarction
• Coronary artery bypass graft
• Percutaneous coronary interventions

Or who had:

• Diagnosis of ischemic vascular disease

Patient should have each of the following during the measurement year:

• LDL-C screening performed
• LDL level < 100

Controlling high blood pressure

Age 18-85

*****

Patients 18-85 with a diagnosis of hypertension whose most recent blood pressure reading was controlled (<140/90).

Exclusions:

• Patients with end stage renal disease (ESRD)
• Pregnant during the measurement year

Use of spirometry testing in the assessment and diagnosis of COPD

Ages 40 and older

Adults with a new (within the measurement year) diagnosis or newly active COPD who received spirometry testing to confirm the diagnosis.

• Spirometry testing must occur 730 days prior to or 180 days after the diagnosing event.

Pharmacotherapy Management of COPD exacerbation

Adults 40 and older

Adults aged 40 or older who had an acute inpatient discharge or an ED encounter with a principal diagnosis of COPD who were dispensed both:

• A systemic corticosteroid within 14 days of discharge
• Bronchodilator within 30 days of discharge

NOTE: the eligible population for this measure is based on the discharges and visits, not the patient. It is possible for the denominator for this measure to include multiple events for the same patient.

Antidepressant medication management

Ages 18 years and older

Adults newly diagnosed with depression and treated with an antidepressant who received the following:

• Effective acute phase: filled sufficient number of Rx to allow for 84 days of continuous therapy.
• Effective continuation phase: filled sufficient number of Rx to allow for 180 days of continuous therapy.

To qualify as a new diagnosis, 2 criteria must be met:

• A 120-day (4 month) negative diagnosis history on or before the start date
• A 90-day (3 month) negative medication history on or before the start date

Comprehensive diabetes care

Age 18-75

*****

Yearly screening of the following:

• HbA1c testing
• HbA1c result > 9.0 = poor control
• HbA1c result < 8.0 = good control
• HbA1c result < 7.0 for selected population
• LDL-C
• LDL-C result < 100
• Retinal eye exam
• Nephropathy screening test or evidence of nephropathy
• Blood pressure collected as 2 measures
  < 140/90
  < 130/80

Follow-up after hospitalization for mental illness

Age 6 and over

Patients discharged from an inpatient mental health admission and receive:

• One follow-up encounter with a mental health provider within 7 days after discharge.
• One follow-up encounter with a mental health provider within 30 days after discharge.

Medical assistance with smoking cessation

Tobacco users age 18 and older

Current smokers who were seen by a practitioner during the measurement year and:

• Received advice to quit
• Cessation medications were recommended and discussed
• Cessation methods were recommended or discussed

Information is received via CAHPS^®** survey methodology.