VSAC and Quality Measures

Learning Objectives At the conclusion of this program, attendees will be able to: Describe how the Quality Data Model (QDM) is related to Value Sets. Explain how the Value Set Authority Center(VSAC) value sets can be used to help with quality measure reporting. Identify where to find eMeasure source documentation for various DSRIP measures.

Acronyms QDM – Quality Data Model VSAC – Value Set Authority Center eCQI – Electronic Clinical Quality Improvement eCQM – Electronic Clinical Quality Measure EC - Eligible Clinicians EP - Eligible Professional OID – Object Identifier

Definitions - General Quality Data Model(QDM): Information model that defines relationships between patients and clinical concepts in a standardized format Value Set Authority Center(VSAC): Central repository for the official versions of value sets that support the electronic Clinical Quality Measures Value Sets: Subset of specific values (terms and their codes) used to describe clinical and administrative concepts in quality measures. The subsets share a common scope of use, e.g., Anticoagulant Therapy

Definitions – Population Criteria Initial Population (IP): The set of patients or episodes of care to be evaluated by the measure. For purposes of the DSRIP program this would be your DSRIP attributed population Denominator (DENOM): A subset of the IP. This can be the same as the IP. Denominator Exclusions (DENEX): A subset of the Denominator that should not be considered for inclusion in the Numerator. Denominator Exceptions (DEXCEP): A subset of the Denominator. Only those members of the Denominator that are considered for Numerator membership and do not meet Numerator criteria are considered for membership in the Denominator Exceptions. Numerator (NUMER): A subset of the Denominator. The Numerator criteria are the processes or outcomes expected for each patient, procedure, or other unit of measurement defined in the Denominator. Numerator Exclusions (NUMEX): A subset of the Numerator that should not be considered for calculation.

Initial Population – DSRIP Attributed Population (A-M)/Bundle Target Population Denominator Numerator

Denominator without Exclusions Initial Population – DSRIP Attributed Population (A-M)/Bundle Target Population Denominator Denominator without Exclusions Denominator without Exceptions Numerator Numerator without Exclusions

DSRIP Final Measure Specifications (Appendix A)

Search for Measure Specifications

Select .html Specifications

Example of Measure Specifications

Example Measure Specification

Quality Data Model (QDM) Category - A single clinical concept that is the highest level of definition for a QDM element e.g., Medication, Procedure, Condition / Diagnosis / Problem, Communication, Encounter. Data Type - Provides context within a category e.g., in a ‘Medication’ category, ‘Medication, Active” and ‘Medication, Administered’ are particular data types. Attribute - Provides specific detail within a data type. There are two types of attributes, data type specific attributes and data flow attributes.

Example Data Criteria (QDM Data Elements) "Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit Grouping Value Set (2.16.840.1.113883.3.526.3.1240)" "Encounter, Performed: Office Visit" using "Office Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1001)“ "Diagnosis: Diabetes" using "Diabetes Grouping Value Set (2.16.840.1.113883.3.464.1003.103.12.1001)" "Laboratory Test, Performed: HbA1c Laboratory Test" using "HbA1c Laboratory Test Grouping Value Set (2.16.840.1.113883.3.464.1003.198.12.1013)"

Example Population Criteria Initial Population (DSRIP Attributed Population/Bundle Target Population)= AND: "Diagnosis: Diabetes" overlaps "Measurement Period" AND: Age>= 18 year(s) at: "Measurement Period" AND: Age< 75 year(s) at: "Measurement Period" AND: Union of: "Encounter, Performed: Office Visit" "Encounter, Performed: Face-to-Face Interaction" "Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up" "Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up" "Encounter, Performed: Home Healthcare Services" "Encounter, Performed: Annual Wellness Visit" during "Measurement Period"

Example Population Criteria Denominator = AND: Initial Population Denominator Exclusions = OR: "Encounter, Performed: Encounter Inpatient (discharge status: Discharged to Home for Hospice Care)" ends during "Measurement Period" OR: "Encounter, Performed: Encounter Inpatient (discharge status: Discharged to Health Care Facility for Hospice Care)" ends during "Measurement Period" OR: Union of: "Intervention, Order: Hospice care ambulatory" "Intervention, Performed: Hospice care ambulatory" overlaps "Measurement Period"

Example Population Criteria Numerator = AND: OR: "Laboratory Test, Performed: HbA1c Laboratory Test" satisfies all: Most Recent: (result) during "Measurement Period" (result > 9 %) OR: AND: Most Recent: "Occurrence A of Laboratory Test, Performed: HbA1c Laboratory Test" during "Measurement Period" AND NOT: "Occurrence A of Laboratory Test, Performed: HbA1c Laboratory Test (result)" OR NOT: "Laboratory Test, Performed: HbA1c Laboratory Test" during "Measurement Period"

VSAC Website

VSAC Website

VSAC Website

Example Data Criteria (QDM Data Elements) "Diagnosis: Diabetes" using "Diabetes Grouping Value Set (2.16.840.1.113883.3.464.1003.103.12.1001)" "Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit Grouping Value Set (2.16.840.1.113883.3.526.3.1240)" "Encounter, Performed: Office Visit" using "Office Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1001)" "Laboratory Test, Performed: HbA1c Laboratory Test" using "HbA1c Laboratory Test Grouping Value Set (2.16.840.1.113883.3.464.1003.198.12.1013)"

VSAC Website

VSAC Website

VSAC Website

Exported Excel Document

Exported Excel Document

DSRIP Specific Population When reporting data for measures in a measure bundle, the eligible denominator population for each measure will be determined by the following process: Step 1: Determine the DSRIP attributed population—the target population (or pool) for accountability under the DSRIP incentive program -- using the prescribed attribution methodology defined below. Step 2: Determine the individuals from step one that are included in the measure bundle or measure target population Step 3: Determine the individuals from the measure bundle target population that meet the measure specific denominator inclusion criteria. Step 4: Determine payer type for individuals or encounters in the denominator following standardized specifications to determine the all payer, Medicaid, and uninsured rate for each measure.  

Step 1: Determine the DSRIP attributed population For Hospital organizations and Physician Practices, the DSRIP attributed population includes individuals that meet at least one of the criteria below. Individuals do not need to meet all or multiple criteria to be included. Medicaid beneficiary attributed to the Performing Provider during the measurement period as determined by assignment to a primary care provider (PCP), medical home, or clinic in the performing providers DSRIP defined system OR Individuals enrolled in a local coverage program (for example, a county-based indigent care program) assigned to a PCP, medical home, or clinic in the performing providers DSRIP defined system OR One preventive service provided during the measurement period (value sets of visit type codes for annual wellness visit, preventive care services - initial office visit, preventive care services - established office visit, preventive care individual counseling) OR One ambulatory encounter during the measurement year and one ambulatory encounter during the year prior to the measurement year OR Two ambulatory encounters during the measurement year OR Other populations managed with chronic disease in specialty care clinics in the performing providers DSRIP defined system One emergency department visit during the measurement year OR One admission for inpatient or observation status during the measurement year OR One prenatal or postnatal visit during the measurement year OR One delivery during the measurement year OR One dental encounter during the measurement year OR Enrolled in a palliative care or hospice program during the measurement year OR Other populations not included above that should be included in a measure bundle target population included in the RHP plan submission and approved by HHSC (for example, individuals enrolled in community based education programs)  

Step 2 - 3: Refer to Measure Bundle Target Population and Measure Specifications  

DSRIP Bundle Target Population Denominator DSRIP Bundle Target Population

Live Demo K2-287 and K1-105

Useful Links https://ecqi.healthit.gov/ https://vsac.nlm.nih.gov/