Consensus Core Set: Cardiovascular Measures Version 1

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Consensus Core Set: Cardiovascular MeasuresVersion 1.0Chronic Cardiovascular Condition MeasuresNQF#MeasureMeasureStewardLevel ofAnalysisConsensus Agreement / NotesCongestive Heart Failure0330Hospital 30-day, all-cause, riskstandardized readmission rate(RSRR) following heart failurehospitalizationCMSFacilityConsensus reached to include measure in core set; measure to be used atthe facility level only.0229Hospital 30-day, all-cause, riskstandardized mortality rate(RSMR) following heart failure(HF) hospitalization for patients18 and olderCMSFacilityConsensus reached to include measure in core set; measure to be used atthe facility level only.0081Heart Failure (HF): AngiotensinConverting Enzyme (ACE)Inhibitor or AngiotensinReceptor Blocker (ARB)Therapy for Left VentricularSystolic Dysfunction (LVSD)AMAPCPIClinicianConsensus reached to include measure in core set.0083Heart Failure (HF): BetaBlocker Therapy for LeftVentricular Systolic Dysfunction(LVSD)AMAPCPIClinicianConsensus reached to include measure in core set.[1]Updated: 2/3/2016

Consensus Core Set: Cardiovascular MeasuresVersion 1.0Chronic Cardiovascular Condition MeasuresNQF#0018MeasureControlling High Blood PressureDescription: The percentage ofpatients 18 to 85 years of agewho had a diagnosis ofhypertension (HTN) and whoseblood pressure (BP) wasadequately controlled ( 140/90)during the measurement year.MeasureStewardNCQALevel ofAnalysisClinicianConsensus Agreement / NotesHypertensionConsensus to include either #0018 or "N/A - Controlling High BloodPressure" HEDIS measure in the core set.Note: Both blood pressure control measures are included in the core set with thechoice being an "either/or" due to controversyi regarding the 2014 JAMA paperiisometimes referred to as “JNC 8”, which recommends relaxing systolic bloodpressure (SBP) targets to 150 mmHg for patients aged 60 and older withoutdiabetes mellitus or chronic kidney disease (CKD).Revised ACC/AHA hypertension guidelines are expected to be released laterthis year. Until these revised guidelines are available, a number of organizationscontinue to recognize the 2004 Joint National Committee (JNC 7) hypertensionguidelines, which recommend a SBP target of 140 mmHg, as the nationalstandard. Given the changing nature of these guidelines, the Collaborative willrevisit this measure topic when the revised guidelines are available to determinewhich blood pressure control measure aligns with the updated evidence base.Note: #0018 is specified for physician-level use.[2]Updated: 2/3/2016

Consensus Core Set: Cardiovascular MeasuresVersion 1.0Chronic Cardiovascular Condition MeasuresNQF#N/AMeasureMeasureStewardControlling High Blood Pressure(HEDIS 2016)NCQAMeasure Description: Thepercentage of members 18-85years of age who had a diagnosisof hypertension and whose BPwas adequately controlled duringthe measurement year based onthe following criteria: 18-59 140/90 mm Hg 60-85 w/ diabetes 140/90 mm Hg 60-85 w/o diabetes 150/90 mm HgLevel ofAnalysisConsensus Agreement / NotesHealthConsensus to include either #0018 or "N/A - Controlling High BloodPlan/Integrated Pressure" HEDIS measure in the core set.DeliveryNote: Both blood pressure control measures are included in the core set with theSystemchoice being an "either/or" due to controversyiii regarding the 2014 JAMApaperiv sometimes referred to as “JNC 8”, which recommends relaxing systolicblood pressure (SBP) targets to 150 mmHg for patients aged 60 and olderwithout diabetes mellitus or chronic kidney disease (CKD).Revised ACC/AHA hypertension guidelines are expected to be released laterthis year. Until these revised guidelines are available, a number of organizationscontinue to recognize the 2004 Joint National Committee (JNC 7) hypertensionguidelines, which recommend a SBP target of 140 mmHg, as the nationalstandard. Given the changing nature of these guidelines, the Collaborative willrevisit this measure topic when the revised guidelines are available to determinewhich blood pressure control measure aligns with the updated evidence base.Note: Please refer to 2016 HEDIS specifications which align with therecommendations in the 2014 JAMA paperv.Note: "N/A - Controlling High Blood Pressure" HEDIS measure is specified forthe health plan or integrated delivery network level use.[3]Updated: 2/3/2016

Consensus Core Set: Cardiovascular MeasuresVersion 1.0Chronic Cardiovascular Condition MeasuresNQF#MeasureMeasureStewardLevel ofAnalysisConsensus Agreement / NotesIschemic Heart Disease / Coronary Heart DiseaseClinicianConsensus reached to include measure in core set.AmericanCollege ofCardiology0066Chronic Stable Coronary ArteryDisease: ACE Inhibitor or ARBTherapy--Diabetes or LeftVentricular Systolic Dysfunction(LVEF 40%)0067Chronic Stable Coronary ArteryDisease: Antiplatelet TherapyAmericanCollege ofCardiologyClinicianConsensus reached to include measure in core set.0070Chronic Stable Coronary ArteryDisease: Beta-Blocker Therapy-Prior Myocardial Infarction (MI)or Left Ventricular SystolicDysfunction (LVEF 40%)AMAPCPIClinicianConsensus reached to include measure in core set.2558Hospital 30-Day, All-Cause,Risk-Standardized MortalityRate (RSMR) FollowingCoronary Artery Bypass Graft(CABG) SurgeryCMSFacilityConsensus reached to include measure in core set; report either #2558 or#0019; measure to be used at the facility level only.0119Risk-Adjusted OperativeMortality for CABGTheSociety ofThoracicSurgeonsClinician andFacilityConsensus reached to include measure in core set; report either #2558 or#0019; measure to calculated at both the physician and facility level.2515Hospital 30-day, all-cause,unplanned, risk-standardizedreadmission rate (RSRR)following coronary artery bypassgraft (CABG) surgeryCMSFacilityConsensus reached to include measure in core set; report either #2515 or#2514.[4]Note: Measure also listed under Acute MI.Updated: 2/3/2016

Consensus Core Set: Cardiovascular MeasuresVersion 1.0Chronic Cardiovascular Condition MeasuresNQF#251415250028MeasureRisk-Adjusted Coronary ArteryBypass Graft (CABG)Readmission Rate (30-days)Chronic AnticoagulationTherapyPreventive Care & Screening:Tobacco Use: Screening &Cessation InterventionMeasureStewardLevel ofAnalysisTheSociety ofThoracicSurgeonsFacilityAmericanCollege ofCardiologyAMAPCPIConsensus Agreement / NotesConsensus reached to include measure in core set; report either #2515 or#2514.ClinicianAtrial fibrillationConsensus reached to include measure in core set.ClinicianPreventionConsensus reached to include measure in core set.Note: Included in ACO and PMCH / Primary Care core set.Acute Cardiovascular Condition MeasuresNQF#MeasureMeasureStewardLevel ofAnalysisNotes & CommentsAcute Myocardial Infarction0505Hospital 30-day all-cause riskstandardized readmission rate(RSRR) following acutemyocardial infarction (AMI)hospitalizationCMSFacilityConsensus reached to include measure in core set; measure to be used at thefacility level only.0163Primary PCI received within 90CMSFacilityConsensus reached to include measure in core set.[5]Updated: 2/3/2016

Consensus Core Set: Cardiovascular MeasuresVersion 1.0Acute Cardiovascular Condition MeasuresNQF#MeasureMeasureStewardLevel ofAnalysisNotes & Commentsminutes of hospital arrival0070Clinician Consensus reached to include measure in core set.Coronary Artery Disease (CAD):Beta-Blocker Therapy—PriorMyocardial Infarction (MI) or LeftVentricular Systolic Dysfunction(LVEF 40%)AMAPCPI0230Hospital 30-day, all-cause, riskstandardized mortality rate(RSMR) following acutemyocardial infarction (AMI)hospitalization for patients 18 andolderCMSFacilityConsensus reached to include measure in core set.053630-day all-cause risk-standardizedmortality rate followingPercutaneous CoronaryIntervention (PCI) for patients withST segment elevation myocardialinfarction (STEMI) or cardiogenicshockAmericanCollege ofCardiologyFacilityConsensus reached to include measure in core set.30-day all-cause riskstandardized mortality ratefollowing percutaneouscoronary intervention (PCI) forpatients without ST segmentelevation myocardial infarction(STEMI) and withoutcardiogenic shockAmericanCollege ofCardiologyFacility0535[6]Note: Measure also listed under chronic CAD section.Note: #0536 is always to be reported with the complementary measure #0535.Consensus reached to include measure in core set.Note: #0535 is always to be reported with the complementary measure #0536.Updated: 2/3/2016

Consensus Core Set: Cardiovascular MeasuresVersion 1.0Acute Cardiovascular Condition MeasuresNQF#MeasureMeasureStewardLevel ofAnalysisNotes & CommentsAngioplasty and Stents0964Therapy with aspirin, P2Y12inhibitor, and statin at dischargefollowing PCI in eligible patientsAmericanCollege ofCardiologyFacilityConsensus reached to include measure in core set.2459In-hospital Risk Adjusted Rate ofBleeding Events for PatientsUndergoing PCIAmericanCollege ofCardiologyFacilityConsensus reached to include measure in core set; measure to be used at thefacility level only.Implantable Cardiac Defibrillators0694Hospital Risk-StandardizedComplication Rate followingImplantation of ImplantableCardioverter-Defibrillator (ICD)AmericanCollege ofCardiologyFacilityConsensus reached to include measure in core set.Cardiac Catheterization0715Standardized adverse event ratiofor children 18 years of ageundergoing cardiac catheterizationBostonChildren sHospitalFacilityConsensus to include in core set however measure may be subject to smallnumbers so should be implemented only when there is adequate sample size.Pediatric Heart Surgery0733[7]Operative Mortality Stratified bythe Five STS-EACTS MortalityCategoriesSociety ofThoracicSurgeonsClinician Consensus to include in core set however measure may be subject to smallnumbers so should be implemented only when there is adequate sample size.Updated: 2/3/2016

Consensus Core Set: Cardiovascular MeasuresVersion 1.0Future Measure for Cardiovascular Care Measure Set InclusionNQF#MeasureMeasure StewardNotes & Comments0541Proportion of Days Covered (PDC): 3 Rates byTherapeutic CategoryPQAConsensus to include in the future pending better availability of data.Rationale: It may be difficult to accurately calculate this measure for someproviders because of the way their EMRs track medications and their refills.Additionally, this measure may not be appropriate for all hypertensionpatients as not all are prescribed medications for diabetes.Measure aligns with CMS Stars and health plans collect measure data;Population is important to monitor.2377Defect Free Care for AMI (CompositeMeasure)American Collegeof CardiologyN/AClinician Level Companion Measure to (0694)Hospital Risk-Standardized Complication Ratefollowing Implantation of ImplantableCardioverter-Defibrillator (ICD)ACCSubmitted to NQF for endorsement. Review in July, 2015.2439Post-Discharge Appointment for Heart FailurePatientsTJCData collection is currently challenging. Reconsider measure upon measureupdates.0671Cardiac Stress Imaging Not MeetingAppropriate Use Criteria: Routine Testingafter Percutaneous Coronary Intervention[8]American Collegeof CardiologyUpdated: 2/3/2016

Consensus Core Set: Cardiovascular MeasuresVersion 1.0Future Areas for Cardiovascular Care Measure DevelopmentHeart Failure: Evidence-based anticoagulation status -- ACC note: Not all HF patients are on anticoagulants Outpatient – symptom control or change in symptoms Functional status or quality of life measure for patients with heart failure.o Seattle Angina Questionnaire. Update is slow but can consider in work group Goals of care (does not need to be specific to heart failure) Follow-up visit after hospitalization by PCP End of life measures for heart failure Management of women with peripartum cardiomyopathy Proportion of days covered for beta blocker therapy: Heart Failure patientsHypertension: Renal function measures (e.g., creatinine measures)Other: Lipid measure based on new guidelines. With changes in guidelines and pending evidence, not yet comfortable adding lipid measures until medicalconsensus is reached. New data coming out which push levels back towards previous guidelines. Additional cost and over-utilization measures. Rehabilitation measures Mental health measures following cardiovascular events Symptom Management measures Disparities in cardiovascular care ICD counseling and appropriate use of ICDs measure. Article in JAMA noting severe underutilizations of ICDs in women and elderly.iWright JT Jr, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patientsaged 60 years or older: the minority view. Ann Intern Med. 2014 Apr 1;160(7):499-503.iiJames PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed tothe Eighth Joint National Committee (JNC 8). JAMA 2014; 311: 507–20.[9]Updated: 2/3/2016

Consensus Core Set: Cardiovascular MeasuresVersion 1.0iiiWright JT Jr, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patientsaged 60 years or older: the minority view. Ann Intern Med. 2014 Apr 1;160(7):499-503.ivJames PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed tothe Eighth Joint National Committee (JNC 8). JAMA 2014; 311: 507–20.vWright JT Jr, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patientsaged 60 years or older: the minority view. Ann Intern Med. 2014 Apr 1;160(7):499-503.[10]Updated: 2/3/2016