The document proposes refining an existing Uniform Data System (UDS) measure related to adult weight screening and follow up to make it more useful for quality improvement. The current measure is seen as too complex, not actionable, and resource-intensive. The proposed changes would specify new BMI measure(s) and ancillary reports to enhance actionability and feasibility. A pilot study would develop and assess the new measures and reports, evaluate their utility, feasibility, and reliability, and assess any difference in care quality metrics between providers receiving different report types. The goal is to create measures that can help target areas for improvement at the patient, provider, and practice levels.
This document discusses planning for successful implementation of electronic health records (EHRs). It notes that EHR implementation projects often fail, with failure rates as high as 70%. To achieve success, the document recommends: 1) establishing an effective implementation team, 2) finalizing goals and priorities, 3) developing an implementation strategy and scope, 4) creating a detailed implementation plan and timeline, 5) emphasizing communication, and 6) establishing benchmarks to measure success. By following these steps, practices can keep EHR implementations on track to realize the benefits of digitization.
This document discusses Community Health Connections' implementation of an electronic health record system. It provides an overview of the organization and outlines their plan to implement OpenVista EHR software across three clinics by February 2011. It describes the anticipated benefits of EHR including reduced errors, improved workflows and access to patient information. The implementation plan includes teams for project management, hardware, software and stakeholders. It also covers training, data migration, technical infrastructure including servers and network upgrades, meeting meaningful use requirements and realizing financial benefits and savings.
Powerpoint on electronic health record lab 1nephrology193
This presentation provides an overview of electronic health records (EHR). It defines EHR as a digital format for documenting a patient's medical history maintained by healthcare providers. EHR files contain sections for different types of health information. The presentation outlines benefits of EHR such as reducing medical errors, improving quality of care through better disease management and education, and decreasing healthcare costs. It also discusses how EHR protects patient privacy through security measures and restrictions on who can access records.
This document discusses the implementation of electronic medical records (EMR). It outlines reasons to implement EMR, such as reducing medical errors from illegible handwriting and inaccurate abbreviations. The implementation process involves choosing software and a vendor, testing, and training. There are costs for equipment, lawsuits, and unnecessary medical procedures that EMR can reduce. EMR also allows for faster treatment decisions and easier transfer of patient information. While costly initially, EMR provides long-term financial benefits and improves patient healthcare overall.
Analysis of the official resolution to implement the IEPS tax to sugar beveragesPaolaAndreaSaravia
This document summarizes an individual's peer review of an article analyzing Mexico's resolution to implement an excise tax on sugar-sweetened beverages. The individual finds several inconsistencies and logical fallacies in the article's arguments. Specifically, the arguments lack concrete evidence and make unsupported generalizations. Additionally, the document does not cite academic sources or include statistics to support its points. The individual concludes that while excessive sugar consumption can affect health, a tax alone will not change nutritional habits or prevent obesity and related diseases.
This document outlines a study plan for GRE preparation. It includes 4 sessions focused on different GRE verbal topics: analytical writing, reading comprehension, text completions and sentence equivalence questions, and vocabulary building. Each session provides an overview of the topic, strategies for answering different types of questions, and examples of vocabulary words to learn. Practice pages and homework assignments involving timed practice tests are included to help prepare for the actual GRE.
This document discusses planning for successful implementation of electronic health records (EHRs). It notes that EHR implementation projects often fail, with failure rates as high as 70%. To achieve success, the document recommends: 1) establishing an effective implementation team, 2) finalizing goals and priorities, 3) developing an implementation strategy and scope, 4) creating a detailed implementation plan and timeline, 5) emphasizing communication, and 6) establishing benchmarks to measure success. By following these steps, practices can keep EHR implementations on track to realize the benefits of digitization.
This document discusses Community Health Connections' implementation of an electronic health record system. It provides an overview of the organization and outlines their plan to implement OpenVista EHR software across three clinics by February 2011. It describes the anticipated benefits of EHR including reduced errors, improved workflows and access to patient information. The implementation plan includes teams for project management, hardware, software and stakeholders. It also covers training, data migration, technical infrastructure including servers and network upgrades, meeting meaningful use requirements and realizing financial benefits and savings.
Powerpoint on electronic health record lab 1nephrology193
This presentation provides an overview of electronic health records (EHR). It defines EHR as a digital format for documenting a patient's medical history maintained by healthcare providers. EHR files contain sections for different types of health information. The presentation outlines benefits of EHR such as reducing medical errors, improving quality of care through better disease management and education, and decreasing healthcare costs. It also discusses how EHR protects patient privacy through security measures and restrictions on who can access records.
This document discusses the implementation of electronic medical records (EMR). It outlines reasons to implement EMR, such as reducing medical errors from illegible handwriting and inaccurate abbreviations. The implementation process involves choosing software and a vendor, testing, and training. There are costs for equipment, lawsuits, and unnecessary medical procedures that EMR can reduce. EMR also allows for faster treatment decisions and easier transfer of patient information. While costly initially, EMR provides long-term financial benefits and improves patient healthcare overall.
Analysis of the official resolution to implement the IEPS tax to sugar beveragesPaolaAndreaSaravia
This document summarizes an individual's peer review of an article analyzing Mexico's resolution to implement an excise tax on sugar-sweetened beverages. The individual finds several inconsistencies and logical fallacies in the article's arguments. Specifically, the arguments lack concrete evidence and make unsupported generalizations. Additionally, the document does not cite academic sources or include statistics to support its points. The individual concludes that while excessive sugar consumption can affect health, a tax alone will not change nutritional habits or prevent obesity and related diseases.
This document outlines a study plan for GRE preparation. It includes 4 sessions focused on different GRE verbal topics: analytical writing, reading comprehension, text completions and sentence equivalence questions, and vocabulary building. Each session provides an overview of the topic, strategies for answering different types of questions, and examples of vocabulary words to learn. Practice pages and homework assignments involving timed practice tests are included to help prepare for the actual GRE.
Writer’s Surname 1[Name of the Writer][Name of Ins.docxannetnash8266
Writer’s Surname 1
[Name of the Writer]
[Name of Instructor]
[Subject]
[Date]
Professional Coder Practicum Documentation
Medical coding is the conversion of medical diagnosis, equipment, procedures, and medical services into universal medical alphanumeric codes. The procedure and diagnoses codes are taken from medical record documentation such as laboratory, radiologic results, and transcription of doctor’s notes. Professional coder practicum make sure the codes are applied correctly during the medical billing process. In this paper four cases has been reviewed to see if there is any missing data in documentation that can be needed by coder. The first case is of a patient suffering from invasive ductal carcinoma (Nie, Liqiang, et al. 2015).
410057
The patient is suffering from invasive ductal carcinoma of the right breast. the patient is 57 years old female with an extensive surgical history involving her bilateral breasts including prior mastopexies as well as breast augmentation. The patient was brought to the preoperative area and was marked for an inferior pedicle wise pattern reduction. According to the coding summary provided by supervisor all the information such as reason for visit, primary diagnosis, secondary diagnosis, procedural details, cancer follow up information, pertinent laboratory tests, medical history, current medication list, and symptoms of disease is present for this case. All the information is present for coder and there is no missing data for this patient.
The second case is of a patient suffering from benign neoplasm of ascending colon.
410092
The patient had colonoscopy at 4/11/2014. Multiple resected polyps diagnosed as tubulovillous adenomas and tubular adenomas. Patient states that not all areas were resected and he is presenting for colonoscopy with endoscopy mucosal resection. The medical notes contain information about his evaluation and detailed medical history which include allergies, anesthetic complications, and cardiovascular history. The case also provide information about patient’s vitals, physical exam details, lab tests details, anesthesia assessment plan, home medications, current hospital medications, pathology consultation report, and procedural details. There is no missing information in this case. The doctor clearly diagnosed the disease and coding is always done on definitive diagnosis. There is information related to gene analysis which has not been assigned any code as per clinic policies.
The third case is of a patient suffering from epidermal cyst.
410198
The patient had the cyst at the site many years ago and recently she has noticed the scar has enlarged, become itchy and at times drains foul smelling material. The female patient is 49 years old and has no other medical condition. The medical notes contain the diagnosis, past medical history, past surgical history, medication details, family history, social history, anesthesia complication, physical exam details, assessm.
state of the Health in United states of AmericaSumit Roy
This document summarizes the career and legacy of Dr. Edward J. Sondik as the long-time director of the National Center for Health Statistics (NCHS). As NCHS Director for 17 years, Dr. Sondik was the strongest supporter of the annual report "Health, United States", advocating for its wider dissemination and easier public access. This expanded its impact on health policy and priorities. Dr. Sondik ensured the report utilized new technologies and addressed emerging issues. His advocacy highlighted the report's findings and importance. Now retiring, Dr. Sondik's legacy includes the success of NCHS data collection programs and advances in the national health information system, especially the enduring assessment of American health
This document outlines the keynote address by Prof. S. Yunkap Kwankam on going digital and scaling digital health interventions. It discusses:
1. Digital health priority areas from 2006 that have not significantly changed, including telemedicine, electronic health records, and mobile health applications.
2. The benefits of digital health are well understood but limited by critical factors like scale. Examples are provided of scale limitations in information-intensive applications.
3. A framework is proposed to guide scaling digital health interventions through identifying obstacles, exchanging ideas, and structuring dialog around specific applications and themes.
4. Conclusions emphasize the need to focus on overall development with digital health, address grand challenges
This document provides an introduction to biostatistics in nursing. It defines biostatistics as statistics arising from biological sciences like medicine and public health. It discusses the importance of understanding biostatistics for nurses due to the increasing use of quantitative methods in medical research and literature. The document outlines different types of data like qualitative, discrete, continuous and scales of measurement. It also demonstrates how to create a frequency distribution table to organize and summarize patient data.
The document proposes a platform that matches patients from online health communities to relevant medical research projects, by developing rich semantic profiles of both patients and projects. It analyzes patient conversations to extract medical conditions, medications, and demographics to create patient profiles. It also analyzes research project descriptions to create profiles. These profiles are then matched using semantic similarity algorithms to find relevant patients for projects. The platform was prototyped and shown to accurately match patients to projects with similar medical conditions.
The document discusses evaluating biometric wearables from academic and industry perspectives. It covers current wearable form factors and types of biometrics measured. It notes the lack of clear benchmarking in the industry for sensor accuracy. The academic perspective section outlines considerations for testing products and respecting the industry. Industry drivers of wearables include health, stress reduction and body composition monitoring. Standardization efforts aim to improve accuracy, including standards for steps, heart rate, sleep and other metrics. Validating biometrics requires understanding sensors, suitable benchmarks, proper methodology and analyzing results to ensure accuracy.
This document provides an executive summary of a report developed to guide sustainability benchmarking for members of the Sustainability Managers Roundtable (SMRT). The report details the development of the SMRT Tool, a customized benchmarking framework for non-profit organizations. Research methods included reviewing existing frameworks, surveying SMRT members, and conducting expert interviews. The resulting SMRT Tool includes 29 key performance indicators across environmental, social, governance and financial categories. Pilot testing revealed a basic and advanced level of reporting based on scope. The tool is intended to help SMRT members benchmark sustainability performance in a feasible way with limited resources.
Measuring and Enhancing Your Academic Medical ImpactMarion Sills
Overview of measuring and enhancing the impact of your scholarly work in academic medicine. The talk reviews how impact is defined and measured, how to improve your own impact metrics and how to describe the impact of your scholarly contributions to science.
Adding Social Determinant Data Changes Children’s Hospitals’ Readmissions Per...Marion Sills
Adding social determinant data to risk adjustment models for pediatric readmissions led to minimal changes in model performance at the discharge level, but resulted in changes to hospital performance rankings. Specifically:
- Adding social determinant variables from electronic health records and zip codes to existing clinical risk adjustment models did not meaningfully improve the accuracy or fit of models predicting individual readmissions.
- However, accounting for social determinants did change some hospitals' risk-adjusted readmission rates and performance deciles compared to peers. This suggests social determinants may influence hospital performance evaluations and penalties if unadjusted.
- Including social determinants in readmissions modeling more fully captures factors influencing readmissions and provides a more accurate assessment of hospital quality.
Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Pra...Marion Sills
Kwan BM, Sills MR, Graham D, Hamer MK, Fairclough DL, Hammermeister KE, Kaiser A, Diaz-Perez MJ, Schilling LM. Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Practice-Based Research Network. JABFM. In Press.
Practice Variability in and Correlates of Patient-Centered Medical Home Chara...Marion Sills
Schilling LM, Sills MR, Fairclough D, Kwan MB. Practice Variability in and Correlates of Patient-Centered Medical Home Characteristics. SAFTINet Convocation. Aurora, Colorado. 13 Feb 2013.
This document describes the design and methods of a prospective cohort study examining the association between practice-level medical home characteristics and asthma outcomes in children and adults. The study will use surveys of medical home characteristics and secondary data from 2011-2013. Asthma control and exacerbations will be measured repeatedly from July 2012 to December 2013. Hierarchical linear models will assess the relationship between medical home scores and asthma outcomes, adjusting for potential confounders. Sensitivity analyses will address issues like misclassification bias. Results will be presented separately for children and adults.
Sills MR. Inpatient capacity margin at children's hospitals during the fall 2009 H1N1 influenza pandemic. Presentation to the Colorado Emergency Medicine Research Center. 14 June 2010.
Sills MR. Overview of the SAFTINet Program. Presented to the Emergency Department Research Committee, Department of Pediatrics, University of Colorado School of Medicine. 6 January 2015.
Patient-reported outcomes for asthma in children and adultsMarion Sills
Patient-reported outcomes for asthma in children and adults. Guided Discussion to Facilitate SAFTINet Stakeholders' Selection of an Asthma PROM. Teleconference. 1 April 2011
Sills MR. Cardiovascular Cohorts PROM Measures Updates and Action Items. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection by SAFTINet Stakeholder Community. 21 March 2012.
Writer’s Surname 1[Name of the Writer][Name of Ins.docxannetnash8266
Writer’s Surname 1
[Name of the Writer]
[Name of Instructor]
[Subject]
[Date]
Professional Coder Practicum Documentation
Medical coding is the conversion of medical diagnosis, equipment, procedures, and medical services into universal medical alphanumeric codes. The procedure and diagnoses codes are taken from medical record documentation such as laboratory, radiologic results, and transcription of doctor’s notes. Professional coder practicum make sure the codes are applied correctly during the medical billing process. In this paper four cases has been reviewed to see if there is any missing data in documentation that can be needed by coder. The first case is of a patient suffering from invasive ductal carcinoma (Nie, Liqiang, et al. 2015).
410057
The patient is suffering from invasive ductal carcinoma of the right breast. the patient is 57 years old female with an extensive surgical history involving her bilateral breasts including prior mastopexies as well as breast augmentation. The patient was brought to the preoperative area and was marked for an inferior pedicle wise pattern reduction. According to the coding summary provided by supervisor all the information such as reason for visit, primary diagnosis, secondary diagnosis, procedural details, cancer follow up information, pertinent laboratory tests, medical history, current medication list, and symptoms of disease is present for this case. All the information is present for coder and there is no missing data for this patient.
The second case is of a patient suffering from benign neoplasm of ascending colon.
410092
The patient had colonoscopy at 4/11/2014. Multiple resected polyps diagnosed as tubulovillous adenomas and tubular adenomas. Patient states that not all areas were resected and he is presenting for colonoscopy with endoscopy mucosal resection. The medical notes contain information about his evaluation and detailed medical history which include allergies, anesthetic complications, and cardiovascular history. The case also provide information about patient’s vitals, physical exam details, lab tests details, anesthesia assessment plan, home medications, current hospital medications, pathology consultation report, and procedural details. There is no missing information in this case. The doctor clearly diagnosed the disease and coding is always done on definitive diagnosis. There is information related to gene analysis which has not been assigned any code as per clinic policies.
The third case is of a patient suffering from epidermal cyst.
410198
The patient had the cyst at the site many years ago and recently she has noticed the scar has enlarged, become itchy and at times drains foul smelling material. The female patient is 49 years old and has no other medical condition. The medical notes contain the diagnosis, past medical history, past surgical history, medication details, family history, social history, anesthesia complication, physical exam details, assessm.
state of the Health in United states of AmericaSumit Roy
This document summarizes the career and legacy of Dr. Edward J. Sondik as the long-time director of the National Center for Health Statistics (NCHS). As NCHS Director for 17 years, Dr. Sondik was the strongest supporter of the annual report "Health, United States", advocating for its wider dissemination and easier public access. This expanded its impact on health policy and priorities. Dr. Sondik ensured the report utilized new technologies and addressed emerging issues. His advocacy highlighted the report's findings and importance. Now retiring, Dr. Sondik's legacy includes the success of NCHS data collection programs and advances in the national health information system, especially the enduring assessment of American health
This document outlines the keynote address by Prof. S. Yunkap Kwankam on going digital and scaling digital health interventions. It discusses:
1. Digital health priority areas from 2006 that have not significantly changed, including telemedicine, electronic health records, and mobile health applications.
2. The benefits of digital health are well understood but limited by critical factors like scale. Examples are provided of scale limitations in information-intensive applications.
3. A framework is proposed to guide scaling digital health interventions through identifying obstacles, exchanging ideas, and structuring dialog around specific applications and themes.
4. Conclusions emphasize the need to focus on overall development with digital health, address grand challenges
This document provides an introduction to biostatistics in nursing. It defines biostatistics as statistics arising from biological sciences like medicine and public health. It discusses the importance of understanding biostatistics for nurses due to the increasing use of quantitative methods in medical research and literature. The document outlines different types of data like qualitative, discrete, continuous and scales of measurement. It also demonstrates how to create a frequency distribution table to organize and summarize patient data.
The document proposes a platform that matches patients from online health communities to relevant medical research projects, by developing rich semantic profiles of both patients and projects. It analyzes patient conversations to extract medical conditions, medications, and demographics to create patient profiles. It also analyzes research project descriptions to create profiles. These profiles are then matched using semantic similarity algorithms to find relevant patients for projects. The platform was prototyped and shown to accurately match patients to projects with similar medical conditions.
The document discusses evaluating biometric wearables from academic and industry perspectives. It covers current wearable form factors and types of biometrics measured. It notes the lack of clear benchmarking in the industry for sensor accuracy. The academic perspective section outlines considerations for testing products and respecting the industry. Industry drivers of wearables include health, stress reduction and body composition monitoring. Standardization efforts aim to improve accuracy, including standards for steps, heart rate, sleep and other metrics. Validating biometrics requires understanding sensors, suitable benchmarks, proper methodology and analyzing results to ensure accuracy.
This document provides an executive summary of a report developed to guide sustainability benchmarking for members of the Sustainability Managers Roundtable (SMRT). The report details the development of the SMRT Tool, a customized benchmarking framework for non-profit organizations. Research methods included reviewing existing frameworks, surveying SMRT members, and conducting expert interviews. The resulting SMRT Tool includes 29 key performance indicators across environmental, social, governance and financial categories. Pilot testing revealed a basic and advanced level of reporting based on scope. The tool is intended to help SMRT members benchmark sustainability performance in a feasible way with limited resources.
Measuring and Enhancing Your Academic Medical ImpactMarion Sills
Overview of measuring and enhancing the impact of your scholarly work in academic medicine. The talk reviews how impact is defined and measured, how to improve your own impact metrics and how to describe the impact of your scholarly contributions to science.
Adding Social Determinant Data Changes Children’s Hospitals’ Readmissions Per...Marion Sills
Adding social determinant data to risk adjustment models for pediatric readmissions led to minimal changes in model performance at the discharge level, but resulted in changes to hospital performance rankings. Specifically:
- Adding social determinant variables from electronic health records and zip codes to existing clinical risk adjustment models did not meaningfully improve the accuracy or fit of models predicting individual readmissions.
- However, accounting for social determinants did change some hospitals' risk-adjusted readmission rates and performance deciles compared to peers. This suggests social determinants may influence hospital performance evaluations and penalties if unadjusted.
- Including social determinants in readmissions modeling more fully captures factors influencing readmissions and provides a more accurate assessment of hospital quality.
Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Pra...Marion Sills
Kwan BM, Sills MR, Graham D, Hamer MK, Fairclough DL, Hammermeister KE, Kaiser A, Diaz-Perez MJ, Schilling LM. Stakeholder Engagement in a Patient-Reported Outcomes Implementation by a Practice-Based Research Network. JABFM. In Press.
Practice Variability in and Correlates of Patient-Centered Medical Home Chara...Marion Sills
Schilling LM, Sills MR, Fairclough D, Kwan MB. Practice Variability in and Correlates of Patient-Centered Medical Home Characteristics. SAFTINet Convocation. Aurora, Colorado. 13 Feb 2013.
This document describes the design and methods of a prospective cohort study examining the association between practice-level medical home characteristics and asthma outcomes in children and adults. The study will use surveys of medical home characteristics and secondary data from 2011-2013. Asthma control and exacerbations will be measured repeatedly from July 2012 to December 2013. Hierarchical linear models will assess the relationship between medical home scores and asthma outcomes, adjusting for potential confounders. Sensitivity analyses will address issues like misclassification bias. Results will be presented separately for children and adults.
Sills MR. Inpatient capacity margin at children's hospitals during the fall 2009 H1N1 influenza pandemic. Presentation to the Colorado Emergency Medicine Research Center. 14 June 2010.
Sills MR. Overview of the SAFTINet Program. Presented to the Emergency Department Research Committee, Department of Pediatrics, University of Colorado School of Medicine. 6 January 2015.
Patient-reported outcomes for asthma in children and adultsMarion Sills
Patient-reported outcomes for asthma in children and adults. Guided Discussion to Facilitate SAFTINet Stakeholders' Selection of an Asthma PROM. Teleconference. 1 April 2011
Sills MR. Cardiovascular Cohorts PROM Measures Updates and Action Items. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection by SAFTINet Stakeholder Community. 21 March 2012.
Sills MR. Evolution of PRO Measure for Cardiovascular Cohorts in SAFTINet. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection by SAFTINet Stakeholders. 2 May 2012.
Sills MR. Medication Adherence PROM Measures Updates and Pilot Results. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection and Refinement by SAFTINet Stakeholders. 2 July 2012.
Sills MR. Medication Adherence PROM Measures and Self Efficacy. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection by SAFTINet Stakeholders. 21 May 2012.
Cer safti net overview edrc 1 feb 2011Marion Sills
Sills MR. Overview of Comparative Effectiveness Research Using SAFTINet as an Example. Methods Talk presented to the Emergency Department Research Conference, Department of Pediatrics, 1 February 2011.
5. 5
Pregnant women Women with a diagnostic code for pregnancy and/or a diagnostic/procedure code
for a delivery during the measurement period
Terminally ill patients (no definition is provided) Patients who die during the measurement period, ICD-9 codes or procedure codes
indicative of terminal illness [e.g., 799.3 (Debility, unspecified), V66.7
(Encounter for palliative care)]
Table&2:&Data&Elements&Required&for&Defining&and&Computing&Current&UDS&BMI&Measures&Using&Electronic&Data&&
Measure Description Definition SAFTINet Fields or Concepts Needed
Denominator
Inclusion of Patients Eligible
for Measure by category:
•! Under!age!65!AND(BMI!
over!25!
•! !Age!65!or!older!AND(BMI!
over!30!!
•! Under!age!65!AND(BMI!
under!18.5!!
•! Age!65!or!older!AND(BMI!
under!22.!
•! All!
•! Age!>!18!years!during!the!
measurement!year!
•! >!1!visit!during!the!
measurement!year!after!
their!18th
!birthday!
•! DOB,(date(of(end(of(reporting(period,(age(at(end(of(reporting(period(
•! Date(of(service(for(all(visits(to(practices,(DOB(
Denominator Exclusion Pregnant women during
reporting period
Diagnostic and procedure codes and associated dates Women with a diagnostic code for
pregnancy and/or a diagnostic/procedure code for a delivery during the measurement period
Denominator Exclusion Terminal illness, indication
during reporting period
Diagnostic and procedure codes and associated date; Patients who die during the
measurement period, V66.7 (Encounter for palliative care)]
Numerators
Number with BMI documented
at most recent visit or within 6
months of most recent visit for
those in the following
categories:
•! Under!age!65!AND(BMI!
BMI documentation by
categories of age and BMI
CPTVII:!3008F!=BMI!documented!or!BMI!value!is!not!null.!
Age!during!reporting!period
6. 6
Measure Description Definition SAFTINet Fields or Concepts Needed
over!25!
•! !Age!65!or!older!AND(BMI!
over!30!!
•! Under!age!65!AND(BMI!
under!18.5!!
•! Age!65!or!older!AND(BMI!
under!22.!
•! All!
BMI follow-up plan
documented for those in the
following categories:
•! Under(age(65(AND(BMI(
over(25(
•! (Age(65(or(older(AND(BMI(
over(30((
•! Under(age(65(AND(BMI(
under(18.5((
•! Age(65(or(older(AND(BMI(
under(22.(
•! All(
BMI plan documented by
categories of age and BMI BMI documented and associated date
FollowVup!plan!V65.3!(dietary!surveillance!and!counseling)
Limitations&of&the&Current&Measure&
!! Feasibility:!chart!review!of!70!charts!from!across!the!organization!is!resourceVintensive,!especially!with!elements!like!documentation!of!a!weightVrelated!
followVup!plan.!
!! Reliability:!What!constitutes!a!weightVrelated!followVup!plan!may!vary!between!chart!reviewers,!especially!as!this!item!involves!examining!free!text!for!
evidence!of!a!followVup!plan.!
!! Utility:!The!current!measure!is!not!useful!for!targeting!patientV,!providerV,!or!practiceVlevel!needs.!!It!cannot!identify…!
"! Which!providers!or!practices!provide!better!care!quality!(and/or!data!quality)!
"! Which!patients!are!out!of!compliance!and!why?!!Is!it!mostly!poor!rate!of!measurement!of!BMI!or!poor!rate!of!providing!counseling!for!high/low!BMI?!
"! Which!patients!are!just!barely!overweight!and!which!are!immensely!so!
7. 7
"! Which!patients!are!overweight!and!which!are!underweight!
!! Data!quality:!If!generated!from!the!EHR,!the!current!reports!would!have!a!lot!of!missing!data!because!providers!are!not!documenting!follow!up!plans!(some,!
because!there!is!no!dedicated!field!for!this)!and!the!EHR!may!not!be!able!to!demonstrate!whether!the!calculated!BMI!value!is!visible!to!the!provider!at!the!
time!of!visit.!!Manual!review!of!70!charts!provides!no!information!about!how!to!remedy!the!data!quality!issues.!
!
Proposed&Improved&UDS&Adult&Weight&Screening&and&Follow&Up&Measure&
Rationale&for&Proposed&Changes&
!! Feasibility:!The!new!measure!would!permit!derivation!from!each!organization’s!existing!administrative!and!EHR!data!sources.!
!! Data!Quality!and!Reliability:!Reports!generated!by!the!new!measure!parameters!would!provide!feedback!to!organizations,!practices!and!providers!regarding!
practiceV!and!providerVlevel!completion!rate!in!documentation!of!BMI!and!of!a!followVup!plan.!The!organizations,!practices!and!providers!could!then!target!
areas!for!improvement!in!reporting!reliability.!
!! Utility:!The!new!measure!would!help!provide!feedback!on!patientV,!providerV,!or!practiceVlevel!care!quality.!!It!can!help!identify!!
"! Which!providers!and!practices!provide!better!care!quality!(or!data!quality—the!practices!would!need!to!work!on!distinguishing!issues!with!quality!of!care!
from!issues!related!to!data!quality)!
"! Which!patients!are!out!of!compliance!and!why?!!!
#! Is!it!mostly!poor!rate!of!measurement!of!BMI!or!poor!rate!of!providing!counseling!for!high/low!BMI?!!
#! Which!patient!groups!based!on!the!UDS!parameters!(four!groups!defined!by!age!and!BMI!noted!above!under!instructions!for!Column!C!for!the!
current!measure!
#! Which!patients!are!higher!priority!for!rectifying!a!missed!followVup!opportunity!based!on!parameters!determined!by!evidence!or!by!practice!
preference—e.g.,!target!patients!who!have!BMI!over!35!as!highest!priority!for!providing!followVup!!
"! Which!patients!are!overweight!and!which!are!underweight!
Proposed Measures (adults >=18, not pregnant)
1. % of those with BMI >=30, % missing BMI, n, subgroup 18-64, >=65
2. % of patient with BMI =30 or greater, and no diagnosis of obesity
3. % of patient with BMI =30 or greater, and nutrition referral or group obesity encounter or ….
Proposed Measures BMI<18 – as above
Table)3:)Added)Elements)to)Help)Enhance)the)Actionable)Value)of)the)UDS)Report&
Additional Element Rationale for Added Value
Sex Can help check to make sure there are no males excluded for pregnancy
8. 8
Additional Element Rationale for Added Value
Indicator for BMI parameter
category
Can help practices better understand which of the four BMI parameter categories experience poorer
compliance with follow-up measure
Indicator for BMI in- or out-of-
parameters
Can help practices determine which patients were compliant with UDS measure because of BMI in-
range and which because of follow-up documentation
Type of follow-up documented If this degree of detail exists, patients who had exercise- or diet-related follow-up documented might
help practices figure out which follow-up category needs improvement in either care quality or data
quality
Height, weight Can help determine whether BMIs are missing because of an EHR calculation issue or because height
is missing (or weight); can verify cause of unrealistic BMI values
Practice Practice associated with the most frequent visits in the measurement period. This can help partners link
measure performance to specific practices
Provider identifier Provider associated with the most frequent visits in the measurement period. This can help partners
link measure performance to specific providers
Patient identifier Practices can identify patients in need of either a BMI measurement or a follow-up action for an out-
of-range BMI
Missing values For each element in Tables 2 and 3, report the proportion missing. This can help identify data quality
gaps that are impacting the measure of care quality
&
Clinical&Quality&Performance&Reports:&options&for&pilot&project&&
Care&Quality&Measures&
The new measure is care quality
Care&Quality&Ancillary&Reports&&
[Bethany—can you put in what you had outlined/drawn in our session after the last R/QI meeting?]
Some ideas for types of ancillary reports:
!! Report!summary!value!as!required!by!UDS!
9. 9
!! Report!akin!to!the!DI!reports,!allowing!partners!to!compare!at!the!practice!level,!varying!parameters!such!as!those!in!Table!2!
!! Report!akin!to!the!DI!reports!with!providerVlevel!metrics,!with!only!the!partner’s!data!available!to!that!partner,!including!variables!from!Tables!2!and!3!
!! Registry!of!all!patients!in!Column!A,!including!variables!from!Tables!2!and!3!
!! “Slice!&!Dice”!care!quality!
!! Broken!down!into!component!parts!!!
!
Data&Quality&Ancillary&Reports&
!
1.! By!Practice!(this!is!really!not!done!at!provider!level),!for!those!>18!years!of!age!at!end!date!of!measurement!period,!with!one!visit!during!measurement!
period!
a.! Gender=males!with!pregnancy!code,!#/%!
b.! Ht!–!DQ!range!check,!acceptable!range!0V90!inches:!missing!and!out!of!range,!#/%!{if!eventually!more!granular!<60,!60V71,!72V!78,!79V84,!>85!}!
c.! Ht!value!where!units!are!not!inches,!#/%!
d.! Wt!–!DQ!range!check,!acceptable!range!0V500!pounds,!missing!and!out!of!range,!#/%,!!{<100,!101!V150,!151V200,!201V250,!251V300,!>300!}!
e.! Wt!value!where!units!are!not!pounds,!#/%!
f.! BMI!range!check,!acceptable!range!0V40,!missing!and!out!of!range,!#/%!
g.! !Age!–!DQ!range!check!
2.! By!Organization,!Practice,!Provider!for!those!>18!years!of!age!at!end!date!of!measurement!period!
a.! #/%!missing!BMI!documentation!
Key&to&Abbreviations&
•! BMI Body Mass Index
•! EHR Electronic Health Record
•! MU Meaningful use
•! PCMH Patient centered medical home
•! PCP Primary care provider
•! UDS Uniform Data System
!
!