Draft Emerging Measures for Future Consideration
Subject to Final Approval by Quality Workgroup
Last Revised: February 10, 2011
This list was compiled by the Quality Workgroup staff as emerging measures/areas of concern that have been raised by the Quality Workgroup, program areas, or clinical subcommittee as a concern in the MaineCare population, may be required under CHIPRA or adult core measures in the future or are part of the consent decree tied to services that will be offered in later years but where measures are not yet fully developed or are not widely used and have no national benchmarks. These indicators/measures may develop over time but need to be fully tested before broadly requiring that MCOs collect for all members. They could also be the subject of special studies required of the plans. Language in the RFP may ask MCOs how they might assist the state in addressing these areas of concern and in identifying/testing measures that could be used.
EMERGING CORE MEASURES
Percent of live births weighing less than 2,500 grams / CHIPRA / Birth Certificates
Cesarean rate for nulliparous singleton vertex / CHIPRA / Hospital Discharge data
% of children with whom a lead risk screening questionnaire was done to determine a child’s level of risk at 12 mo and 24 mo. / IHOC / Medical Record
% of children who had a venous capillary blood sample test for lead at 12 months / IHOC / Claims and Admin Data
% of all children enrolled in MaineCare who have had 2 lead tests prior to 36 months. / IHOC / Claims and Admin data
% of children with full hearing evaluation by 3 mos of age for children identified on newborn hearing test as at-risk. / Medical record
Total eligibles receiving preventive dental services (EPSDT measure Line 12B) / CHIPRA / Claims
Inpatient Safety - Pediatric catheter-associated blood stream infection rates (PICU and NICU) / CHIPRA / Hospital data
Otitis Media with Effusion - avoidance of inappropriate use of systemic antimicrobials - ages 2 -12 / CHIPRA / Claims and pharmacy data
Dental Treatment - Total EPSDT eligibles who received dental treatment services (EPSDT CMS Form 416 Line 12C) / CHIPRA
Comprehensive Ischemic Vascular Disease Care: Complete Lipid Profile and LDL-C Control Rates. / AHRQ Adult Core Measure
Annual number of asthma patients (³ 1 year old) with ³ 1 asthma related ER visit / CHIPRA / Claims
EMERGING SPECIAL POPULATION MEASURES
Proportion of youth with ADHD for whom data was gathered from both parents and teachers in diagnosis and assessment of ADHD treatment response. / Office of Children’s Behavioral Health / Medical record review
Proportion of youth with ADHD who received stimulants and/or behavior therapy. / Office of Children’s Behavioral Health / Claims and Pharmacy Data
Proportion of youth receiving antipsychotics who also received an evidence based psychosocial treatment (recommended by OCFS) / Office of Children’s Behavioral Health / Claims and Pharmacy Data
Alcohol Misuse – Screening, Brief Intervention, Referral for Treatment / AHRQ Adult Core Measure / Medical Record
Number of non-hospitalized members assigned a case manager, to in-home services, and to a community support/integration worker within 7 working days of application for services (3 separate measures) (APS 25-27) / APS / Admin Records
Number of non-hospitalized members who are assigned a community support/integration worker within 3 working days of application for service. / APS / Admin Records
Number of adult members who apply for community support/integration services while an inpatient in a psychiatric facility and who are assigned a community support worker in 7 working days. / APS / Admin Records
Number of adult members who apply for community support/integration services while an inpatient in a psychiatric facility and who are assigned a community support/integration worker. / APS / Admin Records
Number of youth who received an evidence-based mental health/Substance Abuse treatment during reporting period / Claims
HBIPS – 2 Hours of physical restraint use –The number of hours that all patients admitted to a hospital-based inpatient psychiatric setting were maintained in physical restraint per 1000 psychiatric inpatient hours, overall and stratified by age group. / AHRQ Adult Core Measure
Appropriate Use of Antenatal Steroids. Mothers receiving antenatal steroids during pregnancy at any time prior to delivery of a preterm infant. / AHRQ Adult Core Measure
HIV/AIDS Medical Visit. Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with at least one medical visit in each 6 month period with a minimum of 60 days between each visit. / AHRQ Adult Core Measure / Claims
Percentage of babies electively delivered prior to 39 completed weeks gestation / AHRQ Adult Core Measure
Timely transmission of transition record (inpatient discharges to home/self-care or any other site of care). Percentage of patients, regardless of age, discharged from an inpatient facility to home or any other site of care for whom a transition record was transmitted to the facility or primary physician or other health care professional designated for follow-up care within 24 hours of discharge. / AHRQ Adult Core Measure / Medical Record
Transition record with specified elements received by discharged patients (inpatient discharges to home/self care or any other site of care / AHRQ Adult Core Measure / Medical Record
Coronary Artery Disease: Drug Therapy for Lowering LDL Cholesterol. Percentage of patients age 18 years and older with a diagnosis of CAD who were prescribed a lipid lowering therapy. / AHRQ Adult Core Measure / Pharmacy Claims
Bipolar I Disorder 2: annual assessment of weight or BMI, glycemic control and lipids / AHRQ Adult Core Measure / Medical Record
Bipolar 1 Disorder C – proportion of patients with bipolar 1 disorder treated with mood stabilizer medications during the course of bipolar 1 disorder treatment / AHRQ Adult Core Measure / Pharmacy Claims
Schizophrenia 2 – annual assessment of weight or BMI, glycemic control and lipids / AHRQ Adult Core Measure / Medical Record
Schizophrenia B – Proportion of schizophrenia patients with long term use of antipsychotic medications. / AHRQ Adult Core Measure / Pharmacy Claims
Schizophrenia C – Proportion of selected schizophrenia patients with antipsychotic polypharmacy use. / AHRQ Adult Core Measure / Pharmacy Claims
Proportion of days covered – 5 rates by therapeutic category. The percentage of patients 18 years and older who met the proportion of days covered threshold of 80% during the measurement year. A performance rate is calculated separately fo the following medication categories: Beta Blockers (BB), Angiotensin-Converting Enzyme Inhibitor/Angiotensin-Receptor Blocker (ACEI/ARB), Calcium Channel Blockers (CCB), Diabetes Medication, Statins. / AHRQ Adult Core Measure / Pharmacy Claims
Proportion of youth served by rehabilitative and community services (Sect 28) showing reliable improvement on DHHS approved tool (e.g. VABS)
Proportion of youth showing reliable improvement as measured by YOQ and CAFAS, for specific services (HCT, TCM, Child ACT, etc.) for children and youth with serious emotional and behavioral challenges / Office of Children’s Behavioral Health / Functional Assessment data
Proportion of adults showing reliable improvement as measured by OQ and RAS, for specific services (ACT, CI, etc.) for adults with serious mental illness / Office of Mental Health / Functional Assessment data
Percent of children/youth who have at least one valid administration of the YOQ (i.e. no more than 10% of questions are left blank)( limited to children enrolled in specific CBHS services (e.g. HCT) / Office of Children’s Behavioral Health / Functional assessment data/admin records
Percent of Adults who have at least one valid administration of the OQ (i.e. no more than 10% of questions are left blank) – (Limited to adults enrolled in community integration services) / Office of Mental Health / Functional assessment data/admin records
Percent of children/youth who have valid follow-up administration of the YOQ at the state recommended intervals.(Limited to children enrolled in specific CBHS services (e.g. HCT) / Office of Children’s Behavioral Health / Functional Assessment data/admin records
Percent of adults who have valid follow-up administration of the OQ at the state recommended intervals. (Limited to adults enrolled in community integration services) / Office of Mental Health / Functional Assessment data/admin records
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