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Table 2 Outcome measures from HIE and/or EHR data

From: Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma

Measure (Source)

Numerator

Denominator*

Exclusion

Data Source

Aspirin (PQRS 204/NQF 0068)

Patients in denominator with documented use of aspirin or other antithrombotic

Patients 18+ years of age with Ischemic Vascular Disease diagnosis, or hospital discharge for acute myocardial infarction, coronary artery bypass graft, or percutaneous coronary interventions

On another anticoagulant, GI bleeding history, aspirin allergy

Health Information Exchange (HIE)

Blood Pressure Management 1 (PQRS 236/NQF 0018)

Patients in denominator whose blood pressure was adequately controlled (< 140/90)

Patients aged 18 through 85 years with a diagnosis of hypertension

End stage renal disease, dialysis, renal transplant, or diagnosis of pregnancy

HIE

Blood Pressure Management 2

Patients in denominator whose blood pressure was adequately controlled (age 18–59 and/or people with diabetes or chronic kidney disease < 140/90; age 60–85 < 150/90)

Patients aged 18 through 85 with a diagnosis of hypertension

Lacking a DM or CKD diagnosis

HIE

Cholesterol Management 1 (PQRS 316)

Patients in the denominator whose risk-stratified fasting LDL is at or below the recommended LDL goal

Patients aged 20 through 79 years of age who had a fasting LDL performed

 

HIE and chart audits

Cholesterol Management 2

Patients in the denominator who were prescribed the recommended dose of statin based on risk status

Patients aged 20 through 79 years of age who had a fasting LDL performed

 

HIE and chart audits

Smoking Cessation Support (PQRS 226/NQF 0028)

Patients in denominator who were screened about tobacco use one or more times within 24 months AND who received tobacco cessation counseling intervention if identified as a tobacco user

Patients age 18+ years

Documentation of medical reason(s) for not screening for tobacco use

HIE

  1. *Note: Population denominators will be based on active patient—defined as patients who have been seen in the practice within the previous 18 months
  2. Abbreviations: CABG coronary artery bypass grafting, CKD chronic kidney disease, COPD chronic obstructive pulmonary disease, CVA cerebral vascular accident, DM diabetes mellitus, ED emergency department, GI gastric intestinal, LDL low-density lipoprotein, LOS length of stay, MI myocardial infarction, PQRS physician quality reporting system, NQF National Quality Forum