Tufts-healthplan.org

2012 HEDIS Measures*
Preventive health care
Children and adolescents
Weight assessment and Members age 3–17 years who had evidence of body mass index (BMI) percentile including height and weight, counseling for nutrition and counseling for physical activity documented during an outpatient visit, either by a claim or as a medical record entry Six wel care visits at least 2 weeks apart with a PCP showing evidence of al of the Health and development history (physical and mental) Annual wel care visit with a PCP each year showing evidence of al of the fol owing: Health and development history (physical and mental) Annual wel care visit with a PCP or OB/GYN showing evidence of al of the fol owing: Health and development history (physical and mental) Series must be completed by the 2nd birthday: 1 VZV, or documented chicken pox disease (or positive serology) occurring < 4 pneumococcal conjugate (none < 42 days of age 2-3 rotavirus (none < 42 days of age) 1 meningococcal vaccine on or between the 11th and 13th birthdays 1 Tdap or 1 Td on or between the 10th and 13th birthdays Exclusions: Contraindication to either vaccine Children age 2 who received at least one capil ary or venous lead screening test on or children (Medicaid only) before their second birthday. Treatment of children Children age 3 months–18 years who were given a diagnosis of upper respiratory infection (URI) and were NOT dispensed an antibiotic prescription within 3 days of the URI diagnosis. Exclusions: Encounters with > 1 diagnosis, children with a history of antibiotic prescription within 30 days of encounter Children age 2–18 years who had an outpatient visit or ED encounter with only a diagnosis of pharyngitis who were dispensed an antibiotic and also received a Group A streptococcus test three days before or three days after the prescription. Exclusions: Encounters with > 1 diagnosis and children with a history of antibiotic prescription within 30 days of encounter Children age 6–12 years who received an initial prescription for ADHD medication and Received at least one fol ow-up visit with a prescriber within 30 days of Remained on the medication for at least 210 days and who, in addition to the visit in the initiation phase, had at least two more fol ow-up visits between four * HEDIS® is a registered trademark of NCQA Women and adolescent girls
Yearly screening test for chlamydia for women age 16–24 identified as presumed sexual y active by pharmacy prescription data or claims data indicating potential sexual activity Exclusions: Women who had a pregnancy test fol owed within seven days by either a prescription for Accutane (isotretinoin) or an X-ray. For women age 21–24, PAP test within the measurement year or prior two years. Exclusions: Women who have had a complete hysterectomy with no residual cervix. Breast cancer screening For women age 40–69, mammogram in the measurement year or one year prior. Exclusions: Women who have had bilateral mastectomy. Three doses of HPV vaccine on or between the 9th and 13th birthdays adolescents
Prenatal and
Prenatal visit within first trimester (or within 42 days of enrol ment) Postpartum visit between 21–56 days after delivery Patients 20 years and older who had an ambulatory or preventive care visit health services
Adult BMI assessment
People age 18–74 who had their body mass index (BMI) and weight documented during an outpatient visit, either by a claim or as a medical record entry during the Adults age 18–64 diagnosed with acute bronchitis who did not receive an antibiotic prescription on or within three days of diagnosis with acute bronchitis
Colorectal cancer
For adults age 50–75, one or more of the fol owing screenings: Exclusions: Persons with colorectal cancer or who have had a total colectomy Adults age 18 and older on persistent medications (at least 180 days) who received Exclusion: Anyone with a hospitalization in the measurement year For persons age 18 years and older, percentage of acute inpatient stays followed by an acute readmission for any cause within 30 days. * HEDIS® is a registered trademark of NCQA Adults 65 and older who had each of the fol owing during the measurement year: Medicare members age 65 and older without a prior diagnosis of glaucoma or glaucoma suspect who received a glaucoma eye exam by an ophthalmologist or optometrist. Women age 67 and older who received the fol owing within six months after a fracture: • Prescription for a drug to treat or prevent osteoporosis within six months after Exclusions: Women who received screening and/or treatment in the year prior to the fracture. Fractures of the finger, toe, face and skull are not included in this measure. Condition-specific care
Alcohol and other drug dependence
Patients age 13 and older diagnosed with alcohol and other drug dependence who: • receive two additional alcohol/other drug dependence services within 30 days of Children and adults age 5-56 years identified with asthma who received prescription for long-term control of asthma (inhaled corticosteroids, cromolyn sodium, nedocromil, leokotriene modifiers, methylxanthines). Exclusions: Patients with a diagnosis of emphysema, COPD, cystic fibrosis, or acute respiratory failure Note: Long-acting beta-2 agonists alone do not count for this measure. They are The percentage of patients age 5–64 years during the measurement year who were identified as having persistent asthma and were dispensed appropriate medications that they remained on during the treatment period. The percentage of patients who remained on an asthma control er medication for at least 50% of their treatment period The percentage of patients who remained on an asthma control er medication for at least 75% of their treatment period Exclusions: Emphysema, COPD, cystic fibrosis, acute respiratory failure, or no dispensed Persons age 18 and older who were hospitalized and discharged alive after an acute MI who received treatment with beta blockers for six months after discharge Exclusions: Patients identified as having a contraindication or with a history of adverse * HEDIS® is a registered trademark of NCQA Adults age 18-75 who were discharged alive for any of the fol owing: Or who had a diagnosis of ischemic vascular disease. Patient should have each of the fol owing during the measurement year: Adults age 18-85 with a diagnosis of hypertension whose most recent blood pressure Exclusions: Adults with end stage renal disease (ESRD), adultts pregnant during the
Chronic obstructive pulmonary disease (COPD)
Adults age 40 and older with a new (within the measurement year) diagnosis or newly
active COPD who received spirometry testing to confirm the diagnosis. Spirometry testing must occur 730 days prior to or 180 days after the diagnosing event. Adults age 40 or older who had an acute inpatient discharge or an ED encounter with a principal diagnosis of COPD who were dispensed both a systemic corticosteroid within
14 days of discharge and a bronchodilator within 30 days of discharge
This measure is based on discharges and visits. Multiple events for the same patient

Depression
Adults age 18 and older newly diagnosed with depression and treated with an
antidepressant who received the fol owing: Effective acute phase: fil ed sufficient number of prescription to al ow for 84 Effective continuation phase: fil ed sufficient number of prescription to al ow for To qualify as a new diagnosis, two criteria must be met:
A 120-day (4-month) negative diagnosis history on or before the start date A 90-day (3-month) negative medication history on or before the start date
Mental illness
Persons age 6 years and older discharged from an inpatient mental health admission and One fol ow-up encounter with a mental health provider within seven days after One fol ow-up encounter with a mental health provider within 30 days after
Tobacco use
Medical assistance with Current smokers age 18 and older who were seen by a practitioner during the Cessation methods and medications were recommended and discussed * HEDIS® is a registered trademark of NCQA

Source: http://www.tufts-healthplan.org/providers/quality/pdfs/2012_hedis_measures.pdf