Description:

The percentage of members between 18 and 75 years of age as of 12/31 of the reporting year who were continuously enrolled during the reporting year, have a diagnosis of coronary artery disease and who are up-to-date for all appropriate services. Also reported is the percentage of components up-to-date.

Required sample size:

Sample size of 60 records per medical group

Data elements provided for medical record abstraction tool:

· Member’s medical group

· Member’s clinic location as of 12/31 of reporting year

· Member’s current clinic location

· Member name

· Member’s date of birth (DOB)

· Member identification number (DEC#, TD#)

· Date of last LDL level test

· Pharmacy (Rx) benefit

· Measurement set

· Sort by medical group, clinic, alpha sort by patient name

Record exclusions:

· Member does not have CAD (Column K, 1=yes)

· Member was a nursing home resident, hospice resident or died but was not disenrolled during 1999, (Column L, 1=yes)

Data to be collected:

(A) Smoker/advice to quit (A₁); smoker/no advice to quit (A₂) (1=yes, 0=no)

(B) Nonsmoker (1=yes, 0=no)

(C) Unknown tobacco user (1=yes, 0=no)

(D) LDL Date (may be prepopulated)

(E) LDL level (record actual LDL value)

(F) Lipid Rx (1=yes, 0=no, N/A)

(G) ASA Use (1=yes, 0=no, N/A=contraindicated)

(H) Blood Pressure (H1) systolic; (H2) diastolic

(I) Exercise assessment (1=yes, 0=no)

(J) Nutrition assessment (1=yes, 0=no)

(K) Record indicates the number did not have CAD (1=yes)

(L) Nursing home resident, hospice resident or member died in 1999 (1=yes)

(M) Record exists; not available for review (1=yes)

(N) Record does not exist (1=yes)

Location of data in medical record:

· Medical history/problem list

· Preventive summary/risk assessment tools

· Provider progress notes

· Laboratory data

· Smoker/advice to quit/no advice to quit: Most recent visit progress note (up to 12/31/99)

· Non-smoker: Label, general form, most recent visit progress note

Data required to generate a positive result:

A. Smoker: advice to quit (A₁) Most recent visit progress note of ’99. Information at the most recent visit progress note that shows that a user was asked about use at that visit. The visit must be a face-to-face encounter with a health care provider. A provider is defined as an MD, DO, NP, CNM, or PA. Tobacco use includes cigarettes, cigars, pipes or “chew.” If the patient is a child or adolescent (<13), a similar identification should be used to show that the child is not exposed to smoke from a parent, guardian or child care provider (i.e., if the child is breathing the smoke of others regularly, s/he is a smoker). If a special tobacco flowsheet is used, a notation consistent with the date of the last progress notes is adequate. Documentation in the progress note or tobacco flowsheet from the latest visit with a clinician of either advice to quit, or information about the user’s current interest or readiness to quit must exist. “Smoking discussed” is adequate.

Smoker/no advice to quit (A₂): Most recent visit progress note of ’99. Information at the most recent progress note that shows a user was asked about use at that visit. The visit must be a face-to-face encounter with a health care provider. A provider is defined as an MD, DO, NP, CNM, or PA. Tobacco includes cigarettes, cigars, pipes or “chew.” If the patient is a child or adolescent (<13), a similar identification should be used to show that the child is not exposed to smoke from a parent, guardian, or child care provider (i.e., if the child is breathing the smoke of others regularly, s/he is a smoker). If a special tobacco flowsheet is used, a notation consistent with the date of the last progress notes is adequate. If neither advice to quit nor an expression of the user’s interest in quitting is documented, consider no advice given.

B. Non-Smoker: A label or mark anywhere on the chart, or on general forms like a problem list, or on the most recent visit progress note that shows the patient has been asked at least once and reported not using tobacco. If the patient is a child/adolescent (<13), similar documentation should be used to show that the child is not exposed to smoke from a parent, guardian or childcare provider.

C. Unknown with Medical Record: No label or mark on the chart, or a known user with no documentation at the most recent visit as to the current use status. The visit must be a face-to-face encounter with a health care provider. If a discrepancy exists in the chart (e.g., non-smoking sticker on chart and also a note indicating the patient is a smoker) with no documentation at the most recent visit as to the current use status, status should be considered unknown.

D. LDL drawn in reporting year:

· LDL must be drawn during a 12-month reporting period ending December 31, 1999.

Data required to generate a positive result (cont):

· Field will be prepopulated with date of last test from claims, etc. files. If no date is entered, check for LDL within reporting year and record date of most recent.

· If you find a more recent LDL within 1999 than the date given, you may change the date and enter the level of most recent LDL in Column D.

· If no LDL can be found in 1999, Column D = 0.

E. LDL Level

· If multiple LDLs have been drawn over the reporting period, record level of most recent test.

· If no LDL level from the reporting period can be found in the medical record, enter “0” in Column E.

· If lab result = ULDL indicating triglycerides are too high to calculate a LDL level, enter a LDL level of 300 in Column E.

· If no LDL level, the following test values can be recorded on the back of your worksheet to allow us to calculate the LDL level. (We can only calculate the LDL if triglycerides <400): Total cholesterol value, HDL value, Triglycerides value. If lipoprotein is also measured, record this value also. We don’t need this value to calculate the LDL; however, if it is given this value will be used to modify our calculation.

F. Lipid Rx

· Evidence in the medical record that member is using a lipid-lowering drug (drug list attached) at any time during the reporting year.

G.ASA Use

· Evidence in the medical record that member is currently on ASA therapy. Any reference in 1999 for ASA use will be sufficient as long as there is no subsequent evidence in 1999 the member was advised to discontinue ASA.

· List of contraindications for ASA use attached.

H.Blood Pressure

· Blood pressure at the most recent visit of the reporting year. Record systolic in (H₁), and record diastolic in (H₂).

Guidelines for multiple blood pressure readings from a single visit:

· Multiple BPs in different positions–Use sitting BP measurement; if no sitting BP then use supine BP; if no supine then use standing BP.

· Multiple BPs in a given position–Count the lowest BP; the position hierarchy above would still apply.

· Multiple BPs without an indication of position–Use the lowest BP.

I. Exercise assessment

· Exercise assessment documented within reporting year. Example: Risk assessment tool, phone consultation, progress note.

J. Nutrition assessment

· Nutrition assessment documented within reporting year. Example: Risk assessment tool, phone consultation, progress note.

K. Documentation in the medical record must indicate the patient has CAD (see attached list for operational definition of coronary artery disease). If no CAD, enter 1 in Column K.

Data elements required:

· Member’s medical group

· Member’s clinic location as of 12/31 of reporting year

· Member’s current clinic location

· Member’s name

· Member’s date of birth (DOB)

· Member identification number

· Date of last LDL level test

· Pharmacy (Rx) benefit

· Measurement set

(O) Smoker/advice to quit (A₁); smoker/no advice to quit (A₂) (1=yes, 0=no)

(P) Nonsmoker (1=yes, 0=no)

(Q) Unknown tobacco user (1=yes, 0=no)

(R) LDL Date (may be prepopulated)

(S) LDL level (record actual LDL value)

(T) Lipid Rx (1=yes, 0=no, N/A)

(U) ASA Use (1=yes, 0=no, N/A=contraindicated)

(V) Blood Pressure (H1) systolic; (H2) diastolic

(W) Exercise assessment (1=yes, 0=no)

(X) Nutrition assessment (1=yes, 0=no)

(Y) Record indicates the number did not have CAD (1=yes)

(Z) Nursing home resident, hospice resident or member died in 1999 (1=yes)

(AA) Record exists; not available for review (1=yes)

(BB) Record does not exist (1=yes)