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## Complete Summary

#### TITLE

Eye care: percentage of patients aged 18 years and older with a
diagnosis of primary open-angle glaucoma who have an optic nerve head
evaluation during one or more office visits within 12 months.

#### SOURCE(S)

American Academy of Ophthalmology, Physician Consortium for Performance
Improvement®, National Committee for Quality Assurance. Eye care
physician performance measurement set. Chicago (IL): American Medical
Association, National Committee for Quality Assurance; 2007 Oct. 13 p.
\[8 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients aged 18 years
and older with a diagnosis of primary open-angle glaucoma (POAG) who
have an optic nerve head evaluation during one or more office visits
within 12 months.

#### RATIONALE

Changes in the optic nerve are one of two characteristics which
currently define progression and thus worsening of glaucoma disease
status (the other characteristic is visual field). There is a
significant gap in documentation patterns of the optic nerve for both
initial and follow-up care, even among specialists. Examination of the
optic nerve head and retinal nerve fiber layer provides valuable
structural information about glaucomatous optic nerve damage. Visible
structural alterations of the optic nerve head or retinal nerve fiber
layer and development of peripapillary choroidal atrophy frequently
occur before visual field defects can be detected. Careful study of the
optic disc neural rim for small hemorrhages is important, since these
hemorrhages can precede visual field loss and further optic nerve
damage.\*

\*The following clinical recommendation statement is quoted
[verbatim]{.underline} from the referenced clinical guidelines and
represents the evidence base for the measure:

The physical exam focuses on nine elements: visual acuity, pupils,
slit-lamp biomicroscopy of the anterior segment, measurement of
intraocular pressure (IOP), determination of central corneal thickness,
gonioscopy, evaluation of optic nerve head and retinal nerve fiber
layer, documentation of optic nerve head appearance, evaluation of
fundus (through dilated pupil), and evaluation of the visual field.
(American Academy of Ophthalmology \[AAO\])

#### PRIMARY CLINICAL COMPONENT

Primary open-angle glaucoma (POAG); optic nerve head evaluation

#### DENOMINATOR DESCRIPTION

All patients aged 18 years and older with a diagnosis of primary
open-angle glaucoma (POAG) (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients who have an optic nerve head evaluation during one or more
office visits within 12 months

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Primary open-angle
    glaucoma.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=8203)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Fremont AM, Lee PP, Mangione CM, Kapur K, Adams JL, Wickstrom SL,
Escarce JJ. Patterns of care for open-angle glaucoma in managed care.
Arch Ophthalmol2003 Jun;121(6):777-83.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12796247)

Lee PP, Walt JG, Doyle JJ, Kotak SV, Evans SJ, Budenz DL, Chen PP,
Coleman AL, Feldman RM, Jampel HD, Katz LJ, Mills RP, Myers JS, Noecker
RJ, Piltz-Seymour JR, Ritch RR, Schacknow PN, Serle JB, Trick GL. A
multicenter, retrospective pilot study of resource use and costs
associated with severity of disease in glaucoma. Arch Ophthalmol2006
Jan;124(1):12-9.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16401779)

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement\
National reporting

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All patients aged 18 years and older with a diagnosis of primary
open-angle glaucoma (POAG)

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients aged 18 years and older with a diagnosis of primary
open-angle glaucoma (POAG)

**Exclusions**

-   Documentation of medical reason(s) for not performing an optic nerve
    head evaluation

-   Documentation of system reason(s) for not performing an optic nerve
    head evaluation

**Note**: The system reason exclusion may be used if a physician is
asked to report on this measure but is not the physician providing the
primary management for POAG.

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients who have an optic nerve head evaluation during one or more
office visits within 12 months

**Exclusions**\
None

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Measure #1 primary open-angle glaucoma: optic nerve evaluation.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2007&doc=178)

#### MEASURE SET NAME

[Eye Care Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2007&doc=10282)

#### SUBMITTER

American Medical Association on behalf of the American Academy of
Ophthalmology, the National Committee for Quality Assurance, and the
Physician Consortium for Performance Improvement®

#### DEVELOPER

American Academy of Ophthalmology\
National Committee for Quality Assurance\
Physician Consortium for Performance Improvement®

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Paul P. Lee, MD, JD (*Co-Chair*); Jinnet B. Fowles, PhD (*Co-Chair*);
Richard L. Abbott, MD; Lloyd P. Aiello, MD, PhD; Priscilla P. Arnold,
MD; Richard Hellman, MD, FACP, FACE; Leon W. Herndon, MD; Kenneth J.
Hoffer, MD; Jeffrey S. Karlik, MD; Mathew W. MacCumber, MD, PhD; Mildred
M.G. Olivier, MD; James L. Rosenzweig, MD, FACE; Sam J.W. Romeo, MD,
MBA; John T. Thompson, MD

Andrea Gelzer, MD, MS, FACP, Health Plan Representative (HealthNet)

Rebecca A. Kresowik, Consortium Consultant; Timothy F. Kresowik, MD,
Consortium Consultant

Flora Lum, MD, American Academy of Ophthalmology

Heidi Bossley, MSN, MBA, American Medical Association; Karen Kmetik,
PhD, American Medical Association

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Conflicts, if any, are disclosed in accordance with the Physician
Consortium for Performance Improvement® conflict of interest policy.

#### ENDORSER

National Quality Forum

#### INCLUDED IN

Ambulatory Care Quality Alliance\
Physician Quality Reporting Initiative

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2006 Oct

#### REVISION DATE

2007 Oct

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Academy of Ophthalmology, Physician Consortium for Performance
Improvement®, National Committee for Quality Assurance. Eye care
physician performance measurement set. Chicago (IL): American Medical
Association, National Committee for Quality Assurance; 2007 Oct. 13 p.
\[8 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Measure #1 Primary Open-Angle Glaucoma: Optic
Nerve Evaluation,\" is published in the \"Eye Care Physician Performance
Measurement Set.\" This document and technical specifications are
available in Portable Document Format (PDF) from the American Medical
Association (AMA)-convened Physician Consortium for Performance
Improvement® Web site:
[www.physicianconsortium.org](http://www.physicianconsortium.org/).

For further information, please contact AMA staff by e-mail at
<cqi@ama-assn.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on February 11, 2008.
The information was verified by the measure developer on April 14, 2008.

#### COPYRIGHT STATEMENT

© Measures including specifications © 2007 American Medical Association
and National Committee for Quality Assurance.

CPT® Copyright 2006 American Medical Association

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008