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## Complete Summary

#### TITLE

Eye care: percentage of patients aged 18 years and older with a
diagnosis of diabetic retinopathy who had a dilated macular or fundus
exam performed which included documentation of the level of severity of
retinopathy AND the presence or absence of macular edema 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 diabetic retinopathy who had a dilated
macular or fundus exam performed which included documentation of the
level of severity of retinopathy AND the presence or absence of macular
edema during one or more office visits within 12 months.

#### RATIONALE

Several level 1 randomized control trial (RCT) studies demonstrate the
ability of timely treatment to reduce the rate and severity of vision
loss from diabetes (Diabetic Retinopathy Study-DRS, Early Treatment
Diabetic Retinopathy Study-ETDRS). Necessary examination prerequisites
to applying the study results are that the presence and severity of both
peripheral diabetic retinopathy and macular edema be accurately
documented. In the RAND chronic disease quality project, while
administrative data indicated that roughly half of the patients had an
eye exam in the recommended time period, chart review data indicated
that only 19% had documented evidence of a dilated examination. Thus,
ensuring timely treatment that could prevent 95% of the blindness due to
diabetes requires the performance and documentation of key examination
parameters. The documented level of severity of retinopathy and the
documented presence or absence of macular edema assists with the
on-going plan of care for the patient with diabetic retinopathy.\*

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

Since treatment is effective in reducing the risk of visual loss,
detailed examination is indicated to assess for the following features
that often lead to visual impairment: presence of macular edema, optic
nerve neovascularization and/or neovascularization elsewhere, signs of
severe nonproliferative diabetic retinopathy (NPDR) and vitreous or
preretinal hemorrhage. (American Academy of Ophthalmology \[AAO\])

#### PRIMARY CLINICAL COMPONENT

Diabetic retinopathy; dilated macular or fundus exam; documentation of
level of severity of retinopathy; documentation of presence or absence
of macular edema

#### DENOMINATOR DESCRIPTION

All patients aged 18 years and older with a diagnosis of diabetic
retinopathy (see the related \"Denominator Inclusions/Exclusions\" field
in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients who had a dilated macular or fundus exam performed which
included documentation of the level of severity of retinopathy AND the
presence or absence of macular edema during one or more office visits
within 12 months (see the related \"Numerator Inclusions/Exclusions\"
field in the Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

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

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Diabetic
    retinopathy.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=4350)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr
EA. The quality of health care delivered to adults in the United States.
N Engl J Med2003 Jun 26;348(26):2635-45.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12826639)

### 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 diabetic
retinopathy

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients aged 18 years and older with a diagnosis of diabetic
retinopathy

**Exclusions**

-   Documentation of medical reason(s) for not performing a dilated
    macular or fundus examination

-   Documentation of patient reason(s) for not receiving a dilated
    macular or fundus examination

-   Documentation of system reason(s) for not receiving a dilated
    macular or fundus examination

**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 diabetic retinopathy.

#### 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 had a dilated macular or fundus exam performed which
included documentation of the level of severity of retinopathy AND the
presence or absence of macular edema during one or more office visits
within 12 months

**Note**: Medical record must include:

-   Documentation of the level of severity of retinopathy (e.g.,
    background diabetic retinopathy, proliferative diabetic retinopathy,
    nonproliferative diabetic retinopathy)

> AND

-   Documentation of whether macular edema was present or absent.

**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 #7 diabetic retinopathy: documentation of presence or absence of
macular edema and level of severity of retinopathy.

#### 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 #7 Diabetic Retinopathy: Documentation
of Presence or Absence of Macular Edema and Level of Severity of
Retinopathy,\" 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