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## Complete Summary

#### TITLE

Eye care: percentage of patients aged 50 years and older with a
diagnosis of age-related macular degeneration (AMD) who had a dilated
macular examination performed which included documentation of the
presence or absence of macular thickening or hemorrhage, AND the level
of macular degeneration severity 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 50 years
and older with a diagnosis of age-related macular degeneration (AMD) who
had a dilated macular examination performed which included documentation
of the presence or absence of macular thickening or hemorrhage, AND the
level of macular degeneration severity during one or more office visits
within 12 months.

#### RATIONALE

A documented complete macular examination is a necessary prerequisite to
determine the presence and severity of age-related macular degeneration
(AMD), so that a decision can be made as to the benefits of prescribing
antioxidant vitamins. Further, periodic assessment is necessary to
determine whether there is progression of the disease and to plan the
on-going treatment of the disease, since several therapies exist that
reduce vision loss once the advanced \"wet\" form of AMD occurs. While
no data exists on the frequency or absence of regular examinations of
the macula when patients are under the care of an ophthalmologist for
AMD, parallel data for key structural assessments for glaucoma and
cataract and diabetic retinopathy suggest that significant gaps are
likely.\*

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

A stereo biomicroscopic examination of the macula should be completed.
Binocular slit-lamp biomicroscopy of the ocular fundus is often
necessary to detect subtle clinical clues of Choroidal
neovascularization (CNV). These include small areas of hemorrhage, hard
exudates, subretinal fluid, or pigment epithelial elevation. (American
Academy of Ophthalmology \[AAO\])

#### PRIMARY CLINICAL COMPONENT

Age-related macular degeneration (AMD); dilated macular examination;
documentation of macular thickening or hemorrhage; level of macular
degeneration severity

#### DENOMINATOR DESCRIPTION

All patients aged 50 years and older with a diagnosis of age-related
macular degeneration (AMD) (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients who had a dilated macular examination performed which included
documentation of the presence or absence of macular thickening or
hemorrhage AND the level of macular degeneration severity 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

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### 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 50 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 50 years and older with a diagnosis of age-related
macular degeneration (AMD)

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients aged 50 years and older with a diagnosis of age-related
macular degeneration (AMD)

**Exclusions**

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

-   Documentation of patient reason(s) for not performing a dilated
    macular examination

-   Documentation of system reason(s) for not performing a dilated
    macular 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 AMD.

#### 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 examination performed which included
documentation of the presence or absence of macular thickening or
hemorrhage AND the level of macular degeneration severity 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 #3 age-related macular degeneration: dilated macular
examination.

#### 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 #3 Age-Related Macular Degeneration:
Dilated Macular Examination,\" 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