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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 with documented communication to the physician who
manages the on-going care of the patient with diabetes regarding the
findings of the macular or fundus exam at least once 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 with documented communication to the
physician who manages the on-going care of the patient with diabetes
regarding the findings of the macular or fundus exam at least once
within 12 months.

#### RATIONALE

The primary care physician should be aware of the patient\'s dilated eye
examination and severity of retinopathy to manage the on-going diabetes
care. Such communications is important in assisting the primary care
physician to better manage the diabetes. Several studies have shown that
better management of diabetes is directly related to lower rates of
development of diabetic eye disease (Diabetes Control and Complications
Trial - DCCT, UK Prospective Diabetes Study - UKPDS).\*

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

Communicate with the attending physician, e.g., family physician,
internist, or endocrinologist, regarding eye findings. (American Academy
of Ophthalmology \[AAO\])

While it is clearly the responsibility of the ophthalmologist to manage
eye disease, it is also the ophthalmologist\'s responsibility to ensure
that patients with diabetes are referred for appropriate management of
their systemic condition. It is the realm of the patient\'s family
physician, internist or endocrinologist to manage the systemic diabetes.
The ophthalmologist should communicate with the attending physician.
(AAO)

#### PRIMARY CLINICAL COMPONENT

Diabetic retinopathy; dilated macular or fundus exam; documented
communication to physician who manages on-going diabetes care

#### DENOMINATOR DESCRIPTION

All patients aged 18 years and older with a diagnosis of diabetic
retinopathy who had a dilated macular or fundus exam performed (see the
related \"Denominator Inclusions/Exclusions\" field in the Complete
Summary)

#### NUMERATOR DESCRIPTION

Patients with documentation, at least once within 12 months of the
findings of the dilated macular or fundus exam via communication to the
physician who manages the patient\'s diabetic care (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

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 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 who had a dilated macular or fundus exam performed

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients aged 18 years and older with a diagnosis of diabetic
retinopathy who had a dilated macular or fundus exam performed

**Exclusions**

-   Documentation of medical reason(s) for not communicating the
    findings to the physician who manages the on-going care of the
    patient with diabetes

-   Documentation of patient reason(s) for not communicating the
    findings to the physician who manages the on-going care of the
    patient with diabetes

-   Documentation of system reason(s) for not communicating the findings
    to the physician who manages the on-going care of the patient with
    diabetes

**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\
Diagnostic Evaluation\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients with documentation, at least once within 12 months of the
findings of the dilated macular or fundus exam via communication to the
physician who manages the patient\'s diabetic care

**Note**: Communication may include:

-   Documentation in the medical record indicating that the results of
    the dilated macular or fundus exam were communicate (e.g., verbally,
    by letter) with the physician managing the patient\'s diabetic care

> OR

-   A copy of a letter in the medical record to the physician managing
    the patient\'s diabetic care outlining the findings of the dilated
    macular or fundus exam.

**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 #8 diabetic retinopathy: communication with the physician
managing on-going diabetes care.

#### 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 #8 Diabetic Retinopathy: Communication
with the Physician Managing On-going Diabetes Care,\" 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