Breast Cancer Screening
Women 42–69 years as of December 31 of the measurement year who have had a mammogram to screen for breast cancer during the measurement year and the year prior to the measurement year.
Chlamydia Testing
Women 16–25 years as of December 31 of the measurement year who were identified as being sexually active and had at least one Chlamydia test.
Cervical Cancer Screening
Women 21–64 years of age who received one or more Pap tests to screen for cervical cancer as of December 31 of the measurement year.
Persistence of Beta-blocker therapy post acute myocardial infarction
The percentage of members 18 years of age and older during the measurement year who were hospitalized and discharged alive from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of acute myocardial infarction and who received persistent beta-blocker treatment for six months (180 days) after discharge as evidenced by pharmacy claims data. (prescriptions filled.)
HbA1c Testing in Diabetics
One A1C test as of December 31st of the reporting year for members aged 18-75 identified with diabetes.
Lipid Measurement in Diabetes
One LDL-C test as of December 31st of the reporting year for members aged 18-75 identified with diabetes.
Urine Protein Testing in Diabetes
One nephropathy (microalbumin) testas of December 31st of the reporting year or evidence of nephropathy indicated by a positive macroalbumin test confirmed by automated laboratory result data; or evidence of ACE inhibitor/ARB treatment or treatment for nephropathy
Diabetic Eye Exams
Aretinal or dilated eye exam by an eye care professional as of December 31st of the reporting year or a negative retinal exam by an eye care professional in the prior year.
Appropriate Treatment for Children with Upper Respiratory Infection
The percentage of children 3 months – 18 years of age who had an encounter with a
diagnosis of acute upper respiratory infection and who were not dispensed an
antibiotic for the episode.
Appropriate Testing for Children with Pharyngitis
Percentage of children 2-18 years of age who had an encounter with only a diagnosis of pharyngitis, who were dispensed an antibiotic and who received a group A streptococcus test for the episode. Children who received antibiotics in the prior 30 days are excluded.
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Best Practices – Clinical Guidelines NCQA HEDIS Measures
