Proportion of Patients with a Chronic Condition that have a Potentially Avoidable Complication during a Calendar Year
Percent of adult population aged 18+ years who were identified as having at least one of the following six chronic conditions: Asthma, Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease (CAD), Heart Failure (HF), Hypertension (HTN), or Diabetes Mellitus (DM), were followed for at least one-year, and had one or more potentially avoidable complications (PACs) during the most recent 12 months. Please reference attached document labeled NQF_Chronic_Care_PACs_01_24_17.xls, in the tabs labeled PACs I-9 & I-10 for a list of code definitions of PACs relevant to each of the above chronic conditions.
We define PACs as one of two types:
(1) Type 1 PACs - PACs related to the index condition: Patients are considered to have a PAC, if they receive services during the episode time window for any of the complications directly related to the chronic condition, such as for acute exacerbation of the index condition, respiratory insufficiency in patients with Asthma or COPD, hypotension or fluid and electrolyte disturbances in patients with CAD, HF or diabetes etc.
(2) Type 2 PACs - PACs related to Patient Safety or broader System Failures: Patients are also considered to have a PAC, if they receive services during the episode time window for any of the complications related to patient safety or health system failures such as for sepsis, infections, phlebitis, deep vein thrombosis, pressure sores etc.
ACP does not support NQF measure #0709: “Proportion of Patients with a Chronic Condition that have a Potentially Avoidable Complication during a Calendar Year.” This measure represents an important clinical concept; however, the specifications are flawed and we note some potential issues with feasibility. The specifications are not clearly defined and the outcome is subject to individual patient factors; specifications should include some element of risk-adjustment; and developers cite limited evidence to form the basis of the measure. Additionally, the denominator population is too broad. As written, the denominator population includes all hospitalized patients with any complication of every chronic condition. Furthermore, developers limited testing samples to patients who were treated in Vermont healthcare systems; therefore, reliability may be low in other areas of the country. Finally, it is unclear how well this measure will work at smaller levels of attribution. As currently specified, the measure pulls from large plan data to generate results and developers admit that coding may be an inaccurate method for data collection. A more meaningful measure for inclusion in quality improvement programs may focus on preventing potentially avoidable complications of particular conditions.