Clinical Measures for Health Center Grantee Performance Reviews –
Calendar Year 2007

General References for Clinical Measures

• National Quality Measures Clearinghouse (Administration for Healthcare Quality & Research)
• The State of Health Care Quality 2005 (not a U.S. Government Web site)
• Health Disparities Collaborative Overview
• Healthy People 2010 Operational Definitions

End Notes
Each note corresponds to the numbered clinical performance measure.

1. Data for this performance measure may be derived from UDS table 7, line 16a+16b divided by line 8a. The reviewer must also note whether or not the grantee has documented the receipt and use of a perinatal medical risk assessment (e.g., POPRAS, Hollister, Creasy or other equivalent comprehensive assessment) or not. The analysis of this measure includes whether or not a complete perinatal risk assessment is being done. For examples of applied guidelines and systems of care, see Prenatal Care, Routine Guidelines (not a U.S. Government Web site)
2. The performance measure may also be written in terms of the most current American College of Obstetrics and Gynecology (ACOG) guidelines.
3. The performance measure may also be written in terms of the new American Academy of Pediatrics (AAP) guidelines’ algorithm, (e.g., 2 - 5 days), which changed in mid-2005. However, if the new AAP guidelines are followed, the reviewer may need to allow for a lag time for clinical implementation and a year of data collection.
4. “Persistent” asthma would include the mild, moderate and severe persistent asthmatics according to the NHLBI classification scheme. It would not include the mild intermittent asthmatics. According to current clinical practice guidelines, appropriate medications include anti-inflammatory and mast cell stabilizers. See National Heart Lung & Blood Institute Asthma Guidelines . For an applied system of care, see Asthma, Diagnosis and Outpatient Management of Guideline (not a U.S. Government Web site).
5. The behavioral risk assessment may consist of any of or all of the following topics: tobacco, alcohol, illicit drugs, sexual behavior, family planning counseling, abstinence, motor vehicle, accidents/injuries and other risk behavior. The reviewer must specify what elements of the behavioral risk assessment are included for a particular performance review. See Youth Risk Behavior Surveillance System.
6. Specific parameters for a patient being under control as described by the Adult Treatment Panel III (ATP III) are provided below:
   a. LDL < 100 if CAD or high CAD risk;
   b. LDL < 130 if no CAD but > (or equal to) 2 risk factors or moderate CAD risk
   c. LDL < 160 if no CAD and 0-1 risk factors or low CAD risk
   See Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
7. For more information on Cancer screening see Screening & Testing to Detect Cancer and PDQ Cancer Information Summaries: Screening/Detection
   Breast: Breast Disease, Diagnosis of Guideline (not a U.S. Government Web site)
   Cervical: Cervical Cancer Screening Guideline (not a U.S. Government Web site) and Pap Smear, Initial Abnormal: Management of Guideline (not a U.S. Government Web site)
   Colorectal: Colorectal Cancer Screening Guideline (not a U.S. Government Web site)
   Cancer Treatment: Cancer Treatment General Information and PDQ Cancer Information Summaries: Adult Treatment
8. According to guidelines of The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), an adult patient’s blood pressure is controlled if their most recent blood pressure is less than 140/90 mmHg, or for a patient with diabetes or chronic renal disease, if less than 130/80 mmHg. See The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
   An example of a system of care: Hypertension Diagnosis & Treatment Guideline (not a U.S. Government Web site)
9. Tobacco users include patients using cigarettes, cigars, chew, snuff, etc. For more information on tobacco users and quitting see: Tobacco Information & Prevention Source and Fact Sheet: Tobacco/Smoking Cessation.
   An example of an applied system of care for use prevention and cessation: Tobacco Use Prevention and Cessation for Adults and Mature Adolescents Guideline
10. See Clinical Practice Guidelines of the American Diabetes Association (not a U.S. Government Web site)
    An example of a system of care: Diabetes Mellitus, Type 2; Management of Guideline (not a U.S. Government Web site)
11. This operational definition is derived from Indian Health Service, and the Colorado Community Health Network and the HRSA Bureau of Primary Health Care Oral Health Disparities Collaborative pilot.
12. These measures derive from the U.S. Preventive Health Services Task Force and the HRSA Bureau of Primary Health Care Depression Health Disparities Collaborative.
    See U.S. Preventive Services Task Force Screening for Depression and Health Disparities Collaboratives Topics: Depression
    Health Disparities Collaborative on Depression draws on The MacArthur Initiative on Depression and Primary Care
    Another detailed system of care: Depression, Major, in Adults in Primary Care Guideline
13. Immunization guidelines, as defined by age & risk group, are listed below:
    a. Children: by age 2 years (19–35 months) should have received DTaP – four times, IPV- three times, MMR - once, Hib – three times, HepB – three times This sequence of immunizations is referred to as "43133." Although the defined immunization measure is “43133”; a complete series by age 2 may also include: Varicella - once; PCV – four times; and Hib – four times).
    b. Adolescent: 13 years of age with second MMR, completion of HepB three times, Td booster and Varicella.
    c. Adult: 50-64 years of age with annual seasonal influenza vaccine during prior influenza season.
    d. Geriatric: = 65 years of age with a documented pneumococcal vaccination once after 65, and an annual seasonal influenza vaccination during prior influenza season.
    e. HIV/AIDS: documented pneumococcal vaccine, influenza vaccine, completed Hepatitis A – twice, and Hepatitis B – three times
    See Advisory Committee on Immunization Practices
14. The age and overweight or obesity guidelines are:
    a. Children: 2-18 years of age with a BMI >85th% (overweight) or >95th% (obesity), depending on what is tracked by grantee, and who also have healthy weight counseling or other intervention or treatment as documented within the past one year.
    b. Adults: age = 19 years of age with a BMI = 30 with “obesity” written on problem list in their medical record within the last 2 years, and who also have healthy weight counseling or other intervention or treatment documented.
    See 2000: CDC Growth Charts U.S. and Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults