Brief Description of Measure:

CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

CMS124: Cervical Cancer Screening

CMS125: Breast Cancer Screening

CMS127: Pneumococcal Vaccination Status for Older Adults

CMS128: Anti-depressant Medication Management

CMS130: Colorectal Cancer Screening

CMS131: Diabetes: Eye Exam

CMS134: Diabetes: Medical Attention for Nephropathy

CMS136: Follow-Up Care for Children Prescribed ADHD Medication (ADD)

CMS139: Falls: Screening for Future Fall Risk

CMS153: Chlamydia Screening for Women

CMS155: Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents

CMS165: Controlling High Blood Pressure

CMS249: Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture

Description of Issue:

The indicated measures specify patient age requirements that must be met to satisfy the criterion, which currently use 'exclusive brackets', ")". The use of exclusive brackets is a result of adhering to the use of "start of measurement period" as a point-in-time for age calculation and reconciling this deviation from HEDIS parent measures, which typically use the "end of measurement period" for age calculation.

Here is an example from CMS 249:

Current Header: Initial Population
Female patients ages 50 to 64 years with an encounter during the measurement period

Current Logic: Initial Population
...start of "Measurement Period" ) in Interval[50, 64 )

We received feedback that the use of exclusive brackets, ")" in age criteria is confusing. The CQL Style Guide v5 (https://ecqi.healthit.gov/sites/default/files/CQL-Style-Guide-v5.pdf) recommends using closed brackets, [ and ], instead of open brackets.

This issue applies to all of the measures identified, and would follow the same pattern as this example from CMS 249.

Proposed Solution:

NCQA would like to remove any instances in the age criteria logic using open/exclusive brackets and making sure that the corresponding logic and the header still align with the measure intent.

Here is an example of the proposed revision in CMS 249:

Proposed Header: Initial Population
Female patients age 51 to 64 years at the end of the measurement period with an encounter during the measurement period 

Proposed Logic: Initial Population
...end of "Measurement Period" ) in Interval[51, 64]

In measures like CMS 127, where this open and closed bracket issue doesn't apply, we also think it would be a good enhancement to modify the initial population description to that level of specificity (e.g. adding "age X at the start of the measurement period" or "age X at the end of the measurement period").

Rationale for Change:

The current way the logic is written is confusing, and the current headers leave room for ambiguity. NCQA wishes to better describe what the logic is doing in the header, and update the logic to better reflect the intent of the measures.