Performance Measurement in the Hospital Outpatient Setting. Synthesis of Measures Relating to Reasons for Visits

02/01/2008

Table 4.1 presents the key diagnostic categories that we identified as the reasons for visits (based on V codes) to the HOPS by Medicare beneficiaries in 2005, and the corresponding counts of publicly available measures that pertain to these diagnoses. A more thorough review of the measures would be required to fully consider their applicability and how they might need to be modified for use in the hospital outpatient setting.

As Table 4.1 illustrates, there are many existing ambulatory measures designed to assess physician performance that address many of the key reasons for visits to the HOPS. For example, there are a substantial number of cardiology measures for ischemic heart conditions (AMI and coronary artery disease [CAD]) and congestive heart failure (CHF). Likewise, there are a fair number of measures that address diabetes, general medicine screening, respiratory conditions (such as COPD/asthma and pneumonia), and cancer (especially breast, gastrointestinal (GI), and prostate). There are also a significant number of mental health measures.

Table 4.1. Diagnostic Categories Associated with Visits by Medicare Beneficiaries to the HOPS in 2005 and Existing Measures33
Category
HOPS
Diagnostic Category Number of Related Measures
Dermatology Ulcer 9
Infection 1
Inflammation 0
Wounds 0
Benign Lesions 0
Gynecology Breast Mammogram-1
Pelvic Cervical Cancer Screen-3
Head and Neck Ear Hearing Loss-6
Esophagus 0
Hematology34 Anemia Chronic Kidney Disease-3 Medication Use-1
Red cell 0
Platelets 0
Medicine-Cardiology Conduction/dysrhythmias 3
Ischemic heart AMI/ACS-15 Coronary Artery Disease-14
Valvular disease 0
Heart failure 17
Medicine-Endocrinology Diabetes 15
Thyroid 0
Gout 0
Medicine — General Hypertension 16
Hyperlipidemia 3
Nutrition/Metabolism

Undernutrition- 5
Obesity- 3
Chronic Kidney Disease- 3
Heart Failure- 1
Diabetes- 1

 

Table 4.1. Diagnostic Categories Associated with Visits by Medicare Beneficiaries to the HOPS in 2005 and Existing Measures (continued)
Category
HOPS
Diagnostic Category Number of Related Measures
Medicine — General (cont) Drug monitoring 12
Screening 52
Vaccination 6
General Symptoms35 0
Follow up related to previous care 0
Rheumatology Osteoporosis-8 Rheumatoid Arthritis-1
Urinary Incontinence-12 Urinary Tract Infection-2 Benign Prostatic Hyperplasia-12
Venous system 6
Medicine-GI Abdominal symptoms, pain 0
Hepatitis, cirrhosis Hepatitis C-9
Gastroenteritis 0
Diverticulitis 0
Medicine-Infectious Disease HIV 4
Herpes 0
Medicine — Oncology/Neoplasia36 Chemotherapy 34
Radiotherapy 24
Leukemia/Lymphoma 5
Breast 31
Respiratory 1
GI 22
Gynecology 0
Skin 3
Urology (prostate) 18
Head and Neck 1
Medicine-Respiratory Sinusitis 2
Bronchitis 1
Pneumonia 12
Upper respiratory infection, cough 3
COPD/Asthma/Emphysema COPD-13 Asthma-17

 

Table 4.1. Diagnostic Categories Associated with Visits by Medicare Beneficiaries to the HOPS in 2005 and Existing Measures (continued)
Category
HOPS
Diagnostic Category Number of Related Measures
Neurology Parkinson’s disease 0
Alzheimer’s disease Dementia-14
Cerebrovascular 17
Seizures 0
Multiple Sclerosis 0
Peripheral nerve disorders 0
Ophthalmology Glaucoma 2
Cataract 28
Retinal Disorders 2
Orthopedics Spinal conditions 3
Joint pain/Arthritis 16
Osteomyelitis 0
Physical therapy, orthopedic aftercare 6
Limb pain 0
Abnormal radiologic finding 0
Psychiatry Depression 30
Psychoses Bi-Polar-5
Dementia-14 Neuroses 0
Surgery-Genera37 Follow-up care 0
Preoperative services 5
Vascular conditions 5
Complications 0
Urology Kidney Chronic Kidney Disease-33
Prostate Benign Prostatic Hyperplasia-12
Symptoms38 0
Bladder Urinary Tract Infection-2 Incontinence-12

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