• American Academy of Ophthalmology, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Eye care physician performance measurement set. Chicago (IL): American Medical Association, National Committee for Quality Assurance; 2007 Oct. 13 p. [8 references]

Does not apply to this measure

This measure is used to assess the percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage, AND the level of macular degeneration severity during one or more office visits within 12 months.

A documented complete macular examination is a necessary prerequisite to determine the presence and severity of age-related macular degeneration (AMD), so that a decision can be made as to the benefits of prescribing antioxidant vitamins. Further, periodic assessment is necessary to determine whether there is progression of the disease and to plan the on-going treatment of the disease, since several therapies exist that reduce vision loss once the advanced "wet" form of AMD occurs. While no data exists on the frequency or absence of regular examinations of the macula when patients are under the care of an ophthalmologist for AMD, parallel data for key structural assessments for glaucoma and cataract and diabetic retinopathy suggest that significant gaps are likely.*

*The following clinical recommendation statement is quoted verbatim from the referenced clinical guidelines and represents the evidence base for the measure:

A stereo biomicroscopic examination of the macula should be completed. Binocular slit-lamp biomicroscopy of the ocular fundus is often necessary to detect subtle clinical clues of Choroidal neovascularization (CNV). These include small areas of hemorrhage, hard exudates, subretinal fluid, or pigment epithelial elevation. (American Academy of Ophthalmology [AAO])

Age-related macular degeneration (AMD); dilated macular examination; documentation of macular thickening or hemorrhage; level of macular degeneration severity

All patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Patients who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage AND the level of macular degeneration severity during one or more office visits within 12 months

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

Unspecified

Current routine use

Internal quality improvement
National reporting

Ambulatory Care
Physician Group Practices/Clinics

Physicians

Individual Clinicians

Age greater than or equal to 50 years

Either male or female

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Living with Illness

Effectiveness

Users of care only

All patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD)

Patients associated with provider

Inclusions
All patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD)

Exclusions

• Documentation of medical reason(s) for not performing a dilated macular examination
• Documentation of patient reason(s) for not performing a dilated macular examination
• Documentation of system reason(s) for not performing a dilated macular examination

Note: The system reason exclusion may be used if a physician is asked to report on this measure but is not the physician providing the primary management for AMD.

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition
Encounter

Time window is a single point in time

Inclusions
Patients who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage AND the level of macular degeneration severity during one or more office visits within 12 months

Exclusions
None

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Encounter or point in time

Administrative data
Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Measure #3 age-related macular degeneration: dilated macular examination.

American Medical Association on behalf of the American Academy of Ophthalmology, Physician Consortium for Performance Improvement®, and National Committee for Quality Assurance

American Academy of Ophthalmology
National Committee for Quality Assurance
Physician Consortium for Performance Improvement®

Unspecified

Paul P. Lee, MD, JD (Co-Chair); Jinnet B. Fowles, PhD (Co-Chair); Richard L. Abbott, MD; Lloyd P. Aiello, MD, PhD; Priscilla P. Arnold, MD; Richard Hellman, MD, FACP, FACE; Leon W. Herndon, MD; Kenneth J. Hoffer, MD; Jeffrey S. Karlik, MD; Mathew W. MacCumber, MD, PhD; Mildred M.G. Olivier, MD; James L. Rosenzweig, MD, FACE; Sam J.W. Romeo, MD, MBA; John T. Thompson, MD

Andrea Gelzer, MD, MS, FACP, Health Plan Representative (HealthNet)

Rebecca A. Kresowik, Consortium Consultant; Timothy F. Kresowik, MD, Consortium Consultant

Flora Lum, MD, American Academy of Ophthalmology

Heidi Bossley, MSN, MBA, American Medical Association; Karen Kmetik, PhD, American Medical Association

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

National Quality Forum

Ambulatory Care Quality Alliance
Physician Quality Reporting Initiative

Measure was not adapted from another source.

2006 Oct

2007 Oct

This is the current release of the measure.

• American Academy of Ophthalmology, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Eye care physician performance measurement set. Chicago (IL): American Medical Association, National Committee for Quality Assurance; 2007 Oct. 13 p. [8 references]

This NQMC summary was completed by ECRI Institute on February 11, 2008. The information was verified by the measure developer on April 14, 2008.

© Measures including specifications © 2007 American Medical Association and National Committee for Quality Assurance.

CPT® Copyright 2006 American Medical Association