This
table reports data on selected health
outcome indicators by race and ethnicity.
The health outcome indicators are commonly
seen in the health care community as indicators
of overall community health. These indicators
are “intermediate outcome measures”
which means that they document intermediate
outcomes of care as a proxy for good long
term health outcomes. By achieving measurable
intermediate outcomes, we know that negative
health outcomes can be reduced. Thus,
by increasing the proportion of health
center patients who have a good intermediate
health outcome, we can expect improved
health status of the patient population
in the future. For example,
-
Low Birthweight: If there are fewer
low birthweight children born, then
there will be fewer children who suffer
the multiple negative sequela of low
birthweight.
-
Controlled Hypertension: If there is
less uncontrolled hypertension, then
there will be less cardiovascular damage,
fewer heart attacks, less organ damage
later in life.
-
Controlled Diabetes: If there is less
uncontrolled diabetes then there will
be fewer amputations, less blindness,
less organ damage later in life.
While
the selected health outcome indicators
give a good description of the overall
quality of primary care being provided
at the center, it is clear that this is
a subset of possible health outcome indicators
and that individual health centers may
be using others in addition to these.
Table
7 reports health outcomes by race and
ethnicity to provide information on the
extent to which health centers help reduce
health disparities. The total number of
patients reported by race must equal the
total reported by ethnicity. That is,
the totals reported in Column h by race
must equal the totals reported in Column
k by ethnicity. Race and ethnicity is
self-reported by patients and should be
collected as part of a standard registration
process. Health centers who report on
a sample of patients are cautioned against
using their data to evaluate disparities
given small sample sizes. However, on
a state and national level, reported data
will provide health outcome indicators
which can be used to evaluate disparities
for BPHC-funded programs, overall.
The
table is included only in the Universal
Report.
HIV
POSITIVE PREGNANT WOMEN, TOP LINE
Report the total number of HIV positive
pregnant women served by the health center
in column (h).
DELIVERIES AND LOW BIRTH WEIGHT BY RACE
AND ETHNICITY, SECTIONS A AND D (LINES
1-5)
Only
grantees that provide or assume primary
responsibility for some or all of a patient's
prenatal care services, whether or not
the grantee does the delivery" are required
to complete Section A. All CHC prenatal
care patients who also delivered during
the reporting period[3], are reported on lines 1 - 5. This table is similar
to a table previously collected in the
UDS, but has a different population reported.
Prenatal Care Patients Who Delivered During the Year (Line 1) –
Report the total number of women who were
known to have delivered during the year,
even if the delivery was done by another
provider. Include all deliveries, regardless
of the outcome, but do not include deliveries
where you have no documentation that the
delivery occurred (for example, for women
who may have moved out of the area and/or
who were lost to follow-up.)
DELIVERIES
PERFORMED BY GRANTEE PROVIDER (Line 2)
Report the total number of deliveries
performed by center clinicians during
the reporting period in Column H. (This
line is not reported by the race / ethnicity
of the women delivered.) On this line
ONLY, grantee is to include
deliveries of women who were not
part of the grantee’s prenatal care program
during the calendar year. This would include
such circumstances as the delivery of
another doctor’s patients when the clinic
provider participates in a call group
and is on call at the time of delivery;
emergency deliveries when the clinic provider
is on-call for the emergency room; and
deliveries of “un-doctored” patients who
are assigned to the provider as a requirement
for privileging at a hospital. Include
as “health center clinicians” any clinician
who is paid by the provider, regardless
of the method of compensation.
Birthweight of Infants Born to Prenatal Care Patients
During the Year
(Lines 3 – 5.) Report the total number of live births
during the reporting period for women
who received prenatal care from the grantee
or referral provider during the reporting
period, according to the appropriate birthweight
group. NOTE: Grantees
must report deliveries and the birthweight
of children delivered for all women
who were in their prenatal care program
and who delivered during the reporting
period, regardless of whether the grantee
did the delivery themselves, referred
the delivery to another provider or was
for a woman who transferred to another
provider on her own. The number of
deliveries reported on line 1 will normally
not be the same as the total number of
infants reported on lines 3 - 5 because
of multiple births and still births.
HYPERTENSION
AND DIABETES BY RACE AND ETHNICITY, SECTIONS
B AND C
In these
sections, grantees will report on the
findings of their reviews of services
provided to targeted populations of current
medical users (i.e., medical patients
who had at least two medical encounters
during the reporting period):
SECTION
B: HYPERTENSION (Lines 6-8)
Proportion of hypertensive patients whose
most recent blood pressure showed a systolic
pressure under 140 and a diastolic pressure
under 90.
SECTION
C: DIABETES (Lines 9-13)
The proportion of diabetic patients whose
most recent HbA1c is in a given range:
HbA1c levels less than 7%,7% to 9%, greater
than 9%.
Data for
this section may be obtained from an audit
of charts selected through a process of
scientific random sampling or through
the use of Electronic Health Records whose
templates permit the recovery of all records
for all patients which fit the sampling
profile.
For each
of the two populations being surveyed
very rigid and specific definitions are
to be used in order to identify the universe
from which the sample will be drawn. These
are described in detail below and must
be carefully followed to avoid misreporting
findings. (Special care must be taken
since mistakes in this area may portray
a lower quality of care than is actually
the case.)
HYPERTENSION – Lines 6 through 8.
This
section of Table 7 reports on all CHC
adult patients, 18 years and older, who
have been diagnosed as hypertensive before
June 30 of the measurement year, and have
been seen in the health center at least
twice during the reporting year.
PERFORMANCE
MEASURE:
Percentage
of patients born on or before December
31,1990 with diagnosed hypertension (HTN)
whose blood pressure (BP) was less than
140/90 (adequate control) at the time
of the last reading
Numerator:
Patients with last systolic blood pressure
measurement <140 mm Hg and
diastolic blood pressure < 90 mm Hg
during the measurement year among those
patients in denominator.
Denominator:
All patients = 18 years of age as of December
31 of the measurement year with diagnosis
of hypertension (HTN), and have been seen
at least twice during the reporting year,
and have a diagnosis of hypertension before
June 30 of the measurement year.
TOTAL PATIENTS AGED 18+ WITH HYPERTENSION,
ROW 6
Enter
the total number of patients who meet
all of the following criteria:
- Were
born on or before December 31,1990 and
- Have
been seen at least twice during the
reporting year, and
- Have
a diagnosis of hypertension (HTN) before
June 30 of the measurement year as evidenced
by an ICD-9 code of 401.xx. It does
not matter if hypertension was treated
or is currently being treated. The notation
of hypertension may appear during or
prior to the year 2008. Hypertension
may also be identified by finding any
of the following:
In chart
notes, however it is not assumed that
all charts will be screened for these
references:
o
HTN
o
High
blood pressure (HBP)
o
Elevated
blood pressure
o
Borderline
HTN
o
Intermittent
HTN
o
History
of HTN
Statements such as “rule
out hypertension,” “possible hypertension,”
“white-coat hypertension,” “questionable
hypertension,” and “consistent hypertension”
are not sufficient to confirm the diagnosis
of hypertension if such statements are
the only notations hypertension
in the medical record.
Blood
pressures that are self-reported
by the patient such as when a patient
calls in a blood pressure from home are
generally not eligible unless a clinical
management decision is made using that
reading. If the patient is equipped with
reliable technology and the provider is
confident that the reading is reliable
such that the provider is recoding the
automated BP reading and making prescription
changes based on those readings, the health
center can use the measurement.
CHARTS
SAMPLED OR EHR TOTAL, ROW 7
Enter
the total number of health center patients
for whom data have been reviewed. If no
qualifying EHR is present, use all patients
who fit the criteria or a scientifically
drawn sample of 70 patients, whichever
is less. The sampling method is described
in Appendix C. If an EHR is present it
may be used in lieu of a chart review
of a sample of charts if and only if:
- The EHR
includes every patient aged 18 or
older with diagnosed hypertension,
regardless of whether or not they
were specifically treated for hypertension.
- Blood pressure
is regularly recorded in the EHR for
all patients
- The EHR
has been in place throughout the reporting
year.
If the EHR is to be used in lieu of the
chart audit, the number on line 7 will
be equal to the number on line 6.
PATIENTS
WITH CONTROLLED BLOOD PRESSURE, ROW 8
Hypertensive
patients born on or before December 31,1990
(included in line 6 and line 7) whose
systolic blood pressure measurement was
less than 140 mm Hg and whose diastolic
blood pressure was less than 90 mm Hg
at the time of their last measurement
in 2008. (Patients who have not had their
blood pressure tested during the reporting
year will not be counted as meeting the
performance measure.)
DIABETES:
Lines
9 through 13.
This
section of Table 7 reports on all CHC
patients 18 and older who have been diagnosed
as diabetic at some point during their
time as a patient at the CHC.
PERFORMANCE MEASURE:
Proportion
of adult patients born on or before December
31, 1990, with a diagnosis of Type I or
Type II diabetes whose most recent hemoglobin
A1c (HbAlc) was less than 7% (good control);
whose most recent hemoglobin A1c (HbAlc)
was greater than or equal to 7% and less
than or equal to 9%, or whose most recent
hemoglobin A1c (HbAlc) was greater than
9% (poor control).
Numerator:
Number of adult patients whose most recent
hemoglobin A1c level during the measurement
year is less than 7%, greater than or
equal to 7% or less than or equal to 9%,
or greater than 9%, respectively, among
those patients included in the denominator.
Denominator:
Number of adult patients 18 and older
as of December 31 of the measurement year
with a diagnosis of type 1 or 2 diabetes
who have been seen at least twice and
do not meet exclusion criteria.
TOTAL PATIENTS AGED 18+ WITH TYPE I OR II DIABETES, LINE
9
Enter the number of adult patients who
meet the following criteria:
- Were
born on or before December 31,1990 and,
- Have
been seen at least twice for medical
care during the reporting year and,
-
Have
a diagnosis of diabetes. It does not
matter if diabetes was treated or is
currently being treated. The notation
of diabetes may appear during or prior
to the 2008. To confirm the diagnosis
of diabetes, one of the following codes
must be found in the medical record:
-
ICD-9-CM Codes 250, 357.2, 362.0,
366.41, 648.0, or
-
diabetic patients may be identified
from pharmacy data (those who were
dispensed insulin or oral hypoglycemics
/ antihyperglycemics.
Exclude
any patients with a diagnosis of polycystic
ovaries (ICD-9-CM Code 256.4) that do
not have two face-to-face encounters with
the diagnosis of diabetes, in any setting,
during the measurement year or year prior
to the measurement year. Also exclude
any patients with gestational diabetes
(ICD-9-CM Code 648.8) or steroid-induced
diabetes (ICD-9-CM Code 962.0, 251.8)
during the measurement year.
CHARTS SAMPLED OR EHR TOTAL, ROW 10
Enter the total number of health center patients for
whom data have been reviewed. If no EHR
is present, this will be the lesser of
all diabetic patients or a scientifically
drawn sample of 70 charts selected by
following the procedure in Appendix C.
If an EHR is present it may be used in
lieu of a chart review of a sample of
charts if and only if:
- The
EHR includes every diabetic patient.
- Every
item in the criteria is regularly recorded
for all patients
- The
EHR has been in place throughout the
performance year.
If
the EHR is to be used in lieu of the chart
audit, the number on line 10 will be equal
to the number on line 9.
REPORTED HEMOGLOBIN A1c LEVELS, ROW 11-13
For
this report, the most recent hemoglobin
A1c (HbAlc) level as documented through
laboratory data or medical record review
is reported. If there is no HbAlc level
during the measurement year, the level
is considered to be greater than 9.0%.
Thus a patient with no test during the
current year is counted as poor HbAlc
control.
-
Patients with HBA1c < 7% (Line 11):
Number of patients included in the sample
(i.e., in both lines 9 and 10) whose
most recent HbAlc was less than 7%.
-
Patients with 7% ≤ HBA1c ≤
9% (Line 12): Number of patients included
in the sample (i.e., in both lines 9
and 10) whose most recent HbAlc was
greater than or equal to 7%, but less
than or equal to 9%.
-
Patients with HBA1c > 9% (Line 13):
Number of patients included in the sample
(i.e., in both lines 9 and 10) whose
most recent HbAlc was greater than 9%.
Section D: Deliveries
and Low Birthweight by Ethnicity
- Report the same as for Section A, by
ethnicity.
Section E: Hypertension
by Ethnicity
- Report the same as for Section B, by
ethnicity.
Section F: Diabetes by
Ethnicity
- Report the same as for Section C, by
ethnicity.
Questions
and Answers for Table 7
1.
Are
there any changes to this table?
Yes, Section A is not new. However, Section B, C, E and
F are new data elements.
2.
Data
are requested by race and ethnicity. How
are these to be coded?
Race and ethnicity are coded on this table in the exact
same manner that is used for coding on
Table 3B. Refer to instructions for Table
3B for further information.
3. Are patients with diabetes required to bring
to the health center documentation of
HbA1c tests received from outside the
health center?
Patients are encouraged
to provide documentation of HbA1c immunizations
received elsewhere, but this is not required.
Health centers are encouraged to document
HbA1c tests s by contacting providers
of tests directly in order to obtain documentation
by FAX, or by requesting Health Center
patients to mail a copy of test results,
or through other appropriate means. Health
Center patients should not be requested
to return to the center to provide test
documentation.
TABLE
7 – HEALTH OUTCOMES AND DISPARITIES
|
Asian
( a ) |
Native Hawaiian
( b1 ) |
Pacific Islander
( b2 ) |
Black / African American
( c ) |
American Indian/ Alaska Native
( d ) |
White
( e ) |
More than one race
( f ) |
Unreported/
Refused to
Report
( g ) |
Total
( h ) |
HIV Positive pregnant women |
|
|
|
|
|
|
|
|
|
(NO
PRENATAL CARE PROVIDED? CHECK HERE:
☐ ) |
Section A: Deliveries and Low Birth Weight
by Race |
Deliveries and Babies by birth weight |
|
|
1 |
Prenatal
care patients who delivered during
the year |
|
|
|
|
|
|
|
|
|
2 |
Deliveries
performed by Grantee Provider |
|
|
3 |
Live
Births:
< 1500 grams |
|
|
|
|
|
|
|
|
|
4 |
Live
Births
1500–
2499 grams |
|
|
|
|
|
|
|
|
|
5 |
Live
Births
≥ 2500 |
|
|
|
|
|
|
|
|
|
Section B: Hypertension By Race (Check if single site used:
o) |
Patients diagnosed with hypertension whose last blood
pressure was less than 140 / 90
|
6 |
Total
patients aged 18 + with hypertension |
|
|
|
|
|
|
|
|
|
7 |
Charts
sampled or
EHR
total |
|
|
|
|
|
|
|
|
|
8 |
Patients
with controlled blood pressure |
|
|
|
|
|
|
|
|
|
Section C: Diabetes by Race (Check if single site used:
o) |
Patients diagnosed with Type I or Type II diabetes:
Most recent test results |
9 |
Total
patients aged 18 + with Type I or
II diabetes |
|
|
|
|
|
|
|
|
|
10 |
Charts
sampled or
EHR
total |
|
|
|
|
|
|
|
|
|
11 |
Patients
with
HBA1c
< 7% |
|
|
|
|
|
|
|
|
|
12 |
Patients
with
7% less than or
equal to HBA1c less than or equal
to 9% |
|
|
|
|
|
|
|
|
|
13 |
Patients
with
HBA1c > 9% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TABLE
7 – HEALTH OUTCOMES AND DISPARITIES
|
Hispanic or Latino
( i ) |
All other including
Unreported / Refused to Report
( j ) |
TOTAL
( k ) |
Section D: Deliveries and Low Birth Weight
by Ethnicity |
Deliveries and Babies by birth weight |
1 |
Prenatal
care patients who delivered during
the year |
|
|
|
3 |
Live
Births:
< 1500 grams |
|
|
|
4 |
Live
Births
1500–
2499 grams |
|
|
|
5 |
Live
Births
≥ 2500 |
|
|
|
Section E: Hypertension by Ethnicity (Check if single site used:
o) |
Patients diagnosed with hypertension whose last blood
pressure was less than 140 / 90
|
6 |
Total
patients aged 18 + with hypertension |
|
|
|
7 |
Charts
sampled or
EHR
total |
|
|
|
8 |
Patients
with controlled blood pressure |
|
|
|
Section F: Diabetes by Ethnicity (Check if single site used:
o) |
Patients diagnosed with Type I or Type II diabetes:
Most recent test results |
9 |
Total
patients aged 18 + with Type I or
II diabetes |
|
|
|
10 |
Charts
sampled or
EHR
total |
|
|
|
11 |
Patients
with
HBA1c
< 7% |
|
|
|
12 |
Patients
with
7% less than or
equal to HBA1c less than or equal
to 9% |
|
|
|
13 |
Patients
with
HBA1c > 9% |
|
|
|
3
Note that this is a change from prior
years. In prior years only those patients
who had also had a prenatal care visit
in the reporting period were counted,
and some patients who delivered in the
first few days of the new year were left
out. This new table counts those women
as well. . |