Institute for Clinical Systems Improvement

Adult low back pain. NGC:6888

Adult low back pain: percentage of patients with a diagnosis of back pain for whom the physician ordered imaging studies during the six weeks after pain onset, in the absence of "red flag." Institute for Clinical Systems Improvement. 2003 Sep

Assessment and management of chronic pain. NGC:6693

Assessment and management of chronic pain: percentage of patients diagnosed with chronic pain who are prescribed an opioid who have an opioid agreement form and urine toxicology screen documented in the medical record. Institute for Clinical Systems Improvement. 2007 Mar

Atrial fibrillation. NGC:6956

Atrial fibrillation: percentage of patients (without contraindications to anticoagulation) with paroxysmal, persistent, or permanent atrial fibrillation/flutter with risk factors for thromboembolism who are taking warfarin. Institute for Clinical Systems Improvement. 2004 Nov

Atrial fibrillation: percentage of patients with non-valvular atrial fibrillation/flutter with risk factors for thromboembolism having a CHADS2 score of 2 or greater (without contraindications to anticoagulation therapy) who are receiving warfarin. Institute for Clinical Systems Improvement. 2008 Oct

Colorectal cancer screening. NGC:6580

Colorectal cancer screening: percentage of African American patients age 45 and older who are up-to-date with colorectal cancer screening. Institute for Clinical Systems Improvement. 2006 Jun

Colorectal cancer screening: percentage of patients age 50 and older who are up-to-date with colorectal cancer screening. Institute for Clinical Systems Improvement. 2003 Jul

Diagnosis and management of asthma. NGC:6368

Diagnosis and management of asthma: percentage of adults with uncontrolled asthma who are on inhaled corticosteroids medication. Institute for Clinical Systems Improvement. 2005 Mar

Diagnosis and management of asthma: percentage of children with uncontrolled asthma who are on inhaled corticosteroids medication. Institute for Clinical Systems Improvement. 2005 Mar

Diagnosis and management of asthma: percentage of patients with asthma with education about asthma documented in the medical record. Institute for Clinical Systems Improvement. 2005 Mar

Diagnosis and management of asthma: percentage of patients with asthma with spirometry or peak flow meter reading documented in the medical record at the last visit. Institute for Clinical Systems Improvement. 2005 Mar

Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. NGC:5843

Diagnosis and management of attention deficit hyperactivity disorder (ADHD) in primary care for school age children and adolescents: percentage of patients diagnosed with ADHD whose medical record contains documentation that the clinician discussed the need for school-based supports and educational service options for children with ADHD. Institute for Clinical Systems Improvement. 2005 Jan

Diagnosis and management of attention deficit hyperactivity disorder (ADHD) in primary care for school age children and adolescents: percentage of patients newly diagnosed with ADHD whose medical record contains documentation of DSM-IV or DSM-PC criteria being addressed. Institute for Clinical Systems Improvement. 2005 Jan

Diagnosis and management of attention deficit hyperactivity disorder (ADHD) in primary care for school age children and adolescents: percentage of patients treated with medication for the diagnosis of ADHD whose medical record contains documentation of a follow-up visit twice a year. Institute for Clinical Systems Improvement. 2005 Jan

Diagnosis and treatment of chest pain and acute coronary syndrome (ACS). NGC:6889

Diagnosis and treatment of chest pain and acute coronary syndrome (ACS): percentage of patients with acute myocardial infarction (AMI) receiving beta-blockers within 24 hours of arrival and on discharge. Institute for Clinical Systems Improvement. 2004 Nov

Diagnosis and treatment of chest pain and acute coronary syndrome (ACS): percentage of patients with acute myocardial infarction (AMI) receiving thrombolytics with a "door-to-drug time" (time from presentation to administration of drug) of less than 30 minutes. Institute for Clinical Systems Improvement. 2004 Nov

Diagnosis and treatment of chest pain and acute coronary syndrome (ACS): percentage of patients with chest pain symptoms in the emergency department receiving early therapy including intravenous access, oxygen, nitroglycerin, morphine and a chewable aspirin on arrival. Institute for Clinical Systems Improvement. 2004 Nov

Diagnosis and treatment of otitis media in children. NGC:6367

Diagnosis and treatment of otitis media in children: percentage of caregivers receiving education on the symptoms suggestive of otitis media, appropriate indicators for a provider visit, risk factors, and outcomes of otitis media. Institute for Clinical Systems Improvement. 2004 May

Diagnosis and treatment of otitis media in children: percentage of patients with a diagnosis of acute otitis media who were prescribed amoxicillin. Institute for Clinical Systems Improvement. 2004 May

Diagnosis and treatment of respiratory illness in children and adults. NGC:6369

Diagnosis and treatment of respiratory illness in children and adults: percentage of encounters for cold symptoms (phone care and/or office visits) for which there is documentation of home treatment education. Institute for Clinical Systems Improvement. 2004 May

Diagnosis and treatment of respiratory illness in children and adults: percentage of patients with a diagnosis of pharyngitis who had strep screen testing. Institute for Clinical Systems Improvement. 2007 Jan

Diagnosis and treatment of respiratory illness in children and adults: percentage of patients with an office visit for cold symptoms who have had symptoms for less than seven days and who receive an antibiotic. Institute for Clinical Systems Improvement. 2004 May

Diagnosis of breast disease. NGC:6317

Diagnosis of breast disease: percentage of class 4 or class 5 abnormal mammograms that are followed by a biopsy within 7 to 10 days. Institute for Clinical Systems Improvement. 2003 Nov

Domestic violence. NGC:5286

Domestic violence: percentage of health care staff trained in initial assessment of problems of domestic violence every twelve months. Institute for Clinical Systems Improvement. 2003 Nov

Heart failure in adults. NGC:5972

Heart failure in adults: percentage of adult heart failure patients to whom (or to their caregivers) written or verbal instructions or educational material are given during the clinic visit, addressing one or more of the following: activity level, diet, medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen (primary care and outpatient cardiology). Institute for Clinical Systems Improvement. 2006 Aug

Heart failure in adults: percentage of adult heart failure patients who have ever had LVSD and met the following (for which they are eligible) at their last clinic visit: prescribed or were taking ACEI/ARB, prescribed or were on beta blocker therapy, non-smoker (primary care and outpatient cardiology). Institute for Clinical Systems Improvement. 2006 Aug

Heart failure in adults: percentage of adult heart failure patients who have ever had LVSD and were prescribed or were on beta-blocker therapy within the last 12 months of the clinic visit or who have a contraindication to taking beta-blockers (primary care and outpatient cardiology). Institute for Clinical Systems Improvement. 2007 Aug

Heart failure in adults: percentage of adult heart failure patients who have ever had LVSD and were prescribed or were taking an ACEI or ARB within the last 12 months of the clinic visit, or who have contradictions to taking both ACEI or an ARB (primary care and outpatient cardiology). Institute for Clinical Systems Improvement. 2007 Aug

Heart failure in adults: percentage of adult heart failure patients who have not used tobacco anytime during the previous year (primary care and outpatient cardiology). Institute for Clinical Systems Improvement. 2006 Aug

Heart failure in adults: percentage of adult heart failure patients who have used tobacco anytime during the previous year and who were given smoking cessation advice or counseling at the last clinic visit (primary care and outpatient cardiology). Institute for Clinical Systems Improvement. 2006 Aug

Heart failure in adults: percentage of adult heart failure patients with documentation that LVS function was evaluated or will be evaluated (primary care and outpatient cardiology). Institute for Clinical Systems Improvement. 2006 Aug

Heart failure in adults: percentage of adult patients with a primary diagnosis of heart failure discharged home with written instructions or educational material given to the patient or his or her caregiver at discharge or during the hospital stay, addressing all of the following: activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen. Institute for Clinical Systems Improvement. 2006 Aug

Heart failure in adults: percentage of adult patients with a primary diagnosis of heart failure who are readmitted for heart failure within 30 days of discharge. Institute for Clinical Systems Improvement. 2006 Aug

Heart failure in adults: percentage of adult patients with a primary diagnosis of heart failure who have LVSD and who do not have a contraindication to taking beta-blockers, who are prescribed beta-blocker therapy at hospital discharge. Institute for Clinical Systems Improvement. 2006 Aug

Heart failure in adults: percentage of adult patients with a primary diagnosis of heart failure who have LVSD and who do not have contraindications to taking both ACEI and ARBs, who are prescribed an ACEI or an ARB at hospital discharge. Institute for Clinical Systems Improvement. 2006 Aug

Heart failure in adults: percentage of adult patients with a primary diagnosis of heart failure who have used tobacco anytime during the year prior to hospital arrival and who are given smoking cessation advice or counseling during the hospital stay or at discharge. Institute for Clinical Systems Improvement. 2006 Aug

Heart failure in adults: percentage of adult patients with a primary diagnosis of heart failure with documentation in the hospital record that LVS function was evaluated before arrival, during hospitalization, or is planned for after discharge. Institute for Clinical Systems Improvement. 2006 Aug

Hypertension diagnosis and treatment. NGC:6890

Hypertension diagnosis and treatment: percentage of adult patients who have blood pressure less than 140/90 mmHg at their clinic visit. Institute for Clinical Systems Improvement. 2003 Apr

Hypertension diagnosis and treatment: percentage of adult patients with hypertension, presenting in clinic within the last month, for whom patient education about modifiable risk factors has been documented in the medical record. Institute for Clinical Systems Improvement. 2003 Apr

Immunizations. NGC:6754

Immunizations: percentage of adolescents who are on time with recommended immunizations (Hep B, Hep A, HPV, MMR, MCV4, Tdap, VZV). Institute for Clinical Systems Improvement. 2003 Jul

Immunizations: percentage of two-year-old patients who are on time with their primary series of immunizations (DTaP, IPV, MMR/MMRV, PCV7/PPV23, VZV, Hib, Hep B, Hep A, Rota, Influenza). Institute for Clinical Systems Improvement. 2003 Jul

Initial management of abnormal cervical cytology (Pap smear) and HPV testing. NGC:6755

Initial management of abnormal cervical cytology (Pap smear) and human papillomavirus (HPV) testing: percentage of adult women diagnosed with initial abnormal cervical cytology of atypical squamous cells of undetermined significance (ASCUS) with high-risk HPV type who have follow-up colposcopy within six months of abnormality identified. Institute for Clinical Systems Improvement. 2003 Apr

Lipid management in adults. NGC:5886

Lipid management in adults: percentage of patients on a lipid lowering medication who have a fasting lipid panel every 3 to 12 months. Institute for Clinical Systems Improvement. 2003 Jul

Lipid management in adults: percentage of patients with diagnosed coronary heart disease (CHD) or CHD equivalent who have had a diet evaluation. Institute for Clinical Systems Improvement. 2003 Jul

Major depression in adults in primary care. NGC:6525

Major depression in adults in primary care: percentage of patients who commit suicide at any time while under depression management with a primary care physician. Institute for Clinical Systems Improvement. 2008 May

Major depression in adults in primary care: percentage of patients who have a depression follow-up contact within three months of initiating treatment. Institute for Clinical Systems Improvement. 2004 May

Major depression in adults in primary care: percentage of patients who have had a response to treatment at six months (+/- 30 days) after initiating treatment i.e., have had a Patient Health Questionnaire (PHQ-9) score decreased by 50% from initial score at six months (+/- 30 days). Institute for Clinical Systems Improvement. 2008 May

Major depression in adults in primary care: percentage of patients who have reached remission at six months (+/- 30 days) after initiating treatment, i.e., have any PHQ-9 score less than five after six months (+/- 30 days). Institute for Clinical Systems Improvement. 2008 May

Major depression in adults in primary care: percentage of patients whose symptoms are reassessed by the use of a quantitative symptom assessment tool (such as Patient Health Questionnaire [PHQ-9]) within three months of initiating treatment. Institute for Clinical Systems Improvement. 2004 May

Major depression in adults in primary care: percentage of patients with a new diagnosis of major depression, with documentation of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV TR) criteria within the three months prior to initial diagnosis. Institute for Clinical Systems Improvement. 2004 May

Major depression in adults in primary care: percentage of patients with diabetes with documentation of screening for depression. Institute for Clinical Systems Improvement. 2004 May

Management of labor. NGC:5587

Management of labor: percentage of births with amnioinfusion when either of the following is present: thick meconium or repetitive severe variable decelerations or oligohydramnios. Institute for Clinical Systems Improvement. 2002 Oct

Management of labor: percentage of women in the guideline population who have spontaneous rupture of membranes (SROM) or early amniotomy. Institute for Clinical Systems Improvement. 2003 Oct

Management of labor: percentage of women in the guideline population with failure to progress diagnosis who have oxytocin. Institute for Clinical Systems Improvement. 2003 Oct

Management of labor: percentage of women who are assessed for risk status on entry to labor and delivery. Institute for Clinical Systems Improvement. 2002 Oct

Menopause and hormone therapy (HT): collaborative decision-making and management. NGC:6756

Menopause and hormone therapy (HT): collaborative decision-making and management: percentage of women in menopause who have had a bone mineral density (BMD) measurement a year after cessation of HT. Institute for Clinical Systems Improvement. 2004 Oct

Palliative care. NGC:6526

Palliative care: percentage of adult patients with a progressive, debilitating disease who have a palliative care plan documented in the medical record. Institute for Clinical Systems Improvement. 2008 May

Preoperative evaluation. NGC:6682

Preoperative evaluation: percentage of patients with a preoperative health history and physical examination completed prior to the day of scheduled procedure. Institute for Clinical Systems Improvement. 2003 Sep

Prevention and management of obesity (mature adolescents and adults). NGC:5389

Prevention and management of obesity (mature adolescents and adults): percentage of patients with a documented Body Mass Index (BMI) equal to or greater than 25 who were given education and counsel for weight loss strategies. Institute for Clinical Systems Improvement. 2004 Nov

Prevention of falls (acute care). Health care protocol. NGC:7031

Acute care prevention of falls: rate of inpatient falls per 1,000 patient days. Institute for Clinical Systems Improvement. 2008 Mar

Acute care prevention of falls: rate of inpatient falls with injury per 1,000 patient days. Institute for Clinical Systems Improvement. 2008 Mar

Prevention of unintentionally retained foreign objects during vaginal deliveries. Health care protocol. NGC:7035

Foreign object retention: percentage of unintentionally retained foreign objects during labor and delivery. Institute for Clinical Systems Improvement. 2008 Sep

Preventive services for adults. NGC:6757

Preventive services for adults: percentage of patients with all Level I preventive services on time according to the guideline delivery schedule. Institute for Clinical Systems Improvement. 2003 Sep

Preventive services for children and adolescents. NGC:6758

Preventive services for children and adolescents: the percentage of patients who are on time with recommended immunizations. Institute for Clinical Systems Improvement. 2003 Sep

Routine prenatal care. NGC:6704

Routine prenatal care: percentage of all identified preterm birth (PTB) modifiable risk factors assessed that receive an intervention. Institute for Clinical Systems Improvement. 2005 Aug

Routine prenatal care: percentage of pregnant women who report to have received counseling and education by the 28th week visit. Institute for Clinical Systems Improvement. 2003 Jul

Routine prenatal care: percentage of vaginal birth after cesarean (VBAC) eligible women who receive general education describing risks and benefits of VBAC (e.g., the American College of Obstetricians and Gynecologists pamphlet on VBAC). Institute for Clinical Systems Improvement. 2005 Aug

Safe site invasive procedure - non-operating room. Health care protocol. NGC:7036

Safe site invasive procedure -- non-operating room: percentage of appropriate invasive procedure patients who had their site marked by the provider performing the invasive radiological procedure. Institute for Clinical Systems Improvement. 2008 Sep

Safe site invasive procedure -- non-operating room: percentage of cases in which a verbal, active Time Out is conducted by providers present with the patient prior to the start of the procedure. Institute for Clinical Systems Improvement. 2008 Sep

Safe site invasive procedure -- non-operating room: percentage of invasive procedure patients with documentation of verification of correct patient, site/side and procedure. Institute for Clinical Systems Improvement. 2008 Sep

Safe site invasive procedure -- non-operating room: percentage of wrong invasive or high-risk radiological procedure events outside of the operating room per month. Institute for Clinical Systems Improvement. 2008 Sep

Skin safety protocol: risk assessment and prevention of pressure ulcers. Health care protocol. NGC:7033

Skin safety protocol -- risk assessment and prevention of pressure ulcers: percentage of patients with documentation in the medical record that a head-to-toe skin inspection and palpation were completed within six hours of admission. Institute for Clinical Systems Improvement. 2007 Mar

Stable coronary artery disease. NGC:5658

Stable coronary artery disease (CAD): percentage of patients with stable CAD who have aspirin use documented in the medical record. Institute for Clinical Systems Improvement. 2003 Nov

Venous thromboembolism prophylaxis. NGC:6891

Venous thromboembolism prophylaxis: percentage of adult hospitalized patients who are assessed for venous thromboembolism risk within 24 hours of admission. Institute for Clinical Systems Improvement. 2006 Jun

Venous thromboembolism prophylaxis: percentage of hospitalized adult patients who require hospital readmission within 30 days of discharge for conditions related to venous thromboembolism. Institute for Clinical Systems Improvement. 2006 Jun

Venous thromboembolism. NGC:5885

Venous thromboembolism (VTE): percentage of adult patients receiving heparin therapy for VTE who have a baseline platelet count before starting heparin, and then a platelet count every other day for at least the first 3 days of therapy. Institute for Clinical Systems Improvement. 2006 Feb

Venous thromboembolism (VTE): percentage of adult patients suspected of deep vein thrombosis (DVT) who have leg duplex ultrasound with compression performed despite a low clinical pretest probability and a negative D-dimer test. Institute for Clinical Systems Improvement. 2006 Feb

Venous thromboembolism (VTE): percentage of adult patients treated for VTE who have been assessed for the need for graded compression stockings. Institute for Clinical Systems Improvement. 2006 Feb

Venous thromboembolism (VTE): percentage of adult patients who have a high clinical pretest probability for pulmonary embolism (PE) who received low molecular weight heparin (LMWH) during evaluation. Institute for Clinical Systems Improvement. 2006 Feb

Venous thromboembolism (VTE): percentage of low-molecular-weight heparin (LMWH)-eligible patients with deep vein thrombosis (DVT) treated in an outpatient setting. Institute for Clinical Systems Improvement. 2003 Apr

Venous thromboembolism (VTE): percentage of patients diagnosed with VTE who meet the criteria for low-molecular-weight heparin (LMWH) and for whom LMWH is used. Institute for Clinical Systems Improvement. 2003 Apr

Veterans Health Administration

VA/DoD clinical practice guideline for the management of tobacco use. NGC:3962

Smoking cessation: percent of patients using tobacco who have been offered a referral to smoking cessation specialty program to assist with cessation within the past year. Veterans Health Administration. 2007 Oct