VA-*IHD 412 ELEVATED LDL REPORTING (110)    REMINDER DEFINITION (811.9)

• EDIT DATE:   2005-03-11 12:25:37
  EDIT BY:   USER,ONE
  EDIT COMMENTS:   

  Exchange Install
  

Compliance reporting measures the management of IHD patients with an 
 
This national IHD 412 Elevated LDL Reporting reminder is used monthly
to roll up compliance totals for management of a subgroup of IHD 
patients with a 412.nn diagnosis, whose most recent LDL is greater than or
equal to 120mg/dl.
 
This national reminder identifies IHD patients with a documented ICD-9
code 412.nn in the last 5 years, who have had a serum lipid panel within
the last two years, where the most recent LDL lab test (or documented
outside LDL) is greater than or equal to 120 mg/dl.
ICD-9 412.nn diagnosis, whose most recent LDL is greater than or equal
 
If a more recent record of an UNCONFIRMED IHD DIAGNOSIS is found, the 
reminder will not be applicable to the patient.
to 120mg/dl as defined by the VA External Peer Review Program (EPRP)
performance measure and the maximum guideline recommended below:
 
   The VHA/DOD Clinical Practice Guideline for Management of Dyslipidemia 
   recommends an LDL goal of <120 mg/dl for patients with Ischemic Heart 
   Disease; and the NCEP Adult Treatment Panel II recommends a more
   stringent goal of <100 mg/dl.

• FINDING ITEM:   VA-IHD 412 DIAGNOSIS
  USE INACTIVE PROBLEMS:   N
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN PATIENT COHORT LOGIC:   AND
  BEGINNING DATE/TIME:   T-1M
• FINDING ITEM:   VA-LDL >129
  CONDITION:   I (+V>129)
  INTERNAL CONDITION:   I (+V>129)
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR NOT
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-UNCONFIRMED IHD DIAGNOSIS
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN PATIENT COHORT LOGIC:   AND NOT
• FINDING ITEM:   VA-OUTSIDE LDL <100
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-OUTSIDE LDL 100-119
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-OUTSIDE LDL 120-129
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR NOT
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-OUTSIDE LDL >129
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR NOT
  USE IN PATIENT COHORT LOGIC:   OR
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-LDL <100
  CONDITION:   I (+V<100)&(+V>0)
  INTERNAL CONDITION:   I (+V<100)&(+V>0)
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-LDL 100-119
  CONDITION:   I (+V>99)&(+V<120)
  INTERNAL CONDITION:   I (+V>99)&(+V<120)
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-LDL 120-129
  CONDITION:   I (+V>119)&(+V<130)
  INTERNAL CONDITION:   I (+V>119)&(+V<130)
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN RESOLUTION LOGIC:   OR NOT
  BEGINNING DATE/TIME:   T-2Y

• FUNCTION FINDING NUMBER:   1
  LOGIC:   FN(1)>FN(2)
  USE IN RESOLUTION LOGIC:   AND
  FUNCTION STRING:   MRD(3,4,7,8)>MRD(5,6,9,10)
  NO. FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   2
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

• LOGIC:   FN(1)>FN(2)
  FUNCTION STRING:   MRD(1)>MRD(11)
  NO. FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   2
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

This reminder is not for use in CPRS, hence there is no related reminder 
                No mapping necessary.  Use the VA-IHD 412
            most recent visit between the tied facilities.
         
    Reporting roll up will send totals for this reminder and facility 
    for: 
      1) Reminder totals based on reminder evaluation:
         applicable, not applicable, due, not due totals
          
    CPRS vs. Reporting usage reminder: This VA-*IHD 412 ELEVATED LDL 
    REPORTING reminder does not include orders placed, refused, or
    other defer activities which clinicians use in CPRS to manage the
                reminder taxonomy distributed with this term.  
    VA-IHD ELEVATED LDL reminder.  This Reporting reminder is restricted
    to Lab results and Pharmacy medications found during the reminder
    evaluation for each patient in the denominator patient list.
         
   UNCONFIRMED IHD DIAGNOSIS 
                Use the UNCONFIRMED IHD DIAGNOSIS health factor 
                distributed with this term or add any local health 
                factor representing an unconfirmed or incorrect IHD 
                diagnosis.  
         
   LDL          Enter the Laboratory Test names from the Lab Package 
dialog.  
                for calculated LDL and direct LDL with "I +V>0" in
                the CONDITION field.
                The Lab tests defined in this term will also be used to 
                update the following reminder terms' findings with the
                appropriate CONDITION: 
                     LDL <100 
                     LDL 100-119 
                     LDL 120-129 
                     LDL >129 
     
         
    For the following OUTSIDE LDL Reminder Terms, use the health factors 
    distributed with the reminder term or enter the local Health Factor 
    used to represent these values.  
          OUTSIDE LDL <100 
          OUTSIDE LDL 100-119 
          OUTSIDE LDL 120-129 
          OUTSIDE LDL >129 
     
 National Roll-up: 
    This national reminder is used by the VA-IHD QUERI Extract run
Setup issues before using this reminder: 
    monthly to roll up compliance totals for LDL laboratory tests
    completed within the past 2 years, where the most recent LDL result
    is greater than or equal to 120 as of the end of the reporting 
    period.
 
    The patients evaluated for compliance are based on VA EPRP
    performance measure reporting criteria. The performance measure     
    reporting criteria are used to create patient lists.  The patient 
    lists created for this reminder for each reporting period are
    found in the Reminder Patient List file with the following naming
         
    convention:
       VA-*IHD QUERI yyyy Mnn IHD 412 PTS WITH QUALIFY AND ANCHOR VISIT,
       where yyyy is the calendar year, and nn is the month.
     
    The patient lists are based on the VA-*IHD 412 QUERI PTS WITH 
    QUALIFY AND ANCHOR VISIT Extract Finding Rule Set.  The rule set 
    will find IHD 412.nn patients of record within 5 years prior to the
    beginning of the monthly reporting period who had a qualifying 
    clinic visit and an earlier (anchor) visit 13-24 months prior to the
    reporting period. 
1. Use the Reminder Term options to map local representations of 
 
    Rules for building the patient list for the reporting patient  
    denominator used with this reminder are: 
      Rule 1: IHD patients with ICD-9 code 412.nn 
         Start with Patients with an ICD-9 412.nn diagnosis documented 
         within 5 years prior to the beginning of the reporting period.
      Rule 2: Qualifying Visit 
         Find the subset of patients, from rule 1, who have a Qualifying 
         Visit during the one-month reporting period.  
         Qualifying Clinic Codes include: 
   findings: 
           Primary Care: 301 (General Internal Medicine), 322 (Women),  
                         323 (Primary Care/Medicine), 350 (Geriatric),
                         531 and 563 (Mental Health Primary Care) 
           Specialty Care: 303 (Cardiology), 305 (Endocrinology/ 
                        Metabolism), 306 (Diabetes), 309 (Hypertension),
                        312 (Pulmonary/Chest)
           Include patients that had a Qualifying Visit during the 
           reporting period and subsequently died before or after the
           end of the reporting period.
      Rule 3:  Exclude patients from the patient subset resulting 
         
         from Rule 2 that have a primary discharge diagnosis of 410.nn
         within 60 days prior to the Qualifying Visit.
      Rule 4: Anchor Visit 
         Find the subset of patients, after rule 3, with an Anchor 
         Visit 13-24 months prior to the beginning of the reporting 
         period. Use the same clinic codes used for the Qualifying Visit
         in Rule 2.
      Rule 5:  Associated facility 
         The subset of patients resulting from the rules above are 
         assigned an associated facility that is used to accumulate
   IHD 412 DIAGNOSIS 
         national counts.
         The Associated Facility for each patient is based on the
         following criteria:
         1) Use the primary care facility assigned to the patient 
         2) If more than one primary care facility is assigned or no
            primary care facility is assigned, then find which facility
            has the most visits on the local VistA system in the last two 
            years. 
         3) If the count of the number of visits is the same for 
            multiple facilities, use the facility that has the 

• URL:   http://www.oqp.domain.ext/cpg/DL/dl_cpg/algo4frameset.htm
  WEB SITE TITLE:   VHA/DoD CPG for Dyslipidemia
  WEB SITE DESCRIPTION:   

  The VHA/DoD CPG for Management of Dyslipidemia is a comprehensive 
  guideline incorporating current information and practices for 
  practitioners throughout the DoD and Veterans Health Administration 
  system. See Section S, Table 3b for reference to LDL<120 in the
  Guideline.
  

• REMINDER FREQUENCY:   2Y
  NO. OF AGE MATCH LINES:   0
  NO. OF AGE NO MATCH LINES:   0