VA-*IHD ELEVATED LDL REPORTING (112)    REMINDER DEFINITION (811.9)

• EDIT DATE:   2005-03-11 12:24:53
  EDIT BY:   USER,ONE
  EDIT COMMENTS:   

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Compliance reporting measures the management of IHD patients whose most 
 
This national IHD Elevated LDL Reporting reminder is used monthly to
roll up compliance totals for management of IHD patients whose most 
recent LDL is greater than or equal to 120mg/dl.
 
This national reminder identifies patients with known IHD (i.e., a 
documented ICD-9 code for IHD in the last five 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. If a more recent record of an UNCONFIRMED IHD DIAGNOSIS is found,
recent LDL is greater than or equal t0 120mg/dl as defined by the VA
the reminder will not be applicable to the patient.
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 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-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-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
• 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
  BEGINNING DATE/TIME:   T-2Y
• 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-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

• FUNCTION FINDING NUMBER:   1
  LOGIC:   FN(1)>FN(2)
  USE IN RESOLUTION LOGIC:   AND
  FUNCTION STRING:   MRD(3,4,8,14)>MRD(5,6,7,15)
  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(13)
  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-ISCHEMIC HEART DISEASE 
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 reminders: This VA-*IHD ELEVATED LDL REPORTING
reminder does not include orders placed, refused, or other defer
activities which clinicians use in CPRS to manage the VA-IHD ELEVATED 
LDL clinical reminder. This Reporting reminder is restricted to Lab
results found during the reminder evaluation for each patient in the
denominator patient list.
                reminder taxonomy distributed with this term.  
         
   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 
                appropriate CONDITION values:
 
                     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: 
Setup issues before using this reminder: 
The national reporting criteria for VA-IHD QUERI are defined in the
Reminder Extract Parameter.
 
This national reminder is used by the VA-IHD QUERI Extract run 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 used with this reminder are
         
found in the Reminder Patient List file with the following naming
convention:
   VA-*IHD QUERI yyyy Mnn 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 QUERI PTS WITH QUALIFY
AND ANCHOR VISIT Extract Finding Rule Set. The rule set will find
IHD 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 are: 
  Rule 1: IHD Patients
     Start with Patients with an IHD 410.nn, 411.nn, 412.nn, or 414.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.  
   findings: 
     Qualifying Clinic Codes include: 
       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 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 national counts.
   IHD DIAGNOSIS 
     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 associated with the most recent 
        visit between the tied facilities.
 

• 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