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Johns Hopkins Health Plans

APM-E - Metabolic Monitoring for Children and Adolescents on Antipsychotics

Product Lines:
EHP, Priority Partners and USFHP.

Measurement Period: January 1 - December 31

Description:
The percentage of persons 1-17 years of age who had two or more antipsychotic prescriptions and had metabolic testing. Three rates are reported:

  1. The percentage of persons on antipsychotics who received blood glucose testing.
  2. The percentage of persons on antipsychotics who received cholesterol testing.
  3. The percentage of persons on antipsychotics who received blood glucose and cholesterol testing.

Stratifications:
Age as of the last day of the measurement period.

  • 1–11 years.
  • 12–17 years.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

  • ECDS.

Initial Population:

  • Measure Item Count: Person.
  • Age: 1–17 years of age as of the last day of the measurement period.
  • Benefits: Medical and pharmacy.
  • Continuous Enrollment: The measurement period.
  • Allowable Gap: No more than one gap of ≤45 days during the measurement period. No gaps on the last day of the measurement period.

Denominator:
Persons dispensed antipsychotic medications.
Persons with at least two antipsychotic medication dispensing events (APM Antipsychotic Medications List) of the same or different medications on different dates of service during the measurement period.

Numerator:
Numerator 1: Blood glucose.
Persons who received at least one test for blood glucose or HbA1c (Glucose Lab Test Value Set, Glucose Test Result or Finding Value Set, HbA1c Lab Test Value Set, HbA1c Test Result or Finding Value Set) during the measurement period. 

Numerator 2: Cholesterol.
Persons who received at least one test for LDL-C or cholesterol (Cholesterol Lab Test Value Set, Cholesterol Test Result or Finding Value Set, LDL C Lab Test Value Set, LDL C Test Result or Finding Value Set) during the measurement period. 

Numerator 3: Blood glucose and cholesterol.
Persons who were compliant for both numerators 1 and 2

Best Practice and Measure Tips

  • Members who received both of the following during the measurement year on the same or different dates of service: 
    • At least one test for blood glucose or HbA1c and at least one test for LDL-C or cholesterol.
    • If the medications are dispensed on different dates, even if it is the same medication, test both blood glucose with either a glucose or HbA1c test, and cholesterol with either a cholesterol or an LDL-C test.
    • Measure baseline lipid profiles, fasting blood glucose level and body mass index. 
  • Ordering a blood glucose and cholesterol test every year and building care gap alerts in the electronic medical record. 
  • Testing blood glucose and cholesterol at a member’s annual checkup or school physical to reduce additional visits.
  • Educate members and caregivers about the:
    • Increased risk of metabolic health complications from antipsychotic medications.
    • Importance of screening blood glucose and cholesterol levels.
  • Behavioral health providers:
    • Ordering blood glucose and cholesterol screening tests for members who do not have regular contact with their PCP and within 1 month of changing a member’s medication.

Measure Exclusions

Denominator Exclusion:

  • Persons in hospice or using hospice services any time during the measurement period. 
  • Persons who died any time during the measurement period. 

Measure Codes

Need both an A1C or GLUCOSE and LDL-C or CHOLESTEROL.

Blood Glucose 

  • HbA1C Lab Tests 
  • CPT: 83036, 83037 
  • CPT-CAT-II: 3044F, 3046F, 3051F, 3052F
  • LOINC: 17855-8, 17856-6, 4548-4, 4549-2, 96595-4
  • SNOMED CT US Edition: 165679005, 451061000124104

Glucose Lab Tests 

  • CPT: 80047, 80048, 80050, 80053, 80069, 82947, 82950, 82951 
  • LOINC: 10450-5, 1492-8, 1494-4, 1496-9, 1499-3, 1501-6, 1504-0, 1507-3, 1514-9, 1518-0, 1530-5, 1533-9, 1554-5, 1557-8, 1558-6, 17865-7, 20436-2, 20437-0, 20438-8, 20440-4, 2345-7, 26554-6, 41024-1, 49134-0, 6749-6, 9375-7
  • SNOMED CT US Edition: 166890005, 166891009, 166892002, 166921001, 166922008, 442545002, 444780001, 1179458001, 1259140002

Cholesterol 

  • LDL-C Lab Tests 
  • CPT: 80061, 83700, 83701, 83704, 83721
  • CPT-CAT-II: 3048F, 3049F, 3050F
  • LOINC: 12773-8, 13457-7, 18261-8, 18262-6, 2089-1, 49132-4, 55440-2, 96259-7

Cholesterol Lab Test

  • CPT: 82465, 83718, 83722, 84478 
  • LOINC: 2085-9, 2093-3, 2571-8, 3043-7, 9830-1
  • SNOMED CT US Edition: 166830008, 166848004, 259557002, 365793008, 365794002, 365795001, 365796000, 439953004, 707122004, 707123009, 1162800007, 1172655006, 1172656007, 67991000119104

Measure Medications

APM Antipsychotic Medications

  • Amitriptyline-perphenazine
  • Aripiprazole
  • Aripiprazole lauroxil
  • Asenapine
  • Brexpiprazole
  • Cariprazine
  • Chlorpromazine
  • Clozapine
  • Fluoxetine-olanzapine
  • Fluphenazine
  • Haloperidol
  • Iloperidone
  • Loxapine
  • Lurasidone
  • Molindone
  • Olanzapine
  • Paliperidone
  • Perphenazine
  • Pimozide
  • Prochlorperazine
  • Quetiapine
  • Risperidone
  • Thioridazine
  • Thiothixene
  • Trifluoperazine
  • Ziprasidone