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Updated FAQ (October 2017)
- We have multiple clinics/sites within our organization. For which do we need to report PHASE data on a quarterly basis?
Report data for all clinics/sites that are participating in PHASE. “Participation” could include clinics/sites that are implementing QI work, implementing team-based care models, receiving training from CCI or coaching from TMIT, using the PHASE medication protocol (“PHASE on a Page”), etc. - Could you clarify if there’s a difference between “during the past measurement year” and “during the measurement year”?
They are the same thing. For example, for Q2 of 2017, they are both referring to the period of 7/1/2016 to 6/30/2017. - Does a patient have to have systolic blood pressure less than the threshold AND diastolic less than the threshold to be considered “in control”? Or is it an “or”?
For patients aged 18-59 and patients aged 60-85 with a diagnosis of diabetes: a) systolic needs to be under 140 and b) diastolic needs to be under 90.For patients aged 60-85 without a diagnosis of diabetes: a) systolic needs to be under 150 and b) diastolic needs to be under 90. - What does it mean to have a medication order current during the measurement year?
Individual grantees can decide how best to operationalize this definition within their system. It could be that the medication order was current at any point during the measurement year, current during the entire year, or somewhere in between. - For the ASCVD patients, should we be looking at all active patients or patients with a diagnosis from the list in the last year? This question stems from the fact that there is a time frame for the DM patient measure (2 outpatient visits in the measurement year) and for the HTN patient measure (HTN diagnosis in the first 6 months of measurement year), but no specification of a visit rule for ASCVD. Can you please clarify?
The ASCVD population measure is for all active patients, in whatever way the clinics define “active.” Because the DM and HTN measures are linked to HEDIS, there are specific definitions for what “active” means, which isn’t the case for ASCVD. The ASCVD population measure does not roll up into any of the other denominators; in terms of being “accountable” for patients who may no longer be at your clinic, there are no consequences to the lack of a visit rule. However, if the added nuance of a visit rule is more actionable for you, feel free to add one that works within your operationalized definition of an active patient. - Who is included in the HTN patient definition of “patients with an outpatient diagnosis of hypertension during the first 6 months of the measurement year?
It includes patients with a diagnosis of HTN who received that diagnosis at any point prior to 6 months to the end of the measurement year. For example, for Q2 2017 (with the measurement year of 7/1/2016 to 6/30/2017), it would include patients who had a diagnosis of hypertension at any point prior to 12/31/2016. - How do you define unduplicated total patients?
It is the number of unique patients with ASCVD, diabetes, and/or HTN. It is not the sum of the three diagnostic categories because some individuals will have diagnoses of more than one of these conditions. - What is the PHASE definition of follow-up for the tobacco, BMI, and depression screening & follow-up measures?
There is no PHASE-specific definition for follow-up for these measures. It is more important that the definition is operational within your system. Please review the PHASE Clinical and Quality Measures Reporting Template for examples of what you could use as follow-up. As a reminder, regardless of how you define follow-up, you are required to report on the combined measure of both screening and follow-up. - The diabetes control measure is the inverse of the HEDIS measure. Can we report the HEDIS measure, which is for poor control (>9% or missing), instead?
Yes. If it is more actionable for you to report out of control A1c or it aligns better with your other reporting requirements, you may report out of control A1c. However, be sure to let Carly Levitz know that you are reporting the measure as out of control.
Previous FAQ (March 2017)
- Do we need to report all measures, or can we choose a subset of measures?
The grant requirement is to report all measures on a quarterly basis. We recognize that there may be initial challenges or delays with reporting on some measures. - We would like to focus our efforts on a subset of the full population. Can we report on that subpopulation for the quarterly reporting?
The grant requirement is to report the measures as they are defined in the reporting template, using the denominators that are explicitly defined. To be consistent across grantees, we are asking grantees to report on the population similarly. For your own improvement efforts, we encourage you to segment the population to align with your areas of focus - For the medication measures, are the patients who have drug-allergy or drug-drug interaction contraindication included or excluded?
Short answer: they can be excluded.Long answer: The medication measures’ denominators, in the most ideal scenarios, would be only patients for whom the drug is indicated. For this evaluation, we realize that not all grantees would be able to track this, so we didn’t use that as the denominator. We instead use the population that is most likely to be indicated for the medications: diabetics aged 55-75 and those with hypertension aged 18-85. - In the provided list of oral medications for hypertension, Hydrochlorothiazide was not listed as an isolated drug, it is only listed in combination with other drugs. In the definition, there is a note that says “if there are additional medications that you think are appropriate, please use your expert judgment.” Can Hydrochlorothiazide be considered a medication for this measure as an isolated drug?
Yes, Hydrochlorothiazide should be included by itself as an oral anti-hypertensive medication. This was an oversight. - Do you know of any research that has been done comparing the clinical health outcomes of patients who are part of PHASE versus those who are not?
There are three articles that may be of interest:
– Dudl JR, Wang MC, Wong M, Bellows J. Preventing myocardial infarction and stroke with a simplified bundle of cardioprotective medications. Am J Manag Care. 2009; 15(10): e88-e94.
– Gold R, Nelson C, Cowburn S, et al. Feasibility and impact of implementing a private care system’s diabetes quality improvement intervention in the safety net: a cluster-randomized trial. Implementation Science 2015; 10(83): DOI 10.1186/s13012-015-0259-4.
– Wong W, Jaffe M, Wong M, Dudl JR. Community implementation and translation of Kaiser Permanente’s cardiovascular disease risk-reduction strategy. The Permanente Journal 2011; 15(1): 36-41 - Will we receive anything after we report the quarterly data?
Each grantee will receive dashboards of their reported data within one month after data submission. The first dashboards may take longer to produce. The cascading dashboards are at three levels: the initiative, the grantee, and the sub-grantee. The sub-grantees are participating hospital sites of a hospital grantee, participating health center organizations of a consortium grantee, and participating clinic sites of a health center grantee.
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