Changes in Nomation Form from 2015 (previous) to 2016 (current)

Attachment 3c Cross walk of changes to Nomination Form 0920-0976.docx

Million Hearts Hypertension Control Challenge

Changes in Nomation Form from 2015 (previous) to 2016 (current)

OMB: 0920-0976

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ATTACHMENT 3c



Crosswalk of changes to the Million Hearts ® Hypertension Control Champion Nomination Form



Million Hearts® Hypertension Control Champion
Data Verification Form 0920-0976





















Crosswalk of changes from Attachment 3a Nomination Form to Attachment 3b Nomination Form

CDC proposed changes to Attachment 3a Nomination Form based on previous years’ experience and to improve usability. We are inserting 2 new questions: 1) identifying the relationship of the nominator with the nominee; 2) checkbox to identify clinical quality measure (CQM) used to define hypertension control. This will assist in identifying who is identifying the nominated practice, and identify which of several available CQM’s was used. Identifying the CQM will assist with the data validation. We are revising one question asking whether the clinic is rural, urban, or both (in the case of a healthcare system with multiple locations). One question has revised guidance on nomination instructions. We are inserting guided questions to produce the hypertension control rate rather than just having the nominee put a number down, which will assist in understanding how the nominee arrived at their calculation. We have simplified one question that asked about registries and revised to asking if they used an electronic health record, and we have deleted one option from ‘Clinical system supports’ (formerly ‘Sustainable systems’). Table A.15-2. Provides a comparison of these proposed changes to the Nomination Form.

Table A.15-2. Summary of changes to Attachment 3a Nomination Form



Previously approved for 2015

Revision Proposed for 2017





New Question

Check the box which represents your relationship with the nominee:

  • I am the nominee

  • Employee of Nominee

  • Contract with Nominee

  • State health department

  • Other _______________


Current guidance

Nominee information: Please provide the following information for the provider or practice being entered into the Challenge.

Revised guidance

Nominee information: Please provide the following information for the provider or practice being entered into the Challenge. Nominate either practice or provider, but not both.

Current guidance/questions

Check the box which best represents the nominee:

  • A healthcare system

  • A primary care practice/clinician

  • An obstetrics/gynecology practice/clinician

  • A family practice/clinician

  • An internal medicine practice/clinician

  • An osteopathic practice/clinician

  • A cardiovascular care practice/clinician

  • Other ________________________

Revised guidance/questions

Check the box which best represents the nominee:

  • A healthcare system

  • A single clinician or group practice or clinic

Check the box which best represents the nominee’s practice:

  • Obstetrics/gynecology

  • Family practice

  • Internal Medicine

  • Osteopathy

  • Cardiovascular care

Other ________________________

Current Question

Nominee Reach and impact

Describe patient demographics that support the practice or health system’s care for a population with a high prevalence of hypertension:

  • Geographic region served:

    • Is this urban, rural, or both? __________

  • Percent of patients who belong to a racial/ethnic minority:
    __________________

  • Percent of patients whose primary language is not English:
    ______________________

  • Shape1




    Percent of patients who are enrolled in Medicaid: _______

  • Other: ________________


Revised Question

Population served

Describe patient demographics that support the practice or health system’s care for a population with a high prevalence of hypertension:

Geographic location of clinic (select both if you are a healthcare system and both apply):

Rural Urban
Percent of patients who belong to a racial/ethnic minority: ______________

Percent of patients whose primary language is not English: ______________

Percent of patients who are enrolled in Medicaid: ____________________

Percent of patients who have no health insurance: __________________

Other: ____________________


Current content

CDC defines “hypertension control” as a blood pressure reading < 140 mmHg systolic and <90 mmHg diastolic among hypertensive patients. There is no allowance for individuals on two or more medications.

How many adult patients in the total patient population seen annually are diagnosed with hypertension? ________________

Million Hearts™ supports use of the National Quality Forum #0018 or other nationally recognized measures for defining hypertension control (if other, please specify the measure used_________).

What is the Hypertension Control Rate for the practice or healthcare system’s adult hypertensive population? __________________ Date collected ________________.

What was the Hypertension Control Rate for the practice or healthcare system’s adult hypertensive population a year or more previous? ______________ Date collected: ___________


Revised content

Hypertension Control

Nominees are asked to provide two hypertension control rates: a current rate for a 12-month period and a previous rate for a 12-month period a year or more before.

CDC supports the definition of “hypertension control” as patients aged 18 through 85 years who had a diagnosis of hypertension and whose blood pressure was adequately controlled ( <140 mmHg systolic and <90 mmHg diastolic).

For the current Hypertension Control Rate

What is the reporting period (e.g., 1/1/2015 to 12/31/2015)? ________________.

Calculation of Hypertension Control Rate


Of the number of patients enrolled in the practice or health system, how many adult patients (18 – 85 years old) were seen at least once during the reporting period? ______________________

Of this number of patients seen, distribute them by age:

Percent of patients: Age 18-44 _______

Percent of patients: Age 45-64: _______

Percent of patients: Age 65-74: ________

Percent of patients: Age 75-85: _______


Of the number of adult patients (18-85 years old) seen during the reporting period, how many were diagnosed with hypertension? ________


Of the number of adult patients (18-85 years old) diagnosed with hypertension, how many are included in the control rate denominator (after removing the exclusions listed above; e.g., pregnant women, patients with end-stage renal disease)? _____________


How many of the patients were excluded from the denominator?___________


How many of the patients in the denominator had their blood pressure in control (the numerator)?___________


What was the Hypertension Control Rate for the practice or healthcare system’s adult hypertensive population during this reporting period (numerator/denominator)? __________________


For the previous period Hypertension Control Rate:

For the previous reporting period, did the nominee use the same clinical quality measure guidelines as the current reporting period?

  • Yes.

  • No.

If not, which clinical quality measure guideline was used?______________________________


Using the same steps, what was the Hypertension Control Rate for the practice or healthcare system’s adult hypertensive population during the previous reporting period? ______________

What was the previous reporting period (e.g., 1/1/2014 to 12/31/2014): ___________




Current question

If you have a hypertension registry, please describe how it is developed and maintained. If you don’t have a hypertension registry, please describe how the data were obtained.


Revised question

Were the data obtained from an electronic health record system? ________.

If not, how were the data obtained? ________________________________________________



New questions

For the current reporting period, the nominee used which of the following clinical quality measure to define hypertension control. Please check the appropriate box below and provide the requested information:

  • National Quality Forum (NQF) 0018 guidelines. Describe the exclusions the nominee includes (e.g., pregnant women, patients with end-stage renal disease). __________________________________________________________________________

  • CMS Physician Quality Reporting System (PQRS) 236 guidelines. Describe the exclusions the nominee includes (e.g., pregnant women, patients with end-stage renal disease).______________________________________________________________

  • CMS 165v3 guidelines. Describe the exclusions the nominee includes (e.g., pregnant women, patients with end-stage renal disease).___________________________________________________________________

  • NCQA HealthCare Effectiveness Information Set (HEDIS). Describe the exclusions the nominee includes (e.g., pregnant women, patients with end-stage renal disease).____________________________________________________________________

  • HRSA Uniform Data System (UDS). Describe the exclusions the nominee includes (e.g., pregnant women, patients with end-stage renal disease).__________________________________________________________________

  • Other. Describe how the nominee calculates the measure; including who is included in the denominator and what is considered adequate control.

______________________________________________________________________________


Current Content

Sustainable systems”

Revised Content

Clinical system supports







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