Attachment K: Clinical measures template for EHR data extracts

Attachment K: Clinical Measures template (acute care monthly)

Time starts
4/1/2017
4/1/2017
4/1/2017
4/1/2017

Time ends
4/30/2017
4/30/2017
4/30/2017
4/30/2017

Unit code
Acute care 1
Acute care 2
Acute care 3
Acute care 4

Total number
of patient-days AMIKACIN

AMOXICILLINAMOXICILLIN/CLAVULANATE
AMPICILLIN AMPICILLIN/SULBACTAM
AZITHROMYCIN
AZTREONAMCEFACLOR CEFADROXILCEFAZOLIN CEFDINIR

Note:
* Total number of patient-days reflect the aggregate number of days patients were admitted to your hospital unit within the time frame specified in column A and B. If a patient was
admitted to the unit across months - for example, from 4/30/2017 to 5/2/2017 - then 1 day should be counted to April 2017 and 2 days should be counted to May 2017.
* Column E to column BV reflect the aggregate number of days patients were administered to each of the antibiotics withih the time frame specified in column A and B. For example,
if you have 3 patients using Amikacin in April 2017 and they used it for 3, 5, 7 days, respectively, then days of Amikacin in April 2017 was counted as 3+5+7=15 days and you should
fill 15 in cell E2. If a patient used an antibiotic across months - for example, from 4/30/2017 to 5/2/2017 - then 1 day should be counted to April 2017 and 2 days should be counted to
May 2017. Please see the drug code list in Appendix 1.

CEFDITORENCEFEPIME CEFIXIME

CEFOTAXIME

Attachment K: Clinical Measures template (acute care monthly)

CEFOTETAN CEFOXITIN CEFPODOXIME
CEFPROZIL CEFTAROLINE
CEFTAZIDIMECEFTAZIDIME/AVIBACTAM
CEFTIBUTENCEFTOLOZANE/TAZOBACTAM
CEFTRIAXONE
CEFUROXIMECEPHALEXINCIPROFLOXACIN
CLARITHROMYCIN
CLINDAMYCIN
COLISTIMETHATE
DALBAVANCIN
DAPTOMYCINDICLOXACILLIN

Attachment K: Clinical Measures template (acute care monthly)

DORIPENEM DOXYCYCLINE
ERTAPENEMERYTHROMYCIN
ERYTHROMYCIN/SULFISOXAZOLE
FIDAXOMICINFOSFOMYCINGENTAMICINIMIPENEM/CILASTATIN
LEVOFLOXACIN
LINEZOLID MEROPENEMMETRONIDAZOLE
MINOCYCLINE
MOXIFLOXACIN
NAFCILLIN NITROFURANTOIN
ORITAVANCINOXACILLIN

Attachment K: Clinical Measures template (acute care monthly)

PENICILLIN GPENICILLIN VPIPERACILLIN/TAZOBACTAM
POLYMYXIN BQUINUPRISTIN/DALFOPRISTIN
RIFAMPIN SULFAMETHOXAZOLE/TRIMETHOPRIM
TEDIZOLID TELAVANCINTELITHROMYCIN
TETRACYCLINE
TIGECYCLINETOBRAMYCINVANCOMYCIN

Attachment K: Clinical Measures template (acute care quarterly)

Time starts
4/1/2017
4/1/2017
4/1/2017
4/1/2017

Time ends
6/30/2017
6/30/2017
6/30/2017
6/30/2017

Unit code
Acute care 1
Acute care 2
Acute care 3
Acute care 4

Number of Clostridium
difficile infection (CDI)
Total number of laboratory-identifiable
patient-days
(LabID) events

Note:
* Total number of patient-days reflect the aggregate number of days patients were admitted to your hospital unit within the time frame specified in column A and B. If a patient was admitted to the
unit across the timeframe - for example, from 6/30/2017 to 7/2/2017 - then 1 day should be counted to the quarter from April to June and 2 days should be counted to the quarter from July to
September.
* CDI LabID event is defined as the number of all non-duplicate C. difficile toxin-positive laboratory results in the unit within the timeframe specified in column A. Duplicate c.diff positive test is
defined as any C. difficile toxin-positive laboratory result from the same patient and location, following a previous C. difficile toxin-positive laboratory result within the past two weeks [14 days]
(even across quarters and readmissions to the same facility). There should be at least 14 days with no C. difficile toxin-positive laboratory result (e.g. negative result or no test is performed) for
the patient and location before another C. difficile LabID Event is counted for the numerator.

Attachment K: Clinical Measures template (LTC monthly)

Time starts
4/1/2017
4/1/2017
4/1/2017

Time ends
4/30/2017
4/30/2017
4/30/2017

Unit code
LTC 1
LTC 2
LTC 3

Total number
of residentdays

AMIKACIN

AMOXICILLINAMOXICILLIN/CLAVULANATE
AMPICILLIN AMPICILLIN/SULBACTAM
AZITHROMYCIN
AZTREONAMCEFACLOR CEFADROXILCEFAZOLIN CEFDINIR

Note:
* Total number of resident-days reflect the aggregate number of days residents housed to your nursing home within the time frame specified in column A and B. If the resident stayed
in the nursing home across months - for example, from 4/30/2017 to 5/2/2017 - then 1 day should be counted to April 2017 and 2 days should be counted to May 2017.
* Column E to column BV reflect the aggregate number of days residents were administered to each of the antibiotics withih the time frame specified in column A and B. For example,
if you have 3 residents using Amikacin in April 2017 and they used it for 3, 5, 7 days, respectively, then days of Amikacin in April 2017 was counted as 3+5+7=15 days and you
should fill 15 in cell E2. If a resident used an antibiotic across months - for example, from 4/30/2017 to 5/2/2017 - then 1 day should be counted to April 2017 and 2 days should be
counted to May 2017. Please see the drug code list in Appendix 1.
* column BW reflects number of antibiotic prescriptions written after the resident has been admitted to the LTC setting (i.e. the antibiotics initiated in the nursing home). If a resident
was prescribed two new antibiotics from the nursing home within the month, then it should be counted as two. Please note, the field does not include antibiotics prescribed before the
resident admitted to the nursing home (e.g. those prescribed in the acute care setting).
* column BX reflects number of urine culture collected within the month in the LTC setting.

CEFDITORENCEFEPIME CEFIXIME

CEFOTAXIME

Attachment K: Clinical Measures template (LTC monthly)

CEFOTETAN CEFOXITIN CEFPODOXIME
CEFPROZIL CEFTAROLINE
CEFTAZIDIMECEFTAZIDIME/AVIBACTAM
CEFTIBUTENCEFTOLOZANE/TAZOBACTAM
CEFTRIAXONE
CEFUROXIMECEPHALEXINCIPROFLOXACIN
CLARITHROMYCIN
CLINDAMYCIN
COLISTIMETHATE
DALBAVANCIN
DAPTOMYCINDICLOXACILLIN

Attachment K: Clinical Measures template (LTC monthly)

DORIPENEM DOXYCYCLINE
ERTAPENEMERYTHROMYCIN
ERYTHROMYCIN/SULFISOXAZOLE
FIDAXOMICINFOSFOMYCINGENTAMICINIMIPENEM/CILASTATIN
LEVOFLOXACIN
LINEZOLID MEROPENEMMETRONIDAZOLE
MINOCYCLINE
MOXIFLOXACIN
NAFCILLIN NITROFURANTOIN
ORITAVANCINOXACILLIN

Attachment K: Clinical Measures template (LTC monthly)

Number of
new
antibiotics
started
within the
PENICILLIN GPENICILLIN VPIPERACILLIN/TAZOBACTAM
POLYMYXIN BQUINUPRISTIN/DALFOPRISTIN
RIFAMPIN SULFAMETHOXAZOLE/TRIMETHOPRIM
TEDIZOLID TELAVANCINTELITHROMYCIN
TETRACYCLINE
TIGECYCLINETOBRAMYCINVANCOMYCINmonth

Number of
urine culture
collected

Attachment K: Clinical Measures template (LTC quarterly)

Time starts
4/1/2017
4/1/2017
4/1/2017

Time ends
6/30/2017
6/30/2017
6/30/2017

Unit code
LTC 1
LTC 2
LTC 3

Number of Clostridium
difficile infection (CDI)
Total number of laboratory-identifiable
resident-days (LabID) events

Note:
* Total number of resident-days reflect the aggregate number of days resident housed to your nurisng home within the time frame specified in column A and B. If a resident stayed at the nursing
home across two timeframes - for example, from 6/30/2017 to 7/2/2017 - then 1 day should be counted to the quarter from April to June and 2 days should be counted to the quarter from July to
September.
* CDI LabID event is defined as the number of all non-duplicate C. difficile toxin-positive laboratory results in the nursing home within the timeframe specified in column A. Duplicate c.diff positive
test is defined as any C. difficile toxin-positive laboratory result from the same patient and location, following a previous C. difficile toxin-positive laboratory result within the past two weeks [14
days] (even across quarters and readmissions to the same facility). There should be at least 14 days with no C. difficile toxin-positive laboratory result (e.g. negative result or no test is performed)
for the patient and location before another C. difficile LabID Event is counted for the numerator.

Attachment K: Clinical Measures template (ambulatory care)

Time starts
4/1/2017
4/1/2017
4/1/2017
4/1/2017

Time ends
4/30/2017
4/30/2017
4/30/2017
4/30/2017

Unit code
Ambulatory 1
Ambulatory 2
Ambulatory 3
Ambulatory 4

Total
number of
visits

AMIKACIN

AMOXICILLINAMOXICILLIN/CLAVULANATE
AMPICILLIN AMPICILLIN/SULBACTAM
AZITHROMYCIN
AZTREONAMCEFACLOR CEFADROXILCEFAZOLIN CEFDINIR

Note:
* Total number of patient-visits reflect the total number of visits in your ambulatory care setting within the time frame specified in column A and B. If a patient visited your office twice
within the given month and it should be counted as two visits.
* Column E to column BV reflect number of antibiotic prescriptions initiated by your office within the time frame specified in column A and B. If a patient was prescribed two antibiotics
from your office within the given month, then it should be counted as two. Please note, the field does not include antibiotics prescribed from other physician offices or health care
settings. Please see the drug code list in Appendix 1.
* Column BT-CK reflect total number of patients who visited your office within the given month and were diagnosed with each respiratory condition and were subscribed antibiotics.
Please see the ICD-9 and ICD-10 code list in Appendix 2.A and refer to the antibiotic list in Appendix 1.
* Column CL-CW are "garbage" codes, please count them only if patients does not have diagnosis from BT-CK; see the ICD-10 codes list in Appendix 2.B. Please note unlike column
BT-CK, there is no preference for these codes.
* For Column BT-CK, please exclude patients with any ICD-10 codes in Appendix 2.C

CEFDITORENCEFEPIME CEFIXIME

CEFOTAXIME

Attachment K: Clinical Measures template (ambulatory care)

CEFOTETAN CEFOXITIN CEFPODOXIME
CEFPROZIL CEFTAROLINE
CEFTAZIDIMECEFTAZIDIME/AVIBACTAM
CEFTIBUTENCEFTOLOZANE/TAZOBACTAM
CEFTRIAXONE
CEFUROXIMECEPHALEXINCIPROFLOXACIN
CLARITHROMYCIN
CLINDAMYCIN
COLISTIMETHATE
DALBAVANCIN
DAPTOMYCINDICLOXACILLIN

Attachment K: Clinical Measures template (ambulatory care)

DORIPENEM DOXYCYCLINE
ERTAPENEMERYTHROMYCIN
ERYTHROMYCIN/SULFISOXAZOLE
FIDAXOMICINFOSFOMYCINGENTAMICINIMIPENEM/CILASTATIN
LEVOFLOXACIN
LINEZOLID MEROPENEMMETRONIDAZOLE
MINOCYCLINE
MOXIFLOXACIN
NAFCILLIN NITROFURANTOIN
ORITAVANCINOXACILLIN

Attachment K: Clinical Measures template (ambulatory care)

Number of patients
diagnosed with
Number of patients pneumonia and
diagnosed with
prescribed
pneumonia within antibiotics within the
month
PENICILLIN GPENICILLIN VPIPERACILLIN/TAZOBACTAM
POLYMYXIN BQUINUPRISTIN/DALFOPRISTIN
RIFAMPIN SULFAMETHOXAZOLE/TRIMETHOPRIM
TEDIZOLID TELAVANCINTELITHROMYCIN
TETRACYCLINE
TIGECYCLINETOBRAMYCINVANCOMYCINthe month

Number of patients
diagnosed with otitis
media within the
month

Attachment K: Clinical Measures template (ambulatory care)

Number of patients
diagnosed with
Number of patients
Number of patients
Number of patients Number of patients unspecified acute
diagnosed with otitis
diagnosed with
diagnosed with
diagnosed with
lower respiratory
media and
Number of patients acute sinusitis and Number of patients pharyngitis and
unspecified acute infection and
prescribed
diagnosed with
prescribed
diagnosed with
prescribed
lower respiratory
prescribed
antibiotics within the acute sinusitis within antibiotics within the pharyngitis within
antibiotics within the infection within the antibiotics within the
month
the month
month
the month
month
month
month

Number of patients
diagnosed with
Number of patients acute bronchitis and
diagnosed with
prescribed
acute bronchitis
antibiotics within the
within the month
month

Number of patients
diagnosed with
Number of patients influenza and
diagnosed with
prescribed
influenza within the antibiotics within the
month
month

Number of patients
diagnosed with
acute laryngitis and
tracheitis within the
month

Attachment K: Clinical Measures template (ambulatory care)

Number of patients
Number of patients
diagnosed with a
diagnosed with
Number of patients non-specific upper
acute laryngitis and diagnosed with a
respiratory tract
tracheitis and
non-specific upper infection and
prescribed
respiratory tract
prescribed
antibiotics within the infection within the antibiotics within the
month
month
month

Number of patients
diagnosed with
Number of patients other viral agents as
diagnosed with viral the cause of
infection or
disease classified
unspecified site
elsewhere within the
within the month
month

Number of patients
diagnosed with
unspecified disorder
of tympanic
membrane within
the month

Number of patients
diagnosed with
other specified
disorders of middle
ear and mastoid
within the month

Number of patients
diagnosed with
unspecified disorder
of middle ear and
mastoid within the
month

Number of patients
diagnosed with
other disorders of
middle ear and
mastoid in diseases
classified elsewhere
within the month

Number of patients
diagnosed with
other specified
disorders of nose
and nasal sinuses
(rhinorrhea) within
the month

Number of patients
diagnosed with
other specified
diseases of the
upper respiratory
tract within the
month

Number of patients
diagnosed with
disease of the upper
respiratory tract,
unspecified within
the month

Attachment K: Clinical Measures template (ambulatory care)

Number of patients
diagnosed with
Number of patients respiratory
diagnosed with
disorders in
other respiratory
diseases classified
disorders within the elsewhere within the
month
month

Number of patients
diagnosed with
cough within the
month

Attachment K: Clinical Measures template (Appendix 2.A: ICD codes)

Appendix 2.A: Please count patient in the following conditions and take them in the descendng order of preference (i.e. patients could contribute to only one condition in the following table):
Conditions (descending order of preference)
ICD-10 codes
ICD-9 codes
Pneumonia
481, 482, 483, 484,
J12, J13, J14, J15, J16, J17, J18
485, 486
(J09.X1 is influenza due to identified novel influenza A virus
with pneumonia)
(J10.0 is influenza due to other identified influenza virus
with pneumonia)
(J11.0 is influenza due to unidentified influenza virus with
pneumonia)
Otitis media

Acute sinusitis
Pharyngitis
Unspecified acute lower respiratory infection
Acute bronchitis
Influenza
Acute laryngitis and tracheitis
Non-specific upper respiratory tract infection

H65.0, H65.1, H65.9
H66.0, H66.4, H66.9
H67
(J10.83 is Influenza due to other identified influenza virus
with otitis media)
(J11.83 is influenza due to unidentified influenza virus with
otitis media)
J01
J02, J03
J22
J20, J21, J40
J09, J10, J11
J04, J05
J00, J06

381, 382

461, 473
462, 463, 034.0
466, 490
487
464
460, 465

Appendix 2.B: please count patients in the following conditions if they have no conditions listed in Appendix 2.A. There is no preference for the codes (i.e. patients could contribute to more than one conditions in the following table)
Conditions (no preference)
ICD-10 codes
Viral infection of unspecified site (includes B34.9, viral infection, unspecified)
B34
Other viral agents as the cause of diseases classified elsewhere
Unspecified disorder of tympanic membrane
Other specified disorders of middle ear and mastoid
Unspecified disorder of middle ear and mastoid
Other disorders of middle ear and mastoid in diseases classified elsewhere

B97.89
H73.9
H74.8
H74.9
H75

Other specified disorders of nose and nasal sinuses (rhinorrhea)
Other specified diseases of the upper respiratory tract
Disease of the upper respiratory tract, unspecified
Other respiratory disorders
Respiratory disorders in diseases classified elsewhere
Cough

J34.89
J39.8
J39.9
J98
J99
R05

Appendix 2.C: Please exclude patients with any of the following diagosis
Exclusionary ICD-10 Codes
Chronic lung disease
Asthma
COPD

ICD-10 Codes
J47, J41.0, J41.1, J41.8, J42,
J45.0, J45.1, J45.8, J45.9, J46
J44.9, J44.1, J44.8,

Attachment K: Clinical Measures template (Appendix 2.A: ICD codes)

Emphysema

J43, J43.0, J43.1, J43.2, J43.8, J43.9

Cancer

C76, C76.0, C76.1, C76.2, C76.3, C76.4, C76.5, C76.6,
C76.8, C77, C77.0, C77.1, C77.2, C77.3, C77.4, C77.5,
C77.8, C77.9, C78, C78.0, C78.1, C78.2, C78.3, C78.4,
C78.5, C78.6, C78.7, C78.8, C79, C79.0, C79.1, C79.2,
C79.3, C79.4, C79.5, C79.6, C79.7, C79.8, C79.9, C80.0,
C80, C80.9

Diabetes
Immunosuppression
Cellulitis
UTI
GI infection
Bacteremia
Infections with identified bacteria

E10, E11, E12, E13, E14
D89 (D89.0, D89.1, D89.2, D89.3, D89.8, D89.9), D80,
D81, D82, D83, D84, D86)
L03.0, L03.1, L03.2, L03.3, L03.8, L03.9
N39.0
A09, A09.0, A09.9, A05, A04,
A49.9, A49.0, A49.1, A49.2, A49.3, A49.8
A32 (Listeriosis), A36 (Diphtheria), A37 (Whooping cough),
A39 (meningococcus), A40 (Streptococcal sepsis), A46
(Erysipelas)