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

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: ______________________ 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”