Aspect of Care

Quality Improvement Measures (per year)

External Accountability Measures (per year)


Total Cholesterol HDL Cholesterol

240 mg/dl or greater less than 35 mg/dl

200 - 239 mg/dl 35 - 45 mg/dl

less than 200 mg/dl greater than 45 mg/dl

undocumented undocumented

LDL Cholesterol Triglycerides

160 mg/dl or greater 400 mg/dl or greater

130 - 159 mg/dl 200 - 399 mg/dl

100 - 129 mg/dl less than 200 mg/dl

less than 100 mg/dl undocumented




Per Patient: Number of lipid profiles;a trend of values for each test.


Urine Protein Testing

All Patients:

% of patients who received any test for micro-albuminuria.

% of patients with no urinalysis or with negative or trace urine protein, who received a test for microalbumin.

% of patients with at least one test for microalbumin during the measurement year, or if two of the three criteria for low risk are met, during the prior year; or who had evidence of medical attention for existing nephropathy.


Per Patient: Any test for microalbuminuria; if no urinalysis or with negative or trace urine protein, a test for microalbumin.


Eye Exam

All Patients:

% of patients receiving a dilated retinal eye exam.

% of patients receiving other eye exam (e.g., funduscopic photo with interpretation or other) by type of exam.

% of enrolled members who received a dilated eye exam or evaluation of retinal photographs by an optometrist or ophthalmologist during the reporting year, or during the prior year, if patient is at low

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