Clinical Topic (Lead QIO)

Clinical Setting

Performance Measures (% of beneficiaries receiving unless otherwise indicated)

Data Sources

Pneumonia and influenza (Oklahoma Foundation for Medical Quality, < and>)

Doctors’ offices, outpatient settings

State influenza vaccination rate

State pneumococcal vaccination rate

Influenza vaccination or screening

Pneumococcal vaccination or screening

Blood culture before antibiotics are administered

Administration of antibiotics consistent with current recommendations

Initial antibiotic dose within 8 hours of hospital arrival

Centers for Disease Control and Prevention’s Behavioral Risk Factor

Surveillance System

Data; hospital medical records for pneumonia patients

Stroke (Iowa Foundation for Medical Quality <>)


Discharged on antithrombotic (acute stroke or transient ischemic attack [TIA])

Discharged on warfarin (atrial fibrillation)

Avoidance of sublingual patients nifedipine (acute stroke)

Hospital medical records for stroke, TIA, and chronic atrial fibrillation


SOURCE: Adapted from Centers for Medicare and Medicaid Services, 2002b.

1999).8 Much of this assistance is focused on helping the plans to interpret their HEDIS, CAHPS, and HOS results, to identify opportunities for improving care, and to develop and evaluate measurable interventions.9 QIOs are also required to work with ESRD facilities, home-health agen-


The BBA established Part C of Medicare (i.e., the M+C program), which became effective in January 2000.


HEDIS technical specifications are updated annually.

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement