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Patient Safety: Achieving a New Standard for Care
Making the determination that a particular patient is a diabetic and applying the DQIP measures requires a number of data elements:
Presence of the following data elements: insulin medication, oral hypoglycemic medication, date of ambulatory encounter, diagnosis of ambulatory encounter, medication prescribed at ambulatory encounter, date of inpatient encounter, diagnosis at inpatient encounter, date of emergency room (ER) encounter, and diagnosis at ER encounter (see Table 6-1).
The two annual accountability measures for hemoglobin management—percent of patients receiving one or more HbA1C tests and percent of patients with most recent HbA1C level >9.0 percent—require the data elements HbA1C test, date of HbA1C test, and HbA1C level (see Table 6-2).
Computerized physician order entry systems accept physician orders (e.g., for medications and for laboratory/diagnostic tests) electronically in lieu of the physician’s handwritten orders on a prescription pad or an order sheet. Order entry systems offer the potential to reduce medication errors through a number of validation procedures. One procedure is to determine the extent of therapeutic duplication between the newly prescribed medica-
TABLE 6-1 Data Requirements for the Definition of an Adult Diabetes Patient
Those who were dispensed insulin and/or oral hypoglycemics/antihypoglycemics
Oral hypoglycemic medication
Date of ambulatory encounter
Diagnosis of ambulatory encounter
Medication prescribed at ambulatory encounter
Date of inpatient encounter
Diagnosis at inpatient encounter
Date of ER encounter
Those who had two face-to-face encounters in an ambulatory setting or non-acute inpatient setting or one face-to-face encounter in an inpatient or emergency room setting with a diagnosis of diabetes
NOTE: Patients with gestational diabetes excluded.
SOURCE: American Medical Association, Joint Commission on Accreditation of Healthcare Organizations, National Committee for Quality Assurance, 2001.