Clinigence Health Help Desk

Performance scores are calculated at the program, guideline and measure levels.  The calculations vary slightly between the different reporting entities (Provider/Practice/Organization) depending on which patients are considered eligible for the calculation.  It is also important to understand that in some scenarios a patient can be counted more than once in a score.

In all cases once the eligible patients are determined the calculations are as follows:
 

For an Individual Measure:

                                                                                          

For a Guideline or Program:

                                                                                                                 

Example

There are three measures within Guideline A:

When the aggregation for Guideline A is done, the counts for the numerator and denominator for each measure are added to get a performance percentile for Guideline A of 19%:
 

Many of the 1,500 patients in Measure 3’s denominator may also be included in one of the other denominators, so patients may be counted multiple times in both the aggregated numerator and aggregated denominator.
 

The calculation for the Program will be similar to the calculation for each Guideline, in that the performance percentile will be the sum of the numerators and the sum of the denominators for all measures in the program. This will lead to patients being counted multiple times as the numerators and denominators are aggregated for the Program percentile.

Provider Calculations

Provider Level – Measure

Eligible Patients: Each patient that is associated with the provider is a candidate for the initial measure population.  A patient can have many, one or no associated provider.  The patient/provider associations are determined by the data provided by the EHR.
 

Patient Multiplicity: Patients are counted one or zero times in the measure score for a specific provider depending on whether the patient qualifies for the measure denominator.
 

Provider Level - Guideline

Eligible Patients: Each patient that is associated with the provider is a candidate for the initial guideline population.  A patient can have many, one or no associated provider.  The patient/provider associations are determined by the data provided by the EHR.
 

Patient Multiplicity: A patient is counted in the guideline score multiple times if the patient qualifies for the denominator in multiple measures within that guideline.
 

Provider Level – Program

Eligible Patients Each patient that is associated with the provider is a candidate for the initial population for each measure in each guideline in the program A patient can have many, one or no associated provider.  The patient/provider associations are determined by the data provided by the EHR.
 

Patient Multiplicity: A patient is included in the program score multiple times if the patient qualifies for the denominator in multiple measures within a guideline or across multiple guidelines.

• The enrollment status of the individual guidelines for the provider are not taken into consideration.  All guidelines in the program are included in the score so that comparisons can be made at the program level across providers and practices regardless of which guidelines the specific provider has selected for enrollment.

Practice-Level Calculations

Practice Level – Measure

Eligible Patients: All patients in the practice, including those not associated with a specific provider, are candidates for the initial population for each measure in each guideline in the program.   

• At this time a patient can be included in only one practice.

Patient Multiplicity: Patients are counted one or zero times in the measure score depending on whether the patient qualifies for the measure denominator.
 

Practice Level – Guideline

Eligible Patients: All patients in the practice, including those not associated with a specific provider, are candidates for the initial population for each measure in each guideline in the program.   

• At this time a patient can be included in no more than one practice.

Patient Multiplicity: A patient is counted in the guideline score multiple times if the patient qualifies for the denominator in multiple measures within that guideline.
 

Practice Level – Program

Eligible Patients: All patients in the practice, including those not associated with a specific provider, are candidates for the initial population for each measure in each guideline in the program.   

• At this time a patient can be included in no more than one practice.

Patient Multiplicity: A patient is included in the program score multiple times if the patient qualifies for the denominator in multiple measures within a guideline or across multiple guidelines.

• The enrollment status of the individual guidelines for each provider are not taken into consideration.  All guidelines in the program are included in the score so that comparisons can be made at the program level across providers and practices regardless of which guidelines the specific provider has selected for enrollment.