The new release affects both the Measure Details screen and the Patient Lists. To reduce confusion and more intuitively reflect performance, the exclusion and exception patients will be subtracted from the Eligible Population for the purposes of calculating the performance rate. In addition, those patients in the exclusion and exception classes will not appear in the Eligible Population or Outside Target Criteria patient lists.
These changes will make it much easier to identify those patients who are Outside Target Criteria.
Special Cases: Exclusions and Exceptions
Certain guidelines have special cases in which a patient who meets specific criteria may be subtracted from the Eligible Population (denominator) when calculating the current performance percentage.
Exclusions: Patients who meet the criteria for the Eligible Population (denominator) AND meet the Exclusion criteria defined for that guideline by the authority. These patients are subtracted from the Eligible Population when calculating the current performance percentage. Examples of exclusion criteria are conflicting diagnoses or conditions that would prevent the patient from satisfying the target criteria such as a patient with a mastectomy being excluded from the denominator for a breast cancer screening guideline.
Exceptions: Patients who meet the criteria for the Eligible Population (denominator) AND meet the Exception criteria defined for that guideline by the authority. These patients are subtracted from the Eligible Population when calculating the current performance percentage UNLESS they satisfy the Meets Target Criteria (numerator). If they do, in fact, meet the target criteria, they are included in both the Eligible Population count and Meets Target Criteria count when calculating the current performance percentage. Examples of an exception would be when a treatment in unavailable (ran out of flu vaccines) or refused by the patient.
The performance rate is defined as:
Performance Rate = Numerator / (Eligible Population– Exclusion – Exception)
While the number of patients in these special classes is small in most cases, there are a few guidelines that had large numbers in the exclusions and/or exceptions class. Previous versions did not subtract those patients before calculating the performance rate.
Previous version for Prev-11:
The current performance is using the 1205 to calculate the percentage but it should be using (1205-490). Also note that the 490 was being included in the number of patients Outside Target Criteria.
New version for Prev-11, same patient population:
The new version shows the correct performance rate of 93% because the 490 exclusion patients were subtracted from the Eligible Population before calculating the rate. In addition, the number of patients in the Outside Target Criteria is reduced to 49.
Affect on Patient Lists
Now that the numbers of exclusion and exception patients are being intuitively reflected on the Measure Details screen, the Patient Lists are also more intuitive. Patients who qualify for the exclusion class will only show on the tab for Exclusion patients and patients who qualify for the exception class (but do NOT qualify for the numerator) will only show on the tab for Exception patients.Previously, both exclusion and exception patients were displaying in the Eligible Population and Outside Target Criteria patient lists.