Certain guidelines have special cases in which a patient who meets specific criteria may be subtracted from the Eligible Population (denominator) when calculating the 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.

 

Performance Rate Calculation

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 have large numbers in the exclusions and/or exceptions class.