billed-diabetes-management-incentive-code-Q040-past-year

INDICATOR NAME

Name

Percentage of patients with diabetes for whom physicians billed the diabetes management incentive code (Q040) at least once during the past year

Alternate Name

Percentage of patients with diabetes for whom physicians billed the diabetes management incentive code (Q040) at least once during the past year

INDICATOR DESCRIPTION

Description

Percentage of your diabetes patients for whom a diabetes management incentive code (Q040) was claimed in the past year

Indicator Status

Active

HQO Reporting tool/product

Personalized/Custom Reports (includes Practice Reports)

Dimension

Effective

Type

Process

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Percentage

Calculation Methods

Numerator/ Denominator * 100

Numerator including inclusion/exclusion

Number of diabetes patients aged 18 years and older from whom Q040 was billed at least once in the past year

Includes:

Ontario residents aged 18 years and over who are identified as diabetics in the ODD in the previous two years

Denominator including inclusion/exclusion

Total number of diabetes patients aged 18 years and older

Excludes:

Patients who were not residents in Ontario in each year
Patients with a missing or invalid HCN, date of birth or postal code
Women with gestational diabetes

Adjustment (risk, age/sex standardization)- detailed

This data is unadjusted. Unadjusted data reports the physician’s actual practice data. This is useful for comparing one’s own data over time.

Data Source

Discharge Abstract Database (DAD), Ontario Diabetes Database (ODD), Ontario Health Insurance Plan (OHIP) Claims History Database, Registered Persons Database (RPDB)

Data provided to HQO by

Institute for Clinical Evaluative Sciences (ICES)

OTHER RELEVANT INFORMATION

Caveats and Limitations

- ODD does not differentiate between Type I and II cases

Comments Detailed

Further information on the methodology used to generate a diabetes chronic disease cohort from which diabetic patients in this measure are drawn: The algorithm to identify patients with diabetes links different databases at ICES and is based on having two physician claims with a diagnostic code for diabetes (Dx Code 250) or one OHIP fee code for diabetes management, insulin therapy support, diabetic management assessment codes claim (Q040, K029, K030, K045, K046) or one hospitalisation with a diagnostic code of diabetes within 2 years. Gestational diabetes is excluded from this definition based on the following algorithm: Whenever there was a hospital record with a diagnosis of pregnancy care or delivery between 120 days before and 180 days after a gestational admission date, the diabetic record was considered to be for gestational diabetes, and it was excluded. The administrative data case-definition algorithm for diabetes has a sensitivity of 86% and specificity of 97%.5.