Screening for respiratory impairment and appropriate intervention for patients with ALS

Measure purpose: Ensure patients with ALS are routinely screened for respiratory impairment and appropriate intervention. 

The numerator: patients screened every 3 months (±30 days) or more frequently as clinically indicated (e.g., rapid progression) for respiratory impairment and cough strength. If screening result is positive for any of the specified impairments, discussed noninvasive respiratory support (e.g., noninvasive ventilation (NIV), assisted cough) with patients or referred them for NIV

is divided by

The denominator: patients diagnosed with ALS phenotypes characterized by appropriate ICD codes

Exclusions are removed from the denominator:

• Patient using noninvasive or invasive ventilation prior to encounter date

Exceptions are removed from the denominator:

• Patient declines screening and/or referral for NIV on date of encounter
• Patient unable to complete testing on date of encounter

Key Phrases

Examples of key phrases you could use to meet the measure include:

• Patient declines NIV referral
• Unable to establish seal for screening

You must document both components to meet the numerator.

Measure Calculation Example

Between January 1 and December 31, Dr. Ramirez sees 94 patients diagnosed with ALS phenotypes characterized by appropriate ICD codes. This is the denominator. 

Seven of these patients have been using invasive ventilation or NIV before the visit. These patients are removed from the denominator as they meet exclusion criteria for this measure: 94-7=87.

Of these remaining 87 patients, 2 decline screening and 3 are are unable to complete testing. These patients are removed from the denominator as they meet exception criteria: 87-5=82

Dr. Ramirez screened 72 of the remaining patients at least every 3 months.  This is the numerator.

Quality of patient care = 72/94-7-5. Dr. Ramirez has a score of 87.8% for this measure.