Physicians can drive remarkable health improvements in prediabetes through screening, effective interventions and measuring patient outcomes. These are the cornerstones of the AMA Prediabetes Quality Measures initiative, which relies on electronic clinical quality measures to assess and encourage top-tier diabetes prevention care.
Two AMA experts walked through the AMA Prediabetes Quality Measure set during an AMA STEPS Forward™ webinar. Supported by the Centers of Disease Control and Prevention, STEPS Forward is presenting a series of webinars on diabetes prevention and treatment.
The prediabetes initiative includes three measures, all developed as electronic clinical quality measures, said Jennie Folk, MHA, the AMA’s senior program manager for digital health and informatics. Folk co-hosted the webinar with Kate Kirley, MD, MS, the AMA’s director of chronic disease prevention.
The first measure, glucose screening, gauges the percentage of adult patients who should have received a screening test. Among those who had a glycemic screening completed and whose lab value was in the prediabetes range, the second measure represents the share of patients who were provided with an intervention. The third measure indicates how effective diabetes prevention interventions are based on the number of patients who did not progress to diabetes.
Developers have refined and updated these measures based on the latest recommendations from the U.S. Preventive Services Task Force (USPSTF) and American Diabetes Association.
Measure discourages overscreening
The glucose screening measure applies to adult patients with risk factors for type 2 diabetes who are due for glycemic screening, and whose screening process was initiated during a specified measurement period—a 12-month time frame during which the physician ordered the screening test and the patient completed it. The measure includes three glycemic screening tests: fasting plasma glucose, glucose tolerance test, and hemoglobin A1c.
Risk factors include a body mass index (BMI) of 25 kg/m2 or greater and being between 35 and 70 years old. This age range is consistent with USPSTF recommendations, said Folk.
The measure focuses on screening patients who are not already diagnosed with prediabetes, she emphasized. Therefore, it excludes patients with a glycemic screening test performed during a two-year lookback period.
“We don't want to encourage over screening, and the acceptable timeframe to rescreen patients not diagnosed with prediabetes or diabetes is generally three years,” said Folk.
It also does not include patients who are pregnant or who have terminal illnesses.
Lifestyle, medication interventions
The intervention measure captures the share of adult patients identified as high-risk for developing type 2 diabetes who were offered a diabetes prevention intervention during the 12-month measurement period.
Patients must have had a glycemic-screening test result in the prediabetes range during the measurement period. The measure excludes patients who already had a referral or documentation to an intervention prior to the measurement year. It also excludes patients already taking metformin.
Interventions are grouped into these two categories:
- Intensive lifestyle interventions such as the National Diabetes Prevention Program lifestyle-change program, medical nutrition therapy and behavioral counseling for obesity, diabetes or weight management.
- A prescription for metformin.
Learn more with the AMA STEPS Forward toolkit, “Team-Based Care of Type 2 Diabetes and Prediabetes: Approaches to Help Patients Reach Their Glycemic Goals.”
IDing those at high risk for diabetes
Patients targeted in the intervention measure will become the population of interest for the third measure, an outcomes measure, in the following measurement year. The third measure captures the share of adult patients identified as high risk for, but who did not progress to, type 2 diabetes.
Patients of interest had at least one office visit or preventive visit during the measurement year and at least one office visit or preventive visit during the two-year lookback period. They were either diagnosed with prediabetes during the two-year lookback period or had a glycemic test result in the prediabetes range during the two-year lookback period.
The AMA will be using these measures for its own quality-improvement program.
“We're also licensing the measure set for free to most organizations,” said Folk.
The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies.
This comprehensive and customized approach helps clinical practices and health care organizations identify patients with prediabetes and manage their risk of developing type 2 diabetes, including referring patients at risk to a National Diabetes Prevention Program lifestyle-change program based on their individual needs.
