Cardiovascular Disease (CVD) Risk Assessment Measure - Proportion of

Measure Specification

Cardiovascular disease (CVD) has emerged as the leading cause of maternal mortality in the United States, accounting for over one-third of all pregnancy-related deaths. Diagnosis of CVD is challenging as normal pregnancy may mimic CVD. Accurate diagnosis of CVD varies widely among pregnant and postpartum patients and may either result in a lack of follow- up patients who are at risk or may lead to unnecessary testing that burdens the resources of patients who are not at risk.

Patients who are identified at immediate or lifetime risk of developing CVD may be motivated to modify their behavior to improve their cardiovascular health. Our measure is used for standardized identification of pregnant and/or postpartum individuals with previously unknown CVD who are suspected to have or to be at risk of developing CVD. A CVD risk assessment distinguishes patients with a high probability of disease by analyzing several variables included in the tool.

For a universal use of cardiovascular risk assessment in pregnant and postpartum women, a reliable clinical screening approach that monitors the hospital and clinician performance is lacking. The implementation of a measure to perform universal CVD risk assessment in the obstetric population will lead to timely identification and follow-up of women at risk of CVD and reduce maternal morbidity and mortality.

This will help decrease the lifetime onset of CVD through risk factor modification strategies. The implementation of the measure at facilities and feedback on performance has raised awareness of the importance of CVD risk assessment among obstetricians. The easy use (takes less than one minute to complete CVD risk assessment) of the tool allows for integration into the clinic flow and provides an opportunity to discuss with patient actions to improve their cardiovascular during pregnancy and beyond.

We have not seen any evidence that the follow-up of patients who were deemed at high risk for CVD led to inappropriate use of resources.

Delays or missed diagnosis of CVD in pregnant and postpartum patients is the leading contributor to CVD related maternal mortality. Implementation and universal CVD risk assessment using a standardized tool would allow identification of patients at high risk of CVD that require additional cardiac testing and follow-up. We propose implementation of metrics on adherence to the standard risk assessment tool that allows clinicians to add value to the obstetric care of patients.

The measure is user friendly and can easily be calculated for the hospital system, the clinic group/facilities, or to monitor individual clinician performance. The measure allows for the identification of low-performing hospital systems, facilities, or clinicians and addresses modifiable gaps (Kuklina et al, 2011; Small et al, 2012).

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.