Quality Measure Dashboard

When to Use This Skill

Use when a clinician or quality team needs formal HEDIS/CMS quality measure calculations with denominator/numerator logic, benchmark comparison, and actionable gap lists.

Clinical Workflow

1. Select measures to calculate (default core set: A1c control, BP control, breast/colorectal cancer screening, depression screening, statin therapy)
2. For each measure, use fhir_search to build the denominator population from Condition/Patient resources per measure specification
3. Use fhir_search to identify and remove excluded patients (hospice, ESRD, bilateral mastectomy, etc.)
4. Use fhir_search to query numerator evidence: Observation (lab results), Procedure (screenings), DiagnosticReport (imaging)
5. Compute rates: Rate = Numerator / (Denominator - Exclusions) x 100
6. Compare against benchmarks (see references/hedis-measures.md)
7. Identify non-compliant patients (in denominator but not in numerator) as care gaps
8. Present dashboard with rates, targets, gap counts, and patient-level gap lists

FHIR Resources

• Condition -- Denominator identification (diabetes, HTN diagnoses)
• Patient -- Demographics for age/sex stratification
• Observation -- Lab results (A1c, BP), screening scores (PHQ-9)
• Procedure -- Screening procedures (colonoscopy, mammogram)
• DiagnosticReport -- Screening results
• MedicationRequest -- Medication-based measures (statin therapy)
• Encounter -- Visit-based eligibility, hospice exclusions
• Immunization -- Immunization measures

FHIR Query Examples

Pull Diabetes Patients (Denominator)

fhir_search(resourceType="Condition", queryParams="code=http://snomed.info/sct|44054006,http://snomed.info/sct|46635009&clinical-status=active&_count=500")

Pull A1c Results (Numerator)

fhir_search(resourceType="Observation", queryParams="code=http://loinc.org|4548-4&date=ge[measurement-year-start]&_sort=-date&_count=500")

Pull Mammograms (Numerator)

fhir_search(resourceType="DiagnosticReport", queryParams="code=http://loinc.org|24606-6&date=ge[27-months-ago]&_count=500")

Clinical Guidelines

• NCQA HEDIS Technical Specifications
• CMS Star Ratings methodology
• CMS Quality Payment Program (MIPS) measures

Interpretation Guide

• Present measures in dashboard format: measure name, denominator, exclusions, numerator, rate, target, gap-to-goal
• Star rating estimate based on measure performance vs. CMS cut points
• Non-compliant patient lists sorted by: measures with most gaps first, then by longest time since last compliant event
• For each gap patient: patient ID, last relevant result (value and date), recommended action (order test, schedule screening, intensify therapy)

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges