Table 3 All Alerts are on an annual basis unless specified otherwise
TCNY Domain | Measure Name | Brief Description of Measure |
|---|---|---|
Have a regular doctor | Patients see assigned PCG | See assigned PCG at least once |
Be tobacco free | Smoking status | Update smoking status |
| Â | Smoking cessation intervention | Stop smokers with medications or counseling |
Keep your heart healthy | BP control in HTN | Control BP < 140/90 in patients with HTN without DM or IVD |
| Â | Antithrombic | Provide Patients with IVD or DM with antithrombic therapy |
| Â | Body Mass Index | Measure the height and weight for BMI |
| Â | Cholesterol screen | Screen patients without DM or IVD for cholesterol/HDL |
| Â | Cholesterol control | Control patients without DM or IVD to a total cholesterol < 240 or LDL < 160 |
| Â | LDL control (high risk) | Control patients without DM or IVD to an LDL < 100 |
| Â | LDL testing (high risk) | LDL screen for patients with DM or IVD |
| Â | A1C testing | Measure at least one HbA1c in DM patients every 6 months |
| Â | A1C control (< 7%) | Control HbA1c below 7.0% in DM patients |
| Â | BP control in IVD | Control BP < 140/90 with a diagnosis of IVD without DM |
| Â | BP control in IVD AND HTN | Control BP < 140/90 with a diagnosis of IVD AND HTN without DM |
| Â | BP control in DM | Control BP < 130/80 with a diagnosis of DM |
| Â | BP control in DM AND HTN | Control BP < 130/80 with a diagnosis of DM AND HTN |
Know your HIV status | HIV screening | Screen for HIV |
| Â | HIV viral load and CD4 | Monitor HIV patients' viral load and CD4 every 3 months |
Get help for depression | Depression screening | Screen patients for depression |
| Â | Depression follow-up | Monitor patients with depression every 3 months |
| Â | Depression control | Lower depressed patients PHQ-9 score |
Live free of dependence on alcohol and drugs | Alcohol use screening | Screen for alcohol misuse |
Get checked for cancer | Colorectal cancer screening | Screen 50-80 years old patients |
|  | Breast cancer screening | Screen female ≥ 40 years old |
| Â | Cervical cancer screening | Screen female 18-64 years old |
Get the immunizations you need | Influenza vaccine (child) | Vaccinate children 7 months to 5 years old |
| Â | Influenza vaccine (high risk) | Vaccinate high risk patients 5-49 years old |
| Â | Influenza vaccine | Vaccinate > 50 years old |
|  | Pneumococcal vaccine | Vaccinate ≥ 65 years old or ( ≥ 60 months AND in a high risk group) |
Make your home safe and healthy | Lead testing (1 year) | Screen one-year old with a blood lead test |
| Â | Lead testing (2 years) | Screen two-year old with a blood lead test |
| Â | Asthma symptom assessment | Assess 18-56 years old for asthma severity |
| Â | Asthma control | Assess 5-56 years old with persistent asthma who were prescribed appropriate medications |
Have a healthy baby | Chlamydia screening | Screen eligible female patients |
| Â | Sexual history | Update > 18 years old sexual history |
| Â | Sexual history taken | Update 12-17 years old sexual history |