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  • Measure Summary
  • NQMC:009957
  • Nov 2014
  • NQF-Endorsed Measure

Annual monitoring for patients on persistent medications: percentage of patients 18 years of age and older who received at least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and had at least one therapeutic monitoring event for the therapeutic agent in the measurement year.

National Committee for Quality Assurance (NCQA). HEDIS 2015 technical specifications for ACO measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

This is the current release of the measure.

This measure updates a previous version: National Committee for Quality Assurance (NCQA). HEDIS 2013 technical specifications for ACO measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2012. various p.

The measure developer reaffirmed the currency of this measure in November 2015.

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Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients 18 years of age and older who received at least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. Report each of the three rates separately and as a total rate.

  • Annual monitoring for patients on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs)
  • Annual monitoring for patients on digoxin
  • Annual monitoring for patients on diuretics
  • Total rate (the sum of the three numerators divided by the sum of the three denominators)

This measure summary represents the total rate.

Rationale

Patient safety is highly important, especially for patients at increased risk of adverse drug events from long-term medication use. Persistent use of these drugs warrants monitoring and follow-up by the prescribing physician to assess for side-effects and adjust drug dosage/therapeutic decisions accordingly. The drugs included in this measure have deleterious effects in the elderly

The costs of annual monitoring are offset by the reduction in health care costs associated with complications arising from lack of monitoring and follow-up of patients on long-term medications. The total costs of drug-related problems due to misuse of drugs in the ambulatory setting has been estimated to exceed $76 billion annually (Johnson & Bootman, 1995)

Appropriate monitoring of drug therapy remains a significant issue to guide therapeutic decision making and provides largely unmet opportunities for improvement in care for patients on persistent medications (Classen, 2003). Although there are no specific clinical guideline recommendations on the frequency of monitoring for the drugs identified in the measure, annual monitoring represents a conservative standard of care and is supported by U.S. Food and Drug Administration (FDA) drug labeling recommendations for each drug.

Evidence for Rationale

Classen D. Medication safety: moving from illusion to reality. JAMA. 2003 Mar 5;289(9):1154-6. PubMed External Web Site Policy

Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med. 1995 Oct 9;155(18):1949-56. PubMed External Web Site Policy

National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

Primary Health Components

Persistent medication therapy; therapeutic monitoring; annual monitoring; angiotensin converting enzyme (ACE) inhibitors; angiotensin receptor blockers (ARBs); digoxin; diuretics

Denominator Description

  • Rate 1: Annual monitoring for patients on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs): Patients age 18 years and older as of December 31 of the measurement year who received at least 180 treatment days of ACE inhibitors or ARBs during the measurement year
  • Rate 2: Annual monitoring for patients on digoxin: Patients age 18 years and older as of December 31 of the measurement year who received at least 180 treatment days of digoxin during the measurement year
  • Rate 3: Annual monitoring for patients on diuretics: Patients age 18 years and older as of December 31 of the measurement year who received at least 180 treatment days of a diuretic during the measurement year

See the related "Denominator Inclusions/Exclusions" field.

Numerator Description

  • Rate 1: Annual monitoring for patients on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs): At least one serum potassium and a serum creatinine therapeutic monitoring test in the measurement year
  • Rate 2: Annual monitoring for patients on digoxin: At least one serum potassium, at least one serum creatinine, and at least one serum digoxin therapeutic monitoring test in the measurement year
  • Rate 3: Annual monitoring for patients on diuretics: At least one serum potassium and a serum creatinine therapeutic monitoring test in the measurement year

See the related "Numerator Inclusions/Exclusions" field.

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

All HEDIS measures undergo systematic assessment of face validity with review by measurement advisory panels, expert panels, a formal public comment process and approval by the National Committee for Quality Assurance's (NCQA's) Committee on Performance Measurement and Board of Directors. Once NCQA establishes national benchmarks for accountable care organization (ACO) performance, all measures will undergo formal reliability testing of the performance measure score using beta-binomial statistical analysis. Where applicable, measures also are assessed for construct validity using the Pearson correlation test.

Evidence for Extent of Measure Testing

Rehm B. (Assistant Vice President, Performance Measurement, National Committee for Quality Assurance, Washington, DC). Personal communication. 2015 Apr 8.  1 p.

State of Use

Current routine use

Current Use

Accreditation

Collaborative inter-organizational quality improvement

Decision-making by consumers about health plan/provider choice

Decision-making by health plans about provider contracting

Internal quality improvement

Pay-for-performance

Public reporting

Measurement Setting

Accountable Care Organizations

Ambulatory/Office-based Care

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Clinical Laboratory Personnel

Nurses

Pharmacists

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Multisite Health Care or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Making Care Safer
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Safety

Case Finding Period

The measurement year

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Time window brackets index event

Denominator Inclusions/Exclusions

Inclusions

  • Rate 1: Annual monitoring for patients on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs): Patients age 18 years and older as of December 31 of the measurement year who received at least 180 treatment days of ACE inhibitors or ARBs, during the measurement year. Refer to Table ACDC-L in the original measure documentation for a list of ACE inhibitors and ARBs.
  • Rate 2: Annual monitoring for patients on digoxin: Patients age 18 years and older as of December 31 of the measurement year who received at least 180 treatment days of digoxin during the measurement year. Refer to Table AMPM-B in the original measure documentation for a list of drugs to identify patients on digoxin.
  • Rate 3: Annual monitoring for patients on diuretics: Patients age 18 years and older as of December 31 of the measurement year who received at least 180 treatment days of a diuretic, during the measurement year. Refer to Table AMPM-C in the original measure documentation for a list of drugs to identify patients on diuretics.

Note:

  • Treatment days are the actual number of calendar days covered with medication in the measurement year (i.e., a prescription of 90 days supply dispensed or written on December 1 of the measurement year counts as 30 treatment days). Sum the days supply for all medications and subtract any days supply that extends beyond December 31 of the measurement year. Treatment days begin on the date the medication was dispense or prescribed.
  • Rate 1: Patients may switch therapy with any medication listed in Table ACDC-L during the measurement year and have the treatment days for those medications count toward the total 180 treatment days (i.e., a patient who received 90 days of ACE inhibitors and 90 days of ARBs meets the denominator definition for Rate 1).
  • Rate 3: Patients may switch therapy with any medication listed in Table AMPM-C during the measurement year and have the treatment days for those medications count towards the total 180 treatment days.

Exclusions
Patients from each rate who had an inpatient (acute or nonacute) claim/encounter during the measurement year.

Value Set Information
Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site External Web Site Policy to purchase HEDIS 2015 Technical Specifications for ACO Measurement, which includes the Value Set Directory.

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions

  • Rate 1: Annual monitoring for patients on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs): At least one serum potassium and a serum creatinine therapeutic monitoring test in the measurement year. Either of the following during the measurement year meet criteria:
    • A lab panel test (Lab Panel Value Set)
    • A serum potassium test (Serum Potassium Value Set) and a serum creatinine test (Serum Creatinine Value Set)
  • Rate 2: Annual monitoring for patients on digoxin: At least one serum potassium, at least one serum creatinine, and at least one serum digoxin therapeutic monitoring test in the measurement year. Either of the following during the measurement year meet criteria:
    • A lab panel test (Lab Panel Value Set) and a serum digoxin text (Digoxin Level Value Set)
    • A serum potassium test (Serum Potassium Value Set) and a serum creatinine test (Serum Creatinine Value Set) and a serum digoxin text (Digoxin Level Value Set)
  • Rate 3: Annual monitoring for patients on diuretics: At least one serum potassium and a serum creatinine therapeutic monitoring test in the measurement year. Either of the following during the measurement year meet criteria:
    • A lab panel test (Lab Panel Value Set)
    • A serum potassium test (Serum Potassium Value Set) and a serum creatinine test (Serum Creatinine Value Set)

Note:

  • The tests do not need to occur on the same service date, only in the measurement year.
  • Total rate (the sum of the three numerators divided by the sum of the three denominators)

Exclusions
Unspecified

Value Set Information
Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site External Web Site Policy to purchase HEDIS 2015 Technical Specifications for ACO Measurement, which includes the Value Set Directory.

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Pharmacy data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Measure is disaggregated into categories based on different definitions of the denominator and/or numerator

Basis for Disaggregation

This measure is disaggregated based on different definitions of the denominator and numerator. Report each of the three rates separately and as a combined rate.

Denominators:

  • Rate 1: Annual monitoring for patients on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs): Patients age 18 years and older as of December 31 of the measurement year who received at least 180 treatment days of ACE inhibitors or ARBs, during the measurement year.
  • Rate 2: Annual monitoring for patients on digoxin: Patients age 18 years and older as of December 31 of the measurement year who received at least 180 treatment days of digoxin during the measurement year.
  • Rate 3: Annual monitoring for patients on diuretics: Patients age 18 years and older as of December 31 of the measurement year who received at least 180 treatment days of a diuretic, during the measurement year.

Numerators:

  • Rate 1: Annual monitoring for patients on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs): At least one serum potassium and a serum creatinine therapeutic monitoring test in the measurement year.
  • Rate 2: Annual monitoring for patients on digoxin: At least one serum potassium, at least one serum creatinine, and at least one serum digoxin therapeutic monitoring test in the measurement year.
  • Rate 3: Annual monitoring for patients on diuretics: At least one serum potassium and a serum creatinine therapeutic monitoring test in the measurement year.

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Analysis by subgroup (stratification by individual factors, geographic factors, etc.)

Description of Allowance for Patient or Population Factors

The Accountable Care Organization (ACO) aggregate population is reported as a whole, with an option to report Medicaid separately for measures for which HEDIS Health Plan Measurement offers Medicaid specifications.

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

Annual monitoring for patients on persistent medications (AMPM).

Measure Collection Name

HEDIS 2015: Accountable Care Organization (ACO) Collection

Measure Set Name

Effectiveness of Care

Measure Subset Name

Medication Management

Submitter

National Committee for Quality Assurance - Health Care Accreditation Organization

Developer

National Committee for Quality Assurance - Health Care Accreditation Organization

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.

Financial Disclosures/Other Potential Conflicts of Interest

In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.

Endorser

National Quality Forum

NQF Number

2371

Date of Endorsement

2016 Apr 4

Adaptation

This measure was adapted from the HEDIS Technical Specifications for Health Plans ("HEDIS Health Plan Measurement") and HEDIS Physician Measurement.

Date of Most Current Version in NQMC

2014 Nov

Measure Maintenance

Annual

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: National Committee for Quality Assurance (NCQA). HEDIS 2013 technical specifications for ACO measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2012. various p.

The measure developer reaffirmed the currency of this measure in November 2015.

Source(s)

National Committee for Quality Assurance (NCQA). HEDIS 2015 technical specifications for ACO measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

Measure Availability

Source available for purchase from the National Committee for Quality Measurement (NCQA) Web site External Web Site Policy.

For more information, contact NCQA at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on June 12, 2014.

This NQMC summary was updated by ECRI Institute on April 21, 2015.

The information was reaffirmed by the measure developer on November 2, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

Content adapted and reproduced with permission from the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of NCQA. HEDIS measures and specifications were developed by and are owned and copyrighted by NCQA. HEDIS measures and specifications are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. NCQA disclaims all liability for use or accuracy of any coding contained in the specifications.

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