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  • Measure Summary
  • NQMC:009259
  • Jul 2015

Completion rate for comprehensive medication review (CMR): percentage of prescription drug plan members who met eligibility criteria for medication therapy management (MTM) services and who received a CMR during the eligibility period.

Pharmacy Quality Alliance (PQA). Technical specifications for PQA approved measures. Springfield (VA): Pharmacy Quality Alliance (PQA); 2015 Jul. 66 p.

This is the current release of the measure.

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

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 prescription drug plan members 18 years and older who met eligibility criteria for medication therapy management (MTM) services and who received a comprehensive medication review (CMR) during the eligibility period.

Rationale

Medication therapy management (MTM) is a distinct service that optimizes therapeutic outcomes for individual patients. In recognition of their importance, MTM services are mandated by the Centers for Medicare & Medicaid Services (CMS) to include a comprehensive medication review.

Evidence for Rationale

Kuhle J. (Senior Director Performance Measurement, Pharmacy Quality Alliance). Personal communication. 2013 Oct 29.  3 p.

Perlroth D, Marrufo G, Montesinos A, et al. Medication therapy management in chronically ill populations: final report. [internet]. 2013 Aug [accessed 2014 Sep 22].

Primary Health Components

Medication therapy management (MTM); comprehensive medication review (CMR)

Denominator Description

Patients 18 years and older who met eligibility criteria for medication therapy management (MTM) services (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

The number of patients in the denominator that have received one or more comprehensive medication reviews (CMRs) during 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

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

This measure was pilot tested during measure development (see process below), which included reliability and validity testing. The measure since has been adopted into the CMS Medicare Display Measures for Prescription Drug Plans.

Process for Development and Testing of Performance Measures

Step 1: Pharmacy Quality Alliance (PQA) workgroups identify measure concepts that may be appropriate for development into fully specified performance measures. The workgroups focus on specific aspects of the medication-use system and/or specific therapeutic areas. The workgroups are open to all members of PQA and use a consensus-based approach to identify, prioritize and recommend the measure concepts that are deemed to be highly important for supporting quality improvement related to medications.

Step 2: The measure concepts that are recommended for further development through a vote by the PQA workgroups are forwarded to the PQA Quality Metrics Expert Panel (QMEP) for evaluation and refinement. The QMEP reviews the measure concepts to provide an initial assessment of the key properties of performance measures (i.e., feasibility, usability and scientific validity). The measure concepts that are rated highly on these key properties will then undergo technical specification.

Step 3: The draft measure is provided to PQA member organizations for their comments prior to preparing technical specifications for pilot testing. The QMEP reviews member comments, edits the draft measure accordingly and poses testing questions based on this all-member feedback.

Step 4: PQA selects partners to test the draft measure. These partners are often PQA member health plans or academic institutions with expertise in quality and performance measure testing. The testing partner implements the draft technical specifications with their existing datasets and provides a report to PQA that details testing results and recommendations for modifications of the technical specifications.

Step 5: The workgroup that developed the measure reviews the testing results and provides comment. The QMEP reviews the workgroup comments, testing results, recommendations and potential modifications and provides a final assessment of the feasibility and scientific validity of the draft performance measures.

Step 6: Measures that are recommended by the QMEP for endorsement are posted on the PQA web site for member review, written comments are requested, and a conference call for member organizations is scheduled to address any questions. This process allows members to discuss their views on the measures in advance of the voting period.

Step 7: PQA member organizations vote on the performance measure(s) considered for endorsement.

Evidence for Extent of Measure Testing

Pharmacy Quality Alliance (PQA). Process for development and testing of performance measures [available at http://www.pqaalliance.org]. Springfield (VA): Pharmacy Quality Alliance (PQA); 2014. 1 p.

State of Use

Current routine use

Current Use

External oversight/Medicare

Internal quality improvement

Measurement Setting

Managed Care Plans

Other

Professionals Involved in Delivery of Health Services

Nurses

Pharmacists

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age equal to or greater than 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Making Care Safer
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

Staying Healthy

IOM Domain

Effectiveness

Safety

Case Finding Period

The measurement year

Denominator Sampling Frame

Enrollees or beneficiaries

Denominator (Index) Event or Characteristic

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Time window follows index event

Denominator Inclusions/Exclusions

Inclusions
Patients 18 years and older as of the last day of the measurement year who met eligibility criteria for medication therapy management (MTM) services

Note:

  • MTM: MTM is a distinct service or group of services that optimize therapeutic outcomes for individual patients. MTM services are independent of, but can occur in conjunction with, the provision of a medication product. MTM encompasses a broad range of professional activities and responsibilities within the licensed pharmacist's or other qualified health care provider's scope of practice. A comprehensive medication review (CMR) is a common element of MTM services.
  • CMR: A comprehensive medication review consists of a review of a patient's medications, including prescription, over-the-counter (OTC) medications, herbal therapies and dietary supplements to assess medication use and identify drug therapy related problems. A CMR includes an interactive, person-to-person consultation with the patient to address and resolve findings to optimizing patient outcomes.
  • Eligibility for CMR:
    • Prescription Drug Plan MTM Programs: When this measure is used to evaluate a prescription drug plan's MTM program, or the pharmacies providing MTM services within a prescription drug plan network, the plan's CMR eligibility criteria should be used in selecting patients for the denominator.
    • MTM Programs Not Related to a Prescription Drug Plan: MTM providers using this measure for self-assessment should determine CMR eligibility criteria for that is appropriate for their practice and use it for selecting patients for the denominator.
  • Measurement Year: Time period of 365 days where this measure is assessed.
  • Continuous Enrollment for MTM Enrollment Allowable Gap: No more than one gap in enrollment of up to 45 days during each year of continuous enrollment.
  • MTM Anchor Date: Enrolled in the MTM program and identified as eligible for CMR greater than 60 days before the last day of the measurement year.

Exclusions
None

Exclusions/Exceptions

None

Numerator Inclusions/Exclusions

Inclusions
The number of patients in the denominator that have received one or more comprehensive medication reviews (CMRs)* during the measurement year

*CMR: A CMR consists of a review of a patient's medications, including prescription, over-the-counter (OTC) medications, herbal therapies and dietary supplements to assess medication use and identify drug therapy related problems. A CMR includes an interactive, person-to-person consultation with the patient to address and resolve findings to optimizing patient outcomes.

Exclusions
None

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

None

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

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

External comparison of time trends

Internal time comparison

Original Title

Completion rate for comprehensive medication review.

Measure Collection Name

Pharmacy Quality Alliance (PQA) Measures

Measure Set Name

Medication Therapy Management Measure

Submitter

Pharmacy Quality Alliance - Clinical Quality Collaboration

Developer

Pharmacy Quality Alliance - Clinical Quality Collaboration

Funding Source(s)

None

Composition of the Group that Developed the Measure

PQA Workgroup

Financial Disclosures/Other Potential Conflicts of Interest

None

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Jul

Measure Maintenance

Annually

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

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

Source(s)

Pharmacy Quality Alliance (PQA). Technical specifications for PQA approved measures. Springfield (VA): Pharmacy Quality Alliance (PQA); 2015 Jul. 66 p.

Measure Availability

Source not available electronically.

For more information, contact the Pharmacy Quality Alliance (PQA) at 6213 Old Keene Mill Court, Springfield, VA 22152; Phone: 703-690-1987; Fax: 703-842-8150; Web site: www.pqaalliance.org External Web Site Policy; Email: info@PQAalliance.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on August 4, 2014. The information was verified by the measure developer on September 24, 2014.

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.

The Pharmacy Quality Alliance (PQA) performance measures and supporting drug code lists may be used for non-commercial use with permission from PQA. Commercial use of the PQA measures requires a licensing agreement. For information contact PQA at info@PQAalliance.org.

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