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  • Measure Summary
  • NQMC:009250
  • Jul 2015

Diabetes medication dosing (DOS): percentage of patients who were dispensed a dose higher than the daily recommended dose for sulfonylureas.

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


This measure is used to assess the percentage of patients 18 years and older who were dispensed a dose higher than the daily recommended dose for sulfonylureas during the measurement year.


Diabetes mellitus is a chronic disease that has reached epidemic proportions in the U.S. and can lead to increased rates of heart disease, stroke and death. Because of its progressive nature, some patients may be maintained on high, but still inadequate, doses of oral hypoglycemic agents, rather than switching to or adding insulin. High doses of oral hypoglycemic agents are more likely to lead to adverse drug events. This measure identifies the number of patients receiving doses higher than recommended.

Evidence for Rationale

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

Primary Health Components

Diabetes; medication dosing; sulfonylureas

Denominator Description

Patients 18 years and older who were dispensed one or more prescriptions for a sulfonylurea during the measurement year (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

The number of patients who were dispensed a dose of a sulfonylurea higher than the daily recommended dose (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


Extent of Measure Testing

This measure was pilot tested during measure development (see process below), which included reliability and validity testing.

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]. 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


Professionals Involved in Delivery of Health Services



Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size


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



Case Finding Period

The measurement year

Denominator Sampling Frame

Enrollees or beneficiaries

Denominator (Index) Event or Characteristic

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Time window follows index event

Denominator Inclusions/Exclusions

Patients 18 years and older as of the last day of the measurement year who were dispensed one or more prescriptions for a sulfonylurea* during the measurement year


  • Continuous Enrollment:
    • Using Enrollment Data: Subjects should be continuously enrolled during the measurement period. To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage (i.e., a member whose coverage lapses for 2 months [60 consecutive days] is not considered continuously enrolled).
    • Proxy for Enrollment When Using Pharmacy-only Data: Two or more prescriptions for any medication, with 150 days between the first fill and the last fill, over a 12 month period.
  • Measurement Period: The patient's measurement period begins on the date of the first fill of the target medication (i.e., index date) and extends through the last day of the enrollment period or until death or disenrollment. The index date should occur at least 91 days before the end of the enrollment period.

*Refer to Table DOS-D in the original measure documentation for sulfonylurea medications.




Numerator Inclusions/Exclusions

The number of patients who were dispensed a dose of a sulfonylurea higher than the daily recommended dose*

*Refer to Table DOS-E in the original measure documentation for sulfonylurea dosing.


Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Pharmacy data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure


Measure Specifies Disaggregation

Does not apply to this measure



Interpretation of Score

Desired value is a lower 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

This measure requires that separate rates be reported for commercial, Medicare, and Medicaid product lines.

Standard of Comparison

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

External comparison of time trends

Internal time comparison

Original Title

Diabetes medication dosing (DOS): dosing for sulfonylureas.

Measure Collection Name

Pharmacy Quality Alliance (PQA) Measures

Measure Set Name

Diabetes Medication Measures


Pharmacy Quality Alliance - Clinical Quality Collaboration


Pharmacy Quality Alliance - Clinical Quality Collaboration

Funding Source(s)


Composition of the Group that Developed the Measure

PQA Workgroup

Financial Disclosures/Other Potential Conflicts of Interest



This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Jul

Measure Maintenance


Date of Next Anticipated Revision


Measure Status

This is the current release of the measure.

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


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: External Web Site Policy; Email:

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

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