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  • Measure Summary
  • NQMC:009246
  • Jul 2015
  • NQF-Endorsed Measure

Proportion of days covered (PDC): percentage of patients who filled at least two prescriptions for the specified diabetes medications on two unique dates of service who met the PDC threshold of 80% during the measurement 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 patients 18 years and older who filled at least two prescriptions for any of the specified diabetes medications (biguanides, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-IV [DPP-IV] inhibitors, incretin mimetic agents, meglitinides and sodium glucose co-transporter 2 [SGLT2] inhibitors) on two unique dates of service who met the Proportion of Days Covered (PDC) threshold of 80% during the measurement period.

Rationale

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. For those patients who require chronic medication therapy, adherence to hypoglycemic agents can lower blood sugar, and decrease complications such as visual loss and renal failure.

Evidence for Rationale

Lau DT, Nau DP. Oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care. 2004 Sep;27(9):2149-53. PubMed External Web Site Policy

Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005 Jun;43(6):521-30. PubMed External Web Site Policy

Primary Health Components

Medication adherence; biguanide; sulfonylurea; thiazolidinedione; dipeptidyl peptidase-IV (DPP-IV) inhibitor; incretin mimetic agent; meglitinide; sodium glucose co-transporter 2 (SGLT2) inhibitors

Denominator Description

Patients 18 years and older who filled at least two prescriptions for the specified diabetes medications on two unique dates of service during the measurement period (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

The number of patients who met the Proportion of Days Covered (PDC) threshold of 80% 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 Part D Star Ratings program, as well as other programs. PQA receives and reviews data to assess performance of the measure and changes in rates over time.

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

Accreditation

Decision-making by businesses about health plan purchasing

Decision-making by consumers about health plan/provider choice

Decision-making by health plans about provider contracting

External oversight/Medicare

External oversight/Other national programs

Internal quality improvement

Pay-for-performance

Public reporting

Quality of care research

Measurement Setting

Ambulatory/Office-based Care

Managed Care Plans

Other

Professionals Involved in Delivery of Health Services

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 greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

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

Inclusions
Patients 18 years and older as of the last day of the measurement period who filled at least two prescriptions for the specified diabetes medications (biguanides, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-IV [DPP-IV] inhibitors, incretin mimetic agents, meglitinides and sodium glucose co-transporter 2 [SGLT2] inhibitors)* on two unique dates of service during the measurement period

Note:

  • 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 Tables PDC-D, PDC-E, PDC-F, PDC-G, PDC-J and PDC-K in the original measure documentation for diabetes medications.

Exclusions

  • Patients who have one or more prescriptions for insulin in the measurement period
  • Patients with end-stage renal disease (ESRD)

Note: Refer to Table PDC-H in the original measure documentation for insulins.

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
The number of patients who met the Proportion of Days Covered (PDC) threshold* of 80% during the measurement year

Note: Refer to the original measure documentation for additional details.

*PDC Threshold: The level of PDC above which the medication has a reasonable likelihood of achieving most of the potential clinical benefit (80% for diabetes and cardiovascular drugs; 90% for antiretrovirals).

Exclusions
None

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

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

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

Proportion of days covered (PDC): optional diabetes all class rate.

Measure Collection Name

Pharmacy Quality Alliance (PQA) Measures

Measure Set Name

Adherence/Persistence Measures

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

Endorser

National Quality Forum

NQF Number

0541

Date of Endorsement

2012 Jul 10

Core Quality Measures

Cardiology

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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