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  • Measure Summary
  • NQMC:010773
  • Jan 2016

Proportion of days covered (PDC): percentage of patients with COPD who filled at least two prescriptions for any long-acting inhaled bronchodilator on two unique dates of service who met the PDC threshold of 80% during the measurement period.

Pharmacy Quality Alliance (PQA). Adherence to long-acting inhaled bronchodilator agents in COPD patients. Springfield (VA): Pharmacy Quality Alliance (PQA); 2016. 3 p.

This is the current release of the measure.

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 with chronic obstructive pulmonary disease (COPD) who filled at least two prescriptions for any long-acting inhaled bronchodilator on two unique dates of service who met the proportion of days covered (PDC) threshold of 80% during the measurement period.

Rationale

Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality. Adherence to maintenance medications prescribed for COPD, such as long-acting inhaled bronchodilators, decreases exacerbations and hospitalizations and improves health outcomes.

Evidence for Rationale

Kuhle J. (VP Measure Operations, Pharmacy Quality Alliance, Springfield, VA). Personal communication. 2016 Apr 6.  1 p.

Pharmacy Quality Alliance (PQA). Adherence to long-acting inhaled bronchodilator agents in COPD patients. Springfield (VA): Pharmacy Quality Alliance (PQA); 2016. 3 p.

Primary Health Components

Chronic obstructive pulmonary disease (COPD); long-acting inhaled bronchodilator agents; medication adherence

Denominator Description

Patients in the eligible population who filled at least two (2) prescriptions for any long-acting inhaled bronchodilator on two (2) unique dates of service during the measurement period (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

The number of patients in the denominator 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
  • 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

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.

Adherence to Long-Acting Inhaled Bronchodilator Agents in Chronic Obstructive Pulmonary Disease (COPD) Patients

Measure testing was done by two organizations using commercial and Medicare data to further define the measure specifications. Then two additional organizations tested the draft measure using Medicare data. Finally, two organizations provided additional testing analysis using commercial and Medicare data to determine whether COPD must be in the primary diagnosis field and whether hospitalization or Low Income Subsidy status impacted the measure.

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

Pilot testing

Current Use

Internal quality improvement

Measurement Setting

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

Unspecified

Target Population Age

No age threshold

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

Measurement period: The period of time over which the prescription medication fill pattern is assessed. This is typically 12 months.

Denominator Sampling Frame

Enrollees or beneficiaries

Denominator (Index) Event or Characteristic

Clinical Condition

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Patients in the eligible population who filled at least two (2) prescriptions for any long-acting inhaled bronchodilator on two (2) unique dates of service during the measurement period

Eligible population:

  • Ages: No age threshold
  • Diagnoses: Chronic obstructive pulmonary disease (COPD) diagnosis. One claim during the measurement period containing a COPD International Classification of Diseases, Ninth Revision (ICD-9) or International Classification of Diseases, Tenth Revision (ICD-10) code, in any diagnosis field.

Note:

  • Measurement Period: The period of time over which the prescription medication fill pattern is accessed. This is typically 12 months.
  • Refer to Medication List – Table A in the original measure documentation for long-acting (LA) inhaled bronchodilator medications.
  • Refer to Table B in in the original measure documentation for COPD diagnosis codes.

Exclusions
Exclude patients from the denominator if they have one (1) or more prescription claims for any nebulized bronchodilator

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

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

Note: Refer to the original measure documentation for steps to determine whether the patient meets the PDC threshold.

Exclusions
Unspecified

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

Unspecified

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

Adherence to long-acting inhaled bronchodilator agents in COPD patients.

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

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Jan

Measure Maintenance

Annually

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

Pharmacy Quality Alliance (PQA). Adherence to long-acting inhaled bronchodilator agents in COPD patients. Springfield (VA): Pharmacy Quality Alliance (PQA); 2016. 3 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 June 28, 2016. The information was verified by the measure developer on July 5, 2016.

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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