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  • Measure Summary
  • NQMC:009906
  • Jul 2015

Use of benzodiazepine sedative-hypnotic medications in the elderly: percentage of individuals 65 years of age and older who received two or more prescription fills for any benzodiazepine sedative-hypnotic for a cumulative period of more than 90 days.

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 individuals 65 years of age and older who received two or more prescription fills for any benzodiazepine sedative-hypnotic for a cumulative period of more than 90 days.

Rationale

The Beers Criteria are the basis for the medication list in the measure High Risk Medications (HRM) in the Elderly and Drugs to Avoid in the Elderly (DAE). Since the measures only use prescription claims data for calculation, the lists are adapted from the Beers Criteria. Benzodiazepines were not included in the HRM/DAE measures since they are listed as "avoid only for treatment of insomnia, agitation or delirium."

This measure addresses a gap in the HRM/DAE measures that may have the unintended consequence of increasing the use of benzodiazepines for the very diagnoses the Beers Criteria state should be avoided. This measure parallels the HRM/DAE measures using the same criteria for benzodiazepine sedative-hypnotic agents as the non-benzodiazepine hypnotics in the HRM/DAE.

Evidence for Rationale

Pharmacy Quality Alliance (PQA). Technical specifications for PQA approved measures. Springfield (VA): Pharmacy Quality Alliance (PQA); 2014 Sep. 56 p.

Primary Health Components

Sedative-hypnotic medications; benzodiazepines; elderly

Denominator Description

Number of individuals who are 66 years or older on the last day of the measurement year and enrolled in the same health plan for greater than 90 days

Numerator Description

Individuals in the denominator who received two prescriptions for any benzodiazepine sedative-hypnotic medication and a cumulative days supply of greater than 90 days for any benzodiazepine sedative-hypnotic 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.

Pharmacy Quality Alliance (PQA) Measure Development Process

PQA develops performance measures through a consensus-driven process to draft, test, refine and endorse measures of medication-use quality.

Step 1: PQA workgroups comprised of experts in all phases of drug use and management identify measure concepts that may be appropriate for development into fully specified performance measures or indicators for organizational internal quality improvement. The workgroups focus on specific aspects of the medication-use system and/or specific therapeutic areas.

Step 2: PQA workgroups recommend measure concepts 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 undergo technical specification as draft measures.

Step 3: The draft measures are provided to PQA member organizations for their comments prior to preparing technical specifications for pilot testing. PQA staff use member comments and workgroup and QMEP recommendations to formulate a testing plan for each draft measure.

Step 4: PQA selects partners to test the draft measures. 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 within 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 held to gather feedback and 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 endorsement of the Performance Measures and approval of Quality Improvement Indicators.

Evidence for Extent of Measure Testing

Pharmacy Quality Alliance (PQA). Technical specifications for PQA approved measures. Springfield (VA): Pharmacy Quality Alliance (PQA); 2014 Sep. 56 p.

State of Use

Pilot testing

Current Use

Does not apply to this measure

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

Age greater than or equal to 65 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

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

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of individuals who are 66 years or older on the last day of the measurement year and enrolled in the same health plan for greater than 90 days

Exclusions
None

Exclusions/Exceptions

None

Numerator Inclusions/Exclusions

Inclusions
Individuals in the denominator who received two prescriptions for any benzodiazepine sedative-hypnotic medication and a cumulative days supply of greater than 90 days for any benzodiazepine sedative-hypnotic during the measurement year

Note:

  • Benzodiazepine Sedative-hypnotic Agents: estazolam, temazepam, triazolam, flurazepam, quazepam. Refer to the table in the original measure documentation for benzodiazepine sedative-hypnotic agents.
  • The cumulative days supply calculation applies to any of the benzodiazepine sedative-hypnotics listed for the measure not just for each individual medication. A patient is included in the numerator if he/she received at least two prescription fills for any medication in the class and if the cumulative days supply for any product is greater than 90 days during the measurement period. For example, if a patient received a 30 day supply of triazolam and a second fill for 30 days supply of triazolam and then a fill for 35 days supply estazolam (all during the measurement period), this would qualify for inclusion in the numerator.

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​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

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a lower score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Use of benzodiazepine sedative hypnotic medications in the elderly.

Measure Collection Name

Pharmacy Quality Alliance (PQA) Measures

Measure Set Name

Medication Safety 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

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 April 1, 2015. The information was verified by the developer on April 20, 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.

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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