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Use of High-Risk Medications in the Elderly

Last updated: May 9, 2019

CMS Measure ID: CMS156v8
Version: 8
NQF Number: Not Applicable
Measure Description:

Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are reported.

a. Percentage of patients who were ordered at least one high-risk medication.

b. Percentage of patients who were ordered at least two of the same high-risk medications.

Initial Patient Population:

Patients 65 years and older who had a visit during the measurement period

Denominator Statement:

Equals Initial Populationinfo-icon

Denominator Exclusions:

Exclude patients whose hospice care overlaps the measurement period

Numerator Statement:

Numeratorinfo-icon 1: Patients with an order for at least one high-risk medication during the measurement period

Numerator 2: Patients with at least two orders for the same high-risk medication on different days during the measurement period

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Patient Safety
Previous Version:
Measure Scoring: Proportion
Measure Type: Process
Improvement Notation:

Lower score indicates better quality

Guidance:

The intent of Numeratorinfo-icon 1 of the measure is to assess if the patient has been prescribed at least one high-risk medication. The intent of Numerator 2 of the measure is to assess if the patient has been prescribed at least two of the same high-risk medications on different days.

The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication for them.

Quality ID: 238
Meaningful Measure: Medication Management

Specifications

Release Notes

Header

  • Updated eCQMinfo-icon version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Updated NQFinfo-icon number to 'Not Applicable.'

    Measure Section: NQF Number

    Source of Change: Standards Update

  • Updated endorsed by field to 'None.'

    Measure Section: Endorsed By

    Source of Change: Standards Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated rationale statement.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated clinical recommendation statement.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references to align with American Psychological Association (APA) style.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated guidance statement with removal of cumulative medication duration as it was outdated.

    Measure Section: Guidance

    Source of Change: ONC Project Tracking System (JIRA)info-icon: CQMinfo-icon-3153

  • Updated guidance statement for Numeratorinfo-icon 2 to include 'on different days' to clarify the intent of the multiple high risk medication orders.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated numerator statement for Numerator 2 to include 'on different days' to clarify the intent of the multiple high risk medication orders.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated parenthetical citations to align with American Psychological Association (APA) style.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Removed duplicate medication 'Acetaminophen / Diphenhydramine / Phenylephrine' in definition 'Same High Risk Medications Ordered on Different Days.'

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the names of Clinical Quality Language (CQL)info-icon definitions, functions, and/or aliases for clarification and to align with CQL Style Guideinfo-icon.

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7info-icon Standard: Clinical Quality Language Specificationinfo-icon, Release 1 STUinfo-icon 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MATinfo-icon) Global Common Functions Library to align with standards changes, Clinical Quality Language (CQL) Style Guide, and to include two new functions related to calculating hospital stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Hospice Library (Hospice-2.0.000).

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-4.0.000).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Setinfo-icon

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • Value set Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240): Added SNOMED CT extensional value set (2.16.840.1.113883.3.526.2.1772) including 2 codes.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Acetaminophen / Chlorpheniramine / Dextromethorphan / Pseudoephedrine (2.16.840.1.113883.3.464.1003.196.12.1321): Deleted 1 RxNorm code (1293298).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Chlorpheniramine / Phenylephrine (2.16.840.1.113883.3.464.1003.196.12.1343): Deleted 1 RxNorm code (1876117).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Acetaminophen / Diphenhydramine (2.16.840.1.113883.3.464.1003.196.12.1350): Deleted 1 RxNorm code (1245374).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Diphenhydramine Hydrochloride (2.16.840.1.113883.3.464.1003.196.12.1371): Deleted 1 RxNorm code (1049918).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set (2.16.840.1.113883.3.464.1003.101.11.1206): Renamed to Ophthalmologic Services.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set List of Single RxNorm Code Concepts for High Risk Drugs for the Elderly (2.16.840.1.113883.3.464.1003.196.12.1272): Added RxNorm extensional value set (2.16.840.1.113883.3.464.1003.196.11.1302) including 1 code. Deleted 2 RxNorm codes (1291711, 251050).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set High Risk Medications for the Elderly (2.16.840.1.113883.3.464.1003.196.12.1253): Added 1 RxNorm code (1664543) and deleted 12 RxNorm codes.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Chlorpheniramine / Phenylephrine / Phenyltoloxamine (2.16.840.1.113883.3.464.1003.196.12.1453): Removed Chlorpheniramine / Phenylephrine / Phenyltoloxamine.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Chlorpheniramine / Codeine (2.16.840.1.113883.3.464.1003.196.12.1301): Removed Chlorpheniramine / Codeine.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Chlorpheniramine / Phenylephrine / Pyrilamine (2.16.840.1.113883.3.464.1003.196.12.1309): Removed Chlorpheniramine / Phenylephrine / Pyrilamine.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Brompheniramine / Phenylephrine (2.16.840.1.113883.3.464.1003.196.12.1327): Removed Brompheniramine / Phenylephrine.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Direct reference code for Birth date (LOINC Code (21112-8)) now displayed in Human Readable.

    Measure Section: Terminology

    Source of Change: Annual Update

  • ​Removed code systeminfo-icon versions from direct reference codes. Please refer to Appendix A of the Electronic Clinical Quality Measureinfo-icon Logic and Implementation Guidance document for a list of code system versions used in the eCQM specificationsinfo-icon for 2020 reporting/performance.

    Measure Section: Terminology

    Source of Change: Standards Update

  • Standardized purpose statement language in value sets across eCQMsinfo-icon. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set High Risk Medications for the Elderly (2.16.840.1.113883.3.464.1003.196.12.1253): Removed three RxNorm extensional value sets (2.16.840.1.113883.3.464.1003.196.11.1454, 2.16.840.1.113883.3.464.1003.196.11.1310, 2.16.840.1.113883.3.464.1003.196.11.1379).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set List of Single RxNorm Code Concepts for High Risk Drugs for the Elderly (2.16.840.1.113883.3.464.1003.196.12.1272): Removed two RxNorm extensional value sets (2.16.840.1.113883.3.464.1003.196.11.1379, 2.16.840.1.113883.3.464.1003.196.11.1454).

    Measure Section: Terminology

    Source of Change: Measure Lead

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