Use of High-Risk Medications in the Elderly

Last updated: May 17, 2016

CMS Measure ID: CMS156v4
Version: 4
NQF Number: 0022
Measure Description:

Percentage of patients 66 years of age and older who were ordered high-risk medications. Two rates are reported.

  • Percentage of patients who were ordered at least one high-risk medication.
  • Percentage of patients who were ordered at least two different high-risk medications.
Initial Patient Population:

Patients 66 years and older who had a visit during the measurement period

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

None

Numerator Statement:

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

Numerator 2: Patients with an order for at least two different high-risk medications during the measurement period.

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Patient Safety
Next Version: Use of High-Risk Medications in the Elderly
Previous Version: Use of High-Risk Medications in the Elderly
Measure Score: Proportion
Improvement Notation:

Lower score indicates better quality

Guidance:

The intent of Numerator 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 different high-risk medications.

CUMULATIVE MEDICATION DURATION is an individual's total number of medication days over a specific period; the period counts multiple prescriptions with gaps in between, but does not count the gaps during which a medication was not dispensed.

To determine the cumulative medication duration, determine first the number of the Medication Days for each prescription in the period: the number of doses divided by the dose frequency per day. Then add the Medication Days for each prescription without counting any days between the prescriptions.

For example, there is an original prescription for 30 days with 2 refills for thirty days each. After a gap of 3 months, the medication was prescribed again for 60 days with 1 refill for 60 days. The cumulative medication duration is (30 x 3) + (60 x 2) = 210 days over the 10 month period.

Specifications

Release Notes

Header

  • Copyright updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • eMeasure version number incremented from 4.0.000 to 4.1.000.

Logic

  • Introduced logic to capture Sum > 90 day(s) of: 'Medication, Order: High-Risk Medications With Days Supply Criteria' with attribute cumulative medication duration to calculate cumulative medication duration.
  • Replaced 'ORs' with 'Union of' operator.
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.

Value Sets

  • Value set High Risk Medications for the Elderly (OID 2.16.840.1.113883.3.464.1003.196.12.1253): Added 4 RXNORM codes (1047805, 1190931, 1441392, 603806); Deleted 73 RXNORM codes.

XML

  • This measure contains multiple Population Criteria sections. The earlier version of this measure contained mismatches between the applicable Population Criteria human readable narrative sections and their associated computer-readable sections in the XML file. This issue has been corrected.
  • An empty stratifier was included in the XML file of the earlier posted version of the measure. This empty stratifier has been removed with this update.

External Resources