Use of High-Risk Medications in the Elderly

Last updated: January 31, 2017

CMS Measure ID: CMS156v5
Version: 5
NQF Number: 0022
Measure Description:

Percentage of patients 66 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 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
National Quality Strategy Domain: Patient Safety
Previous Version: Use of High-Risk Medications in the Elderly
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.

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.

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

  • Updated Clinical Recommendation Statement.

    Section: Clinical Recommendation Statement

    Source: Measure Lead

  • ‚ÄčUpdated Copyright.

    Section: Copyright

    Source: Annual Update

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Clarified the intent of the of the measure.

    Section: Guidance

    Source: Measure Lead

  • Updated Rationale.

    Section: Rationale

    Source: Measure Lead

  • Updated References.

    Section: Reference

    Source: Measure Lead

Logic

  • Value Set Ophthalmologic Outpatient Visit (2.16.840.1.113883.3.464.1003.101.11.1206): Added Ophthalmologic Outpatient Visit value set to measure.

    Section: Initial Population

    Source: JIRA (CQM-1494)

  • Value Set Ophthalmologic Outpatient Visit (2.16.840.1.113883.3.464.1003.101.11.1206): Added Ophthalmologic Outpatient Visit value set to measure.

    Section: QDM Data Elements

    Source: JIRA (CQM-1494)

Value Set

  • Value set High Risk Medications for the Elderly (2.16.840.1.113883.3.464.1003.196.12.1253): Added 13 RXNORM codes and deleted 115 RXNORM codes.

    Section: None

    Source: None

  • Value set High-Risk Medications With Days Supply Criteria (2.16.840.1.113883.3.464.1003.196.12.1254): Added 3 RXNORM codes (311991, 1648755, 1648759) and deleted 1 RXNORM code (311992).

    Section: None

    Source: None

  • Value Set Ophthalmologic Outpatient Visit (2.16.840.1.113883.3.464.1003.101.11.1206): Added Ophthalmologic Outpatient Visit value set to measure.

    Section: None

    Source: JIRA (CQM-1494)

External Resources