["Medication, Dispensed": "Antidepressant Medication"]

Data elements that meet criteria using this datatype should document that a prescription for the medication indicated by the QDM category and its corresponding value set has been dispensed and provided to the patient or patient proxy. In the ambulatory setting, medications are primarily taken directly by patients and not directly observed. Hence, dispensed or fulfillment information is the closest health provider documentation of medication compliance. In settings where patients attest to taking medications in electronic format (perhaps a Personal Health Record), patient attestation of medication taken may be available. The QDM datatype, “Medication, Administered” addresses medication taken; to address the source of the information, a measure addressing such patient attestation would require use of the QDM entity (Patient, Care Partner, or Practitioner) fulfilling the role of the performer attribute for the administration event.

Timing:

• relevant dateTime references the dateTime the prescription dispensing event occurred, i.e., the time the prescription was handed over to the patient or patient’s representative.
• relevantPeriod addresses the time period for which the dispensed supply is to be administered/taken (i.e., not including refills; each dispensing event relevantPeriod is evaluated individually).
• In the initial publication of QDM 5.5, relevantPeriod referenced the validity period, i.e., the time period for which the ordered supply is authorized by the prescription authorizing the dispensing event.
• author dateTime references the date and time the dispensing event is recorded.

Notes:

• The dispensing record is unlikely to indicate a relevantPeriod, the date or time at which a patient should start taking a medication and the date and time at which the patient should stop taking the medication. Therefore, to determine the number of days covered by a single dispensing event, use the daysSupplied attribute and the relevant dateTime of the event to determine when the dispensed medication will run out. If daysSupplied is not available, derive it from the supply (quantity of medication dispensed) divided by the dosage (amount of medication to be taken at a single administration) times the frequency (number of units per time period – e.g., per day):
  daysSupplied = supply / (dosage x frequency). And, starting with the relevant dateTime add the number of daysSupplied to determine when the dispensed medication quantity will run out.
• Each dispensing event is unique. Therefore, when calculating cumulative medication duration (CMD) the measure developer should use CQL logic to address multiple dispensing events over a period of time.
• negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.

Refer to Special Cases in Section 5.7 for scenarios to consider in calculating cumulative medication duration.