Gout: Anti-Inflammatory Prophylaxis with Urate Lowering Therapy (ULT)

Initial Patient Population =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Measurement Period"
- AND: MOST RECENT:
  - OR: "Occurrence A of Encounter, Performed: Office Visit (reason: 'Gout')"
  - OR: "Occurrence A of Encounter, Performed: Outpatient Consultation (reason: 'Gout')"
  - OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction (reason: 'Gout')"
  - OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit (reason: 'Gout')"
  - OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility (reason: 'Gout')"
  - OR: "Occurrence A of Encounter, Performed: Home Healthcare Services (reason: 'Gout')"
  - during "Measurement Period"
- AND:
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Office Visit"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Office Visit"
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Outpatient Consultation"
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Nursing Facility Visit"
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Home Healthcare Services"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Home Healthcare Services"
Denominator =
- AND: "Initial Patient Population"
Denominator Exclusions =
- None
Numerator =
- AND:
  - OR:
    - OR:
      - AND: "Occurrence A of Medication, Active: Low Dose Colchicine" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
      - AND NOT: "Occurrence A of Medication, Active: Low Dose Colchicine" ends before start of "Occurrence A of Encounter, Performed: Office Visit"
    - OR:
      - AND: "Occurrence A of Medication, Active: Low Dose Colchicine" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
      - AND NOT: "Occurrence A of Medication, Active: Low Dose Colchicine" ends before start of "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - OR:
      - AND: "Occurrence A of Medication, Active: Low Dose Colchicine" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      - AND NOT: "Occurrence A of Medication, Active: Low Dose Colchicine" ends before start of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - OR:
      - AND: "Occurrence A of Medication, Active: Low Dose Colchicine" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
      - AND NOT: "Occurrence A of Medication, Active: Low Dose Colchicine" ends before start of "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - OR:
      - AND: "Occurrence A of Medication, Active: Low Dose Colchicine" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
      - AND NOT: "Occurrence A of Medication, Active: Low Dose Colchicine" ends before start of "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - OR:
      - AND: "Occurrence A of Medication, Active: Low Dose Colchicine" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
      - AND NOT: "Occurrence A of Medication, Active: Low Dose Colchicine" ends before start of "Occurrence A of Encounter, Performed: Home Healthcare Services"
  - OR:
    - OR:
      - AND: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
      - AND NOT: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" ends before start of "Occurrence A of Encounter, Performed: Office Visit"
    - OR:
      - AND: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
      - AND NOT: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" ends before start of "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - OR:
      - AND: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      - AND NOT: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" ends before start of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - OR:
      - AND: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
      - AND NOT: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" ends before start of "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - OR:
      - AND: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
      - AND NOT: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" ends before start of "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - OR:
      - AND: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
      - AND NOT: "Occurrence A of Medication, Active: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" ends before start of "Occurrence A of Encounter, Performed: Home Healthcare Services"
  - OR:
    - OR:
      - AND: "Occurrence A of Medication, Active: Glucocorticoid for Gout" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
      - AND NOT: "Occurrence A of Medication, Active: Glucocorticoid for Gout" ends before start of "Occurrence A of Encounter, Performed: Office Visit"
    - OR:
      - AND: "Occurrence A of Medication, Active: Glucocorticoid for Gout" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
      - AND NOT: "Occurrence A of Medication, Active: Glucocorticoid for Gout" ends before start of "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - OR:
      - AND: "Occurrence A of Medication, Active: Glucocorticoid for Gout" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      - AND NOT: "Occurrence A of Medication, Active: Glucocorticoid for Gout" ends before start of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - OR:
      - AND: "Occurrence A of Medication, Active: Glucocorticoid for Gout" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
      - AND NOT: "Occurrence A of Medication, Active: Glucocorticoid for Gout" ends before start of "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - OR:
      - AND: "Occurrence A of Medication, Active: Glucocorticoid for Gout" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
      - AND NOT: "Occurrence A of Medication, Active: Glucocorticoid for Gout" ends before start of "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - OR:
      - AND: "Occurrence A of Medication, Active: Glucocorticoid for Gout" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
      - AND NOT: "Occurrence A of Medication, Active: Glucocorticoid for Gout" ends before start of "Occurrence A of Encounter, Performed: Home Healthcare Services"
  - OR: "Medication, Order: Low Dose Colchicine" starts during
    - OR: "Occurrence A of Encounter, Performed: Office Visit"
    - OR: "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - OR: "Occurrence A of Encounter, Performed: Home Healthcare Services"
  - OR: "Medication, Order: Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" starts during
    - OR: "Occurrence A of Encounter, Performed: Office Visit"
    - OR: "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - OR: "Occurrence A of Encounter, Performed: Home Healthcare Services"
  - OR: "Medication, Order: Glucocorticoid for Gout" starts during
    - OR: "Occurrence A of Encounter, Performed: Office Visit"
    - OR: "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - OR: "Occurrence A of Encounter, Performed: Home Healthcare Services"
Denominator Exceptions =
- AND:
  - OR:
    - AND: "Medication, Order not done: Medical Reason" for "Low Dose Colchicine" during "Measurement Period"
    - AND: "Medication, Order not done: Medical Reason" for "Non-Steroidal Anti-Inflammatory Drug-NSAID for Gout" during "Measurement Period"
    - AND: "Medication, Order not done: Medical Reason" for "Glucocorticoid for Gout" during "Measurement Period"
  - OR:
    - AND:
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Office Visit"
        
        AND: "Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result < 30 )"
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Outpatient Consultation"
        
        AND: "Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result < 30 )"
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
        
        AND: "Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result < 30 )"
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Nursing Facility Visit"
        
        AND: "Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result < 30 )"
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
        
        AND: "Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result < 30 )"
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Home Healthcare Services"
        
        AND: "Occurrence A of Laboratory Test, Result: Estimated Glomerular Filtration Rate-eGFR (result < 30 )"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 3" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 3" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 3" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 3" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 3" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 3" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 4" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 4" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 4" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 4" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 4" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 4" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 5" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 5" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 5" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 5" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 5" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
      - OR: "Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 5" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
      - OR: "Occurrence A of Diagnosis, Active: End Stage Renal Disease" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
      - OR: "Occurrence A of Diagnosis, Active: End Stage Renal Disease" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
      - OR: "Occurrence A of Diagnosis, Active: End Stage Renal Disease" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      - OR: "Occurrence A of Diagnosis, Active: End Stage Renal Disease" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
      - OR: "Occurrence A of Diagnosis, Active: End Stage Renal Disease" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
      - OR: "Occurrence A of Diagnosis, Active: End Stage Renal Disease" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
    - AND:
      - OR: "Occurrence A of Diagnosis, Active: Diabetes" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
      - OR: "Occurrence A of Diagnosis, Active: Diabetes" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
      - OR: "Occurrence A of Diagnosis, Active: Diabetes" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      - OR: "Occurrence A of Diagnosis, Active: Diabetes" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
      - OR: "Occurrence A of Diagnosis, Active: Diabetes" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
      - OR: "Occurrence A of Diagnosis, Active: Diabetes" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Office Visit"
        
        AND: "Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result > 9 %)"
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Outpatient Consultation"
        
        AND: "Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result > 9 %)"
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
        
        AND: "Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result > 9 %)"
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Nursing Facility Visit"
        
        AND: "Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result > 9 %)"
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
        
        AND: "Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result > 9 %)"
      - OR:
        
        AND: MOST RECENT:"Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result)" <= 6 month(s) starts before start of "Occurrence A of Encounter, Performed: Home Healthcare Services"
        
        AND: "Occurrence A of Laboratory Test, Result: HbA1c Laboratory Test (result > 9 %)"

eMeasure Title	Gout: Anti-Inflammatory Prophylaxis with Urate Lowering Therapy (ULT)
eMeasure Identifier (Measure Authoring Tool)		eMeasure Version number	0
NQF Number	2526 (Under Consideration)	GUID	8c07728d-446f-496c-8953-91b3aa684079
Measurement Period	January 1, 20xx through December 31, 20xx
Measure Steward	American College of Rheumatology
Measure Developer	American College of Rheumatology
Endorsed By	None
Description	Percentage of patients aged 18 and older with a diagnosis of gout initiated on urate- lowering therapy (ULT), who are receiving concomitant anti-inflammatory prophylaxis (defined as low dose colchicine, non-steroid anti-inflammatory drug (NSAID) or glucocorticoid)
Copyright	Copyright (C) 2014, American College of Rheumatology All materials are subject to copyrights owned by the College. The College hereby provides limited permission for the user to reproduce, retransmit or reprint for such user's own personal use (and for such personal use only) part or all of any document as long as the copyright notice and permission notice contained in such document or portion thereof is included in such reproduction, retransmission or reprinting. All other reproduction, retransmission, or reprinting of all or part of any document is expressly prohibited, unless the College has expressly granted its prior written consent to so reproduce, retransmit, or reprint the material. All other rights reserved.
Disclaimer	This performance measure has not been tested for all potential applications. The measure and specifications are provided “as is” and without warranty of any kind. CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Measure Scoring	Proportion
Measure Type	Process
Stratification	None
Risk Adjustment	None
Rate Aggregation	None
Rationale	After initiating urate lowering therapy, there is an increased rate of acute gout flares for several months. For the recent randomized control trials, where prophylaxis was continued for only 8 weeks, 40% of patients flared upon cessation of prophylaxis, whereas if prophylaxis was continued for 6 months, only 5% of patients flared [1]. In a small randomized control trial using colchicine vs. placebo, patients assigned to colchicine had fewer flares at 0-3 and 3-6 months (0.57 and 0 flares) vs. patients assigned to placebo (1.91, 1.05 flares), both differences statistically different [2]. Forty-three subjects were studied. Subjects treated with colchicine experienced fewer total flares (0.52 vs 2.91, p = 0.008), fewer flares from 0 to 3 months (0.57 vs 1.91, p = 0.022), fewer flares 3-6 months (0 vs 1.05, p = 0.033), less severe flares as reported on VAS (3.64 vs 5.08, p = 0.018), and fewer recurrent gout flares (p = 0.001). Colchicine was well tolerated.
Clinical Recommendation Statement	Pharmacologic anti-inflammatory prophylaxis is recommended for all gout patients when pharmacologic urate lowering is initiated, and should be continued if there is any clinical evidence of continuing gout disease activity and/or the serum urate target has not yet been achieved. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or oral colchicine are appropriate first-line options for treatment of acute gout, and certain combinations can be employed for severe or refractory attacks. Khanna, Dinesh, et. al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 2: Therapy and Anti-inflammatory Prophylaxis of Acute Gouty Arthritis. Arthritis Care & Research 2012; 64: 1447-61.
Improvement Notation	Higher score indicates better quality
Reference	[1] Wortmann RL, Macdonald PA, Hunt B, Jackson RL. Effect of prophylaxis on gout flares after the initiation of urate lowering therapy: analysis of data from three phase III trials. Clin Ther 2010;32:2386–97.
Reference	[2] Borstad GC, Bryant LR, Abel MP, Scroogie DA, Harris MD, Alloway JA. Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J Rheumatol 2004;31:2429–32.
Definition	Prescribed includes prescription for anti-inflammatory prophylaxis ordered at the most recent visit in the measurement period OR patient actively taking anti-inflammatory prophylaxis at the time of the most recent visit as documented in the current medication list.
Guidance	For this measure, a patient qualifies for a ‘Medical Reason’ denominator exception only when the patient has a documented contraindication, allergy or intolerance to each of the three anti-inflammatory prophylaxis (eg, low-dose colchicine, NSAID, and glucocorticoid) medications included in the numerator; if a patient has a documented contraindication, allergy or intolerance to one or two of the drug classes, it would be expected that a medication from the remaining class(es) would be prescribed.
Transmission Format	TBD
Initial Patient Population	Patients aged 18 and older with an established gout diagnosis initiating urate lowering (ULT) therapy
Denominator	Equals Initial Patient Population
Denominator Exclusions	None
Numerator	Patients prescribed anti-inflammatory prophylaxis (including low-dose colchicine, non-steroidal anti-inflammatory (NSAID) or glucocorticoid)
Numerator Exclusions	Not Applicable
Denominator Exceptions	Documentation of medical reason(s) for not prescribing any of the options for anti-inflammatory prophylaxis (eg, patients with eGFR<30 mL/min or Stage 3 or greater Chronic Kidney Disease AND poorly controlled diabetes (diagnosis of diabetes and HbA1c > 9), other medical reason)
Measure Population	Not Applicable
Measure Observations	Not Applicable
Supplemental Data Elements	For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents

Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements