Drugs to be avoided in the elderly: a. Patients who receive at least one drug to be avoided, b. Patients who receive at least two different drugs to be avoided (NQF 0022)

eMeasure Name Drugs to be avoided in the elderly: a. Patients who receive at least one drug to be avoided, b. Patients who receive at least two different drugs to be avoided eMeasure Id 0364AC44-0827-4B3B-B36A-5D02B23AD2EE
Version number 1 eMeasure Set Id 7406953B-16F4-4528-B5C7-0A2E3D0D8345
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Endorsed by National Quality Forum
Description Percentage of patients ages 65 years and older who received at least one drug to be avoided in the elderly in the measurement year.Percentage of patients 65 years of age and older who received at least two different drugs to be avoided in the elderly in the measurement year.
Copyright
©  National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Seniors receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to seniors who receive appropriate medications. (Fu) In 2005, rates of potentially inappropriate medication use in the elderly were as large or larger than in a 1996 national sample, highlighting the need for progress in this area. (Simon)     While some adverse drug events are not preventable, studies estimate that between 30% and 80% of adverse drug events in the elderly are preventable. (MacKinnon)

Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings.  Conservative estimates of extra costs due to potentially inappropriate medications in the elderly average $7.2 billion a year. (Fu)  Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered. (Rothberg) By the year 2030, nearly 1 in 5 U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double in number from 38.7 million in 2008 to more than 88.5 million in 2050.1,2 Likewise, the population aged 85 years or older is expected to increase almost 4-fold, from 5.4 million to 19 million between 2008 and 2050.1 As the elderly population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed continues to increase, resulting in polypharmacy. (Gray)
Clinical Recommendation Statement
The measure is based on the literature and key clinical expert consensus processes by Beers in 1997, Zahn in 2001 and an updated process by Fick in 2003, which identified drugs of concern in the elderly based on various high-risk criteria. NCQA's Medication Management expert panel selected a subset of drugs that should be used with caution in the elderly for inclusion in the proposed measure based upon these two lists.  NCQA analyzed the prevalence of drugs prescribed according to their Beers and Zhan's classifications and determined that drugs identified by Zhan that are classified as never or rarely appropriate would form the basis for the list. (Fick)

Certain medications (MacKinnon) are associated with increased risk of harms from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in the elderly. (Kaufman) Studies link prescription drug use by the elderly with adverse drug events that contribute to hospitalization, increased length of hospital stay, increased duration of illness, nursing home placement and falls and fractures that are further associated with physical, functional and social decline in the elderly. (AHRQ)
Improvement notation
Lower score indicates better quality
Measurement duration
12 month(s)
Reference
Zhan, C, et al. Potentially inappropriate medication use in the community-dwelling elderly. JAMA 2001; 286(22):2823-2868.
Reference
Beers, M.H. Explicit criteria for determining potentially inappropriate medication use by the elderly. Arch Intern Med 1997; 157:1531-1536.
Reference
Fick, DM, et al.Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Intern Med 2003; 163:2716-2724.
Reference
Fu AZ, et al. Inappropriate Medication Use and Health Outcomes in the Elderly, Journal of the American Geriatrics Society 2004; Volume 52, Issue 11, 1934-9.
Reference
Gray, PharmD, Gardner, MD. Adverse Drug Events in the Elderly: An Ongoing Problem, Journal of Managed Care Pharmacy Sep. 2009; Vol. 15, No. 7.
Reference
AHRQ, National Quality Measures Clearinghouse. www.qualitymeasures.ahrq.gov (Accessed Web page: October 12, 2009).
Reference
Rothberg MB, Perkow PS, Liu F, et al. Potentially inappropriate medication use in hospitalized elders. J Hosp Med. 2008;3:91-102.
Definition
Initial Patient Population(s): All patients 65 years and older during the measurement period.
Definition
Denominator(s): Patients in the initial population with an encounter during the measurement period.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): 
Numerator 1: The number of patients who had at least one prescription dispensed for any high-risk medication during the measurement period. 
Numerator 2: The number of patients who had at least two prescriptions dispensed for different high-risk medications during the measurement period.
Definition
Denominator Exception(s): N/A
Guidance
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012