• National Committee for Quality Assurance (NCQA). HEDIS® 2009: Healthcare Effectiveness Data & Information Set. Vol. 1, Narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2008 Jul. 90 p.



• National Committee for Quality Assurance (NCQA). HEDIS® 2009: Healthcare Effectiveness Data & Information Set. Vol. 2, Technical Specifications. Washington (DC): National Committee for Quality Assurance (NCQA); 2008 Jul. various p.

Does not apply to this measure

This Patient Safety measure addresses medication management to prevent the harms associated with certain medications in the elderly.

Certain medications 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. 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.

Reducing prescriptions of high-risk drugs in the elderly also represents an opportunity to reduce the costs associated with the harm from medications (e.g., hospitalizations from drug toxicity) and encourage clinicians to consider safer, alternative medications. Reducing unnecessary prescribing will also help to reduce cost, given that the elderly population represent one third of all prescription drug expenditures in the U.S. but comprises only 13 percent of the population.

Medication safety; use of high-risk medications in the elderly

Medicare members 65 years of age and older as of December 31 of the measurement year (see the "Description of Case Finding" field in the Complete Summary)

Members who received at least two prescriptions dispensed for different high-risk medication during the measurement year (refer to Table DAE-A in the original measure documentation for high-risk medications)

• A formal consensus procedure involving experts in relevant clinical, methodological, and organizational sciences
• One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Use of this measure to improve performance

• National Committee for Quality Assurance (NCQA). The state of health care quality 2008: industry trends and analysis. Washington (DC): National Committee for Quality Assurance (NCQA); 2008. 131 p.

Current routine use

Accreditation
Decision-making by businesses about health-plan purchasing
Decision-making by consumers about health plan/provider choice
External oversight/Medicare
Internal quality improvement

Managed Care Plans

Measure is not provider specific

Single Health Care Delivery Organizations

Age greater than or equal to 65 years

Either male or female

Unspecified

• One in 20 prescriptions filled by the elderly are for drugs classified as "always avoid"; more than 1 in 10 are for drugs that would rarely be considered appropriate.
• Studies have found that 21 to 37 percent of elderly patients filled at least one potentially inappropriate prescription and more than 15 percent filled at least two.

• The elderly face particular challenges in prescription drug use. Expenditures for prescription drugs in the U.S. are disproportionately high among those over 65 years of age. This population is twice as likely as others to experience adverse drug events and seven times as likely to be hospitalized.
• Seniors receiving inappropriate medications are more likely than others to report poor health status at a follow-up visit with their physician.

Studies link prescription of inappropriate drugs to higher risk of harmful side effects, hospitalization, increased length of illness, nursing home placement and falls and fractures that can hasten physical, functional and social decline.

See also the "Rationale" field.

See the "Rationale" field.

See the "Rationale" field.

Staying Healthy

Safety

Both users and nonusers of care

Medicare members 65 years of age and older as of December 31 of the measurement year who were continuously enrolled during the measurement year with no more than one gap in enrollment of up to 45 days during the measurement year

Enrollees or beneficiaries

Inclusions
Medicare members 65 years of age and older as of December 31 of the measurement year

Exclusions
Unspecified

All cases in the denominator are equally eligible to appear in the numerator

Patient Characteristic

Time window precedes index event

Inclusions
Members who received at least two prescriptions dispensed for different high-risk medication during the measurement year (refer to Table DAE-A in the original measure documentation for high-risk medications)

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Fixed time period

Administrative data
Pharmacy data

Individual Case

Unspecified

Rate

Better quality is associated with a lower score

Unspecified

External comparison at a point in time
External comparison of time trends
Internal time comparison

Unspecified

Use of high-risk medications in the elderly (DAE).

National Committee for Quality Assurance

Unspecified

National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.

In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.

National Quality Forum

Measure was not adapted from another source.

2005 Jan

2008 Jul

Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.

• National Committee for Quality Assurance (NCQA). HEDIS® 2009: Healthcare Effectiveness Data & Information Set. Vol. 1, Narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2008 Jul. 90 p.



• National Committee for Quality Assurance (NCQA). HEDIS® 2009: Healthcare Effectiveness Data & Information Set. Vol. 2, Technical Specifications. Washington (DC): National Committee for Quality Assurance (NCQA); 2008 Jul. various p.

This NQMC summary was completed by ECRI on June 6, 2006. The information was not verified by the measure developer. This NQMC summary was updated by ECRI on January 31, 2007. The updated information was not verified by the measure developer. This NQMC summary was updated by ECRI Institute on April 21, 2008. The information was verified by the measure developer on May 30, 2008. This NQMC summary was updated again by ECRI Institute on March 20, 2009. The information was verified by the measure developer on May 29, 2009.