Use of High Risk Medications in the Elderly (DAE)

Use of High Risk Medications in the Elderly (DAE)

Contents

OVERVIEW ................................................................................................................................................. 1

TECHNICAL SPECIFICATIONS ...................................................................................................................... 3

APPENDIX 1 ................................................................................................................................................ 5

OVERVIEW

Measure Description

The percentage of patients 65 years of age and older who received at least one high-risk medication.

The percentage of patients 65 years of age and older who received at least two different high-risk

medications.

Deviations from HEDIS Specifications

The denominator from the third-party specifications includes beneficiaries who have ¡°continuous medical

and pharmacy benefit enrollment for the measurement year with no more than one gap in enrollment of

up to 45 days during the measurement year. The patient must be enrolled as of December 31 of the

measurement year.¡± The common enrollment specifications (and exclusion of 2010 part year

beneficiaries) mean that all beneficiaries in the denominator will have enrollment for all of 2010. Also, the

allowed gap of 45 days for HEDIS specs is different from the one-month gap allowed in our specs.

The third-party specifications do not specify the setting for the NDC codes, but there are no NDC codes on

claims other than Part D so we will only be searching in Part D claims.

Assumptions/Notes

The eligible population for this measure is based on discharges, not patients. This differs from how the

eligible population is defined for other performance measures. It is possible for the denominator to

contain multiple discharge records for the same individual.

Data Sources

Denominator inclusion data:

2010 Part A file

2010 Part B file

2010 Part D file

Denominator exclusion data:

None

Numerator inclusion data:

2010 Part D file

1

Denominator

Beneficiaries are included in the denominator if the following criteria are met:

65 years and older as of December 31 of the measurement year

Continuous medical and pharmacy benefit enrollment for the measurement year with no more than one

gap in enrollment of up to 45 days during the measurement year

Enrolled as of December 31 of the measurement

Denominator Exclusions

None

Numerator

Beneficiaries are included if the beneficiary meets the following criteria:

Numerator 1: At least one prescription dispensed for any high-risk medication during the measurement

year.

Numerator 2: At least two prescriptions dispensed for different high-risk medications during the

measurement year.

Rate Calculations

For both rates, a lower rate represents better performance.

2

TECHNICAL SPECIFICATIONS

Denominator

The eligible population of beneficiaries who were a) 65 years and older as of December 31 of the measurement

year and b) have continuous medical and pharmacy benefit enrollment for the measurement year with no more

than one gap in enrollment of up to 45 days during the measurement year. Note that the patient must be enrolled

as of December 31 of the measurement year.

A. For each beneficiaryi attributed to providerk use the enrollment arrays created in the enrollment preprocessing program and create NCQA_HRME_DENi = 1 if:

1.

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