Continuous Improvement and the Expansion of Quality ... - NCQA

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T H E S TAT E o f H E A l T H C A R E Q U A l I T y 2 0 1 1 • H E D I S M E A S U R E S o f C A R E MEDICATIoN IN THE ElDERly The elderly are twice as likely as younger adults to have an adverse drug reaction and are seven times more likely to be hospitalized as the result of an adverse drug event. 1 The Use of High-Risk Medications in the Elderly measure assesses how often elderly individuals are exposed to potentially harmful drugs. 2-4 The Potentially Harmful Drug-Disease Interactions in the Elderly measure assesses how often patients with a specific diagnosis are prescribed high-risk medications that are considered potentially dangerous. • In a 2002–2005 study of 384 American hospitals, 49 percent of patients received at least one potentially inappropriate medication; among patients 65 years of age and older, 13 percent were given a potentially harmful medication. 5 • In a study that measured potentially inappropriate medication use in the elderly, 40 percent of the population filled at least one prescription for such medications and 13 percent filled two or more. 6 the Case for Improvement • Exposure to high-risk medications increases health care costs, including medication costs, an estimated $7.2 billion annually. 7 • The use of high-risk medications increases the risk for hospitalization, death and adverse health outcomes. 6,8 • Mobility problems from dementia are exacerbated by the use of high-risk medications, and patients exposed to these 107 medications are more likely to be admitted to long-term care facilities. 9 • Prescribing harmful drugs to the elderly population puts them at risk for further complications, which include falls, fractures and longer duration of illnesses. Data from a multidisciplinary falls clinic and a cooperative adverse drug event surveillance project show that patients on five or more medications are twice as likely to have impaired balance and are at higher risk for further inappropriate medication use. 1,10 HEdIs Measure definition The measures assess two different dimensions of medication management in the Medicare population 65 years of age and older. Potentially Harmful Drug-Disease Interactions in the Elderly The percentage of adults 65 and older who have evidence of an underlying disease, condition or health concern and who were dispensed an ambulatory prescription for a M E A S U R E S T A R G E T E D A T o l D E R A D U l T S
M E A S U R E S T A R G E T E D A T o l D E R A D U l T S contraindicated medication, concurrent with or after the diagnosis. Use of High-Risk Medications in the Elderly The percentage of adults 65 and older who received at least one high-risk medication and the percentage of adults 65 and older who received at least two different high-risk medications. A combined rate is reported. results Currently, close to a quarter of all Medicare patients are prescribed one potentially harmful medication. Although some drugs are harmful regardless of a patient’s current health, some drugs prescribed for patients with a specific disease are associated with poor physical and cognitive performance, including balance disorders and an increased likelihood of falls. 9,11 yEAR 108 N AT I o N A l C o M M I T T E E f o R Q U A l I T y A S S U R A N C E PotEntIally HarMful drugdIsEasE IntEraCtIons In tHE EldErly: ovErall ratE* CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 NA NA 23.3 21.8 NA 2009 NA NA 23.2 21.8 NA 2008 NA NA 23.0 21.7 NA 2007 NA NA 21.8 21.5 NA yEAR usE of HIgH-rIsk MEdICatIons In tHE EldErly: at lEast onE MEdICatIon* CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 NA NA 22.1 21.9 NA 2009 NA NA 23.0 22.3 NA 2008 NA NA 23.4 22.1 NA 2007 NA NA 23.2 22.1 NA 2006 NA NA 23.1 23.1 NA yEAR usE of HIgH-rIsk MEdICatIons In tHE EldErly: at lEast tWo MEdICatIons* CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 NA NA 5.1 5.1 NA 2009 NA NA 5.7 5.3 NA 2008 NA NA 6.0 5.4 NA 2007 NA NA 6.0 5.3 NA 2006 NA NA 5.9 6.5 NA
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2 This Report and the data containe
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4 N AT I o N A l C o M M I T T E E
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24 HEDIS MEASURES of CARE about HEd
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C H R o N I C D I S E A S E M A N A
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158 APPENDIx 8: PUblICly REPoRTING
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160 N AT I o N A l C o M M I T T E
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172 MEASURE N AT I o N A l C o M M
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180 APPENDIx 16A: VARIATIoN IN PlAN
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182 APPENDIx 16b: VARIATIoN IN PlAN
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184 REfERENCES N AT I o N A l C o M
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ACkNoWlEDGMENTS Health Plans The 20
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Continuous Improvement and the Expansion of Quality ... - NCQA

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