Description:    The percentage of members who were diagnosed with rheumatoid arthritis and who were dispensed at least one ambulatory prescription for a disease-modifying anti-rheumatic drug (DMARD).


Denominator:  

Product lines
Commercial, Medicaid, Medicare (report each product line separately).
Ages
18 years and older as of December 31 of the measurement year.
Continuous enrollment
The measurement year.
Allowable gap
No more than one gap in enrollment of up to 45 days. To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage (i.e., a member whose coverage lapses for 2 months [60 days] is not considered continuously enrolled).
Anchor date
December 31 of the measurement year.
Benefits
Medical and pharmacy.
Event/ diagnosis
Two of the following with different dates of service on or between January 1 and November 30 of the measurement year. Visit type need not be the same for the two visits.
  • Outpatient visit (Outpatient Value Set), with any diagnosis of rheumatoid arthritis (Rheumatoid Arthritis Value Set).
  • Nonacute inpatient discharge, with any diagnosis of rheumatoid arthritis (Rheumatoid Arthritis Value Set). To identify nonacute inpatient discharges:
    • Identify all acute and nonacute inpatient stays (Inpatient Stay Value Set).
    • Confirm the stay was for nonacute care based on the presence of a nonacute code (Nonacute Inpatient Stay Value Set ) on the claim.
    • Identify the discharge date for the stay.


Denominator Exclusions (when applicable) 

  • A diagnosis of HIV (HIV Value Set; HIV Type 2 Value Set) any time during the member’s history through December 31 of the measurement year.
  • A diagnosis of pregnancy (Pregnancy Value Set) any time during the measurement year.




Numerator:  

Numerator
Members who had at least one ambulatory prescription dispensed for a DMARD during the measurement year. There are two ways to identify members who received a DMARD: by claim/encounter data and by pharmacy data. The organization may use both methods to identify the numerator, but a member need only be identified by one method to be included in the numerator.
Claim/encounter data. A DMARD prescription (DMARD Value Set) during the measurement year.
Pharmacy data. Members who were dispensed a DMARD during the measurement year on an ambulatory basis (Table ART-C).