Measure Name:
Outcome of High Risk Pain Medications Prescribed in Last 6 Months
QCDR Measure ID:
SGC6
QCDR Measure Type:
Existing Approved QCDR Measure With Changes
NQF ID Number (if applicable)
N/A
High Priority Type:
Opioid-related Measure
Measure Type:
Outcome
NQS Domain:
Patient Safety
Inverse Measure?
No
Proportional Measure?
Yes
Continuous Variable Measure?
No
Ratio Measure?
No
Number of performance rates to be calculated and submitted in the XML
1
Risk-Adjusted?
Yes
If risk-adjusted, indicate which score is risk-adjusted
Age, chronic conditions such as OA and hospice admission
Measure Description:
Percentage of patients aged 18 years and older prescribed and actively taking one or more high risk medications in the last 6 months meeting the following criteria:
o Evaluation of polypharmacy AND
o Reduction to the high risk medication where clinically appropriate (e.g., change pain medication, number of medications, dosage and/or frequency prescribed)
What one meaningful measure area applies to this measure?
Prevention and Treatment of Opioid and Substance Use Disorders
Rational:
Evaluating patient outcomes after being prescribed an opioid prescription in the last 6 months along with evaluation of polypharmacy will help to evaluate the effectiveness and appropriateness of opioid prescriptions for the patient in addition to polypharmacy interaction.  Appropriate prescription identification and interaction will allow the provider to appropriately adjust the patient prescriptions will still allowing for an appropriate therapeutic effect.
Denominator:
Patients 18 age and older on date of encounter
AND
Patient encounter during the reporting period
Denominator Exclusions:
Trauma case
Hospice services received by patient any time during the measurement period
Patients who are receiving comfort care only at the time of encounter
Numerator:
Patients prescribed and actively taking high risk pain medications in the last 6 months
Performance Met:          Patient evaluated for polypharmacy resulting in a clinically appropriate reduction in the number of medications used in treatment
AND/OR
Performance Met:          Patient evaluated for polypharmacy resulting in the patient prescribed a different pain management medication
AND/OR
Performance Met:          Patient evaluated for polypharmacy resulting in a clinically appropriate change in dosage and/or frequency of the high risk pain medication
OR
Performance Exclusion:             Patient not prescribed a high risk pain medication.
OR
Performance Not Met:    Patient evaluated for polypharmacy resulting in no change in patient's pharmacologic treatment regimen
OR
Performance Not Met:    Patient not evaluated for polypharmacy, reason not given
Numerator Exclusions:
Patient not prescribed a high risk pain medication.
Denominator Exceptions:
None