Brief Description of Measure:

​CMS156: Use of High-Risk Medications in Older Adults:
Percentage of patients 65 years of age and older who were ordered at least two of the same high-risk medications.

Description of Issue:

Upon internal review, the measure developer identified two  issues related to the Numerator requirement of having "at least two orders of high-risk medications".
 
First, the measure intent is to identify two dispensing events of high-risk medications on different days. The measure specification is based on prescription orders, so the logic uses this function "More Than One of Same Medication Order" to identify two orders authored on different days. To align the logic better with the intent, there is an opportunity to utilize the order "refills" attribute and allow both of the following instances to meet criteria:

• At least two orders authored on different days
• At least one order authored with at least one refill
  Essentially, in the measure, an "order" can be identified by either a prescription order or a prescription refill.
   
  Second, the current function "More Than One of Same Medication Order" identifies "different days" by evaluating  whether two orders are authored 24 hours apart. The logic uses this syntax, "...OrderMedication1.authorDatetime 1 day or more after OrderMedication2.authorDatetime".
   
  The intent is to evaluate orders based on "different days", not 24 hours apart, so the measure developer plans to update the logic accordingly.

Proposed Solution:

​//Header: Definition - add the following definition:
An order is identified by either a prescription order or a prescription refill.

//Logic
//Before
define function "More Than One of Same Medication Order"(Medication List<"Medication, Order"> ):
"Medication" OrderMedication1
  with "Medication" OrderMedication2
    such that OrderMedication1.authorDatetime 1 day or more after OrderMedication2.authorDatetime
      and OrderMedication1.authorDatetime during "Measurement Period"
      and OrderMedication2.authorDatetime during "Measurement Period"
  return OrderMedication1

//After
...
"Medication" OrderMedication1
  with "Medication" OrderMedication2
    such that ( OrderMedication1.authorDatetime during "Measurement Period"
        and OrderMedication1.refills >= 1
    )
      or ( date from OrderMedication1.authorDatetime !~ date from OrderMedication2.authorDatetime
          and OrderMedication1.authorDatetime during "Measurement Period"
          and OrderMedication2.authorDatetime during "Measurement Period"
      )
  return OrderMedication1

Rationale for Change:

This change will align the measure logic with the measure intent to capture dispensing events or refills on different days.