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  1. eCQM Issue Tracker
  2. CQM-5600

CRP: Update how IPSD with negative medication history is derived

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    • Other
    • Resolution: Unresolved
    • Moderate
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      Brief description of measure:
      CMS136: ​Follow-Up Care for Children Prescribed ADHD Medication (ADD)
      Percentage of children 6-12 years of age and newly prescribed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported. a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase. b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

      Description of issue:
      The HEDIS ADD measure "Follow-Up Care for Children Prescribed ADHD Medication (ADD, ADD-E)" requires the Index Prescription Start Date (IPSD) to be the earliest prescription dispensing date for an ADHD medication where the date is in the intake period and there is a negative medication history. The eCQM measure does not currently follow the same steps in identifying the IPSD; the eCQM measure identifies the IPSD first then disqualifies the IPSD without a negative medication history.

      Goal of review:
      Obtain clinical feedback
      Show
      Brief description of measure: CMS136: ​Follow-Up Care for Children Prescribed ADHD Medication (ADD) Percentage of children 6-12 years of age and newly prescribed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported. a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase. b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended. Description of issue: The HEDIS ADD measure "Follow-Up Care for Children Prescribed ADHD Medication (ADD, ADD-E)" requires the Index Prescription Start Date (IPSD) to be the earliest prescription dispensing date for an ADHD medication where the date is in the intake period and there is a negative medication history. The eCQM measure does not currently follow the same steps in identifying the IPSD; the eCQM measure identifies the IPSD first then disqualifies the IPSD without a negative medication history. Goal of review: Obtain clinical feedback
    • Hide
      Proposed solution:
      //Header - before
       
      Definition: Index Prescription Start Date (IPSD): The earliest prescription date for an ADHD medication where the date is in the Intake Period and an ADHD medication was not prescribed during the 120 days prior.
       
      Initial Population 1: Children 6-12 years of age as of the Intake Period who were prescribed an ADHD medication during the Intake Period and […]. Children are removed if they were actively on ADHD medication in the 120 days prior to the IPSD, or had an acute inpatient stay […].
       
      Initial Population 2: Children 6-12 years of age as of the Intake Period who were prescribed an ADHD medication during the Intake Period and […]. Children are removed if they were actively on ADHD medication in the 120 days prior to the IPSD, or had an acute inpatient stay […].
       
      //Header - after
       
      Definition: Index Prescription Start Date (IPSD): The earliest prescription date for an ADHD medication where the date is in the Intake Period and the patient is not actively on ADHD medication during the 120 days prior.
       
      Initial Population 1: Children 6-12 years of age as of the Intake Period who had an IPSD and […]. Children are removed if they had an acute inpatient stay […].
       
      Initial Population 2: Children 6-12 years of age as of the Intake Period who had an IPSD and […]. Children are removed if they had an acute inpatient stay […].
       
       
      //Logic – before
       
      define "Initial Population 1":
       […]
         and "First ADHD Medication Prescribed During Intake Period" is not null
         and not exists "Previously on ADHD Medication"
         and […]
       
      define "Initial Population 2":
      […]
         and "First ADHD Medication Prescribed During Intake Period" is not null
         and […]
         and not exists "Previously on ADHD Medication"
         and […]
       
      define “First ADHD Medication Prescribed During Intake Period”:
      First("ADHD Medication Prescribed During Intake Period”)
       
      define "ADHD Medication Prescribed During Intake Period ":
          ["Medication, Order": "ADHD Medications"] ADHDMedicationOrder
            where Coalesce(ADHDMedicationOrder.relevantPeriod.low, ADHDMedicationOrder.authorDatetime)during "Intake Period"
            sort by Coalesce(relevantPeriod.low, authorDatetime)asc
       
       define "Previously on ADHD Medication":
          ["Medication, Active": "ADHD Medications"] ActiveADHDMedication 
            with "First ADHD Medication Prescribed During Intake Period" InitialADHDMedication
              such that Global."ToDateInterval" ( Global."NormalizeInterval" ( ActiveADHDMedication.relevantDatetime, ActiveADHDMedication.relevantPeriod ) ) overlaps Interval[date from Coalesce(InitialADHDMedication.relevantPeriod.low, InitialADHDMedication.authorDatetime)- 120 days, date from Coalesce(InitialADHDMedication.relevantPeriod.low, InitialADHDMedication.authorDatetime))
        
       
      //Logic – after
       
      define "Initial Population 1":
        […]
          and "First ADHD Medication Prescribed During Intake Period" is not null
          and […]
        
       define "Initial Population 2":
       […]
          and "First ADHD Medication Prescribed During Intake Period" is not null
          and […]
       
       define “First ADHD Medication Prescribed During Intake Period”:
       First("ADHD Medication Prescribed During Intake Period and Not Previously on ADHD Medication")
        
      define "ADHD Medication Prescribed During Intake Period and Not Previously on ADHD Medication":
        ( ( ["Medication, Order": "ADHD Medications"] ) ADHDMedicationsOrder
         where Coalesce(ADHDMedicationsOrder.relevantPeriod.low, ADHDMedicationsOrder.authorDatetime) during "Intake Period" ) QualifyingADHDMedication
         without ( ["Medication, Active": "ADHD Medications"] ) ActiveADHDMedication
           such that Global."ToDateInterval" ( Global."NormalizeInterval" ( ActiveADHDMedication.relevantDatetime, ActiveADHDMedication.relevantPeriod ) ) overlaps Interval[date from Coalesce(QualifyingADHDMedication.relevantPeriod.low, QualifyingADHDMedication.authorDatetime) - 120 days, date from Coalesce(QualifyingADHDMedication.relevantPeriod.low, QualifyingADHDMedication.authorDatetime) )
         sort by Coalesce(relevantPeriod.low, authorDatetime) asc

      Rationale for change:
      ​The purpose of this change is to more accurately reflect the measure intent of the measure, and align the eCQM specification with the HEDIS parent measure.

      While this change may result in the identification of a slightly larger denominator, the Measure Developer does not consider this a substantive change.
      Show
      Proposed solution: //Header - before   Definition: Index Prescription Start Date (IPSD): The earliest prescription date for an ADHD medication where the date is in the Intake Period and an ADHD medication was not prescribed during the 120 days prior.   Initial Population 1: Children 6-12 years of age as of the Intake Period who were prescribed an ADHD medication during the Intake Period and […]. Children are removed if they were actively on ADHD medication in the 120 days prior to the IPSD, or had an acute inpatient stay […].   Initial Population 2: Children 6-12 years of age as of the Intake Period who were prescribed an ADHD medication during the Intake Period and […]. Children are removed if they were actively on ADHD medication in the 120 days prior to the IPSD, or had an acute inpatient stay […].   //Header - after   Definition: Index Prescription Start Date (IPSD): The earliest prescription date for an ADHD medication where the date is in the Intake Period and the patient is not actively on ADHD medication during the 120 days prior.   Initial Population 1: Children 6-12 years of age as of the Intake Period who had an IPSD and […]. Children are removed if they had an acute inpatient stay […].   Initial Population 2: Children 6-12 years of age as of the Intake Period who had an IPSD and […]. Children are removed if they had an acute inpatient stay […].     //Logic – before   define "Initial Population 1":  […]    and "First ADHD Medication Prescribed During Intake Period" is not null    and not exists "Previously on ADHD Medication"    and […]   define "Initial Population 2": […]    and "First ADHD Medication Prescribed During Intake Period" is not null    and […]    and not exists "Previously on ADHD Medication"    and […]   define “First ADHD Medication Prescribed During Intake Period”: First("ADHD Medication Prescribed During Intake Period”)   define "ADHD Medication Prescribed During Intake Period ":     ["Medication, Order": "ADHD Medications"] ADHDMedicationOrder       where Coalesce(ADHDMedicationOrder.relevantPeriod.low, ADHDMedicationOrder.authorDatetime)during "Intake Period"       sort by Coalesce(relevantPeriod.low, authorDatetime)asc    define "Previously on ADHD Medication":     ["Medication, Active": "ADHD Medications"] ActiveADHDMedication        with "First ADHD Medication Prescribed During Intake Period" InitialADHDMedication         such that Global."ToDateInterval" ( Global."NormalizeInterval" ( ActiveADHDMedication.relevantDatetime, ActiveADHDMedication.relevantPeriod ) ) overlaps Interval[date from Coalesce(InitialADHDMedication.relevantPeriod.low, InitialADHDMedication.authorDatetime)- 120 days, date from Coalesce(InitialADHDMedication.relevantPeriod.low, InitialADHDMedication.authorDatetime))      //Logic – after   define "Initial Population 1":   […]     and "First ADHD Medication Prescribed During Intake Period" is not null     and […]     define "Initial Population 2":  […]     and "First ADHD Medication Prescribed During Intake Period" is not null     and […]    define “First ADHD Medication Prescribed During Intake Period”:  First("ADHD Medication Prescribed During Intake Period and Not Previously on ADHD Medication")    define "ADHD Medication Prescribed During Intake Period and Not Previously on ADHD Medication":   ( ( ["Medication, Order": "ADHD Medications"] ) ADHDMedicationsOrder    where Coalesce(ADHDMedicationsOrder.relevantPeriod.low, ADHDMedicationsOrder.authorDatetime) during "Intake Period" ) QualifyingADHDMedication    without ( ["Medication, Active": "ADHD Medications"] ) ActiveADHDMedication      such that Global."ToDateInterval" ( Global."NormalizeInterval" ( ActiveADHDMedication.relevantDatetime, ActiveADHDMedication.relevantPeriod ) ) overlaps Interval[date from Coalesce(QualifyingADHDMedication.relevantPeriod.low, QualifyingADHDMedication.authorDatetime) - 120 days, date from Coalesce(QualifyingADHDMedication.relevantPeriod.low, QualifyingADHDMedication.authorDatetime) )    sort by Coalesce(relevantPeriod.low, authorDatetime) asc Rationale for change: ​The purpose of this change is to more accurately reflect the measure intent of the measure, and align the eCQM specification with the HEDIS parent measure. While this change may result in the identification of a slightly larger denominator, the Measure Developer does not consider this a substantive change.

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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