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Proposed solution:
//Header - before
Description: Percentage of children who remained on ADHD medication for at least 210 days…
Initial Population 2: … and remained on the medication for at least 210 days…
Definition: […]
//Header - after
Description: Percentage of children who remained on ADHD medication for at least 210 treatment days…
Initial Population 2: … and remained on the medication for at least 210 treatment days…
Definition:
Treatment days (covered days): The actual number of calendar days covered with prescriptions during the 301-day period.
Use the following steps to identify and calculate covered days.
Step 1: For same medications that are prescribed on the same day or on different days with overlapping days supply, the days supply is summed. The start and end dates are then identified. The start date is the date of service of the earliest prescription event and the first covered day. The end date is the calendar day when the days supply runs out. The start date through the end date are considered covered days. This rule assumes that the patient will take one prescription at a time (and start taking the next prescription after exhausting the previous prescription).
Step 2: For all other events (multiple prescriptions for the same medication on different days without overlap, multiple prescriptions for different medications on the same or different days, with or without overlap), the covered days are identified by the start and end dates for each prescription event individually. The start date through the end date are considered covered days. This rule assumes the member will take the different medications concurrently.
Step 3: Each calendar day covered by one or more medications is considered one covered day.
//Terminology - before
valueset "ADHD Medications": 'urn:oid:2.16.840.1.113883.3.464.1003.196.12.1171'
//Terminology - after
valueset "Atomoxetine": 'urn:oid:2.16.840.1.113883.3.464.1003.1170'
valueset "Clonidine": 'urn:oid:2.16.840.1.113883.3.464.1003.1171'
valueset "Dexmethylphenidate": 'urn:oid:2.16.840.1.113883.3.464.1003.1172'
valueset "Dextroamphetamine": 'urn:oid:2.16.840.1.113883.3.464.1003.1173'
valueset "Lisdexamfetamine": 'urn:oid:2.16.840.1.113883.3.464.1003.1174'
valueset "Methylphenidate": 'urn:oid:2.16.840.1.113883.3.464.1003.1176'
valueset "Guanfacine": 'urn:oid:2.16.840.1.113883.3.464.1003.196.11.1252'
code "methamphetamine hydrochloride 5 MG Oral Tablet": '977860' from "RXNORM" display 'methamphetamine hydrochloride 5 MG Oral Tablet'
//Logic - before
define "ADHD Medications Taken on IPSD or During Continuation and Maintenance Phase":
"ADHD Medication Prescribed During Intake Period" ADHDMedication
let IPSD: date from Coalesce("First ADHD Medication Prescribed During Intake Period".relevantPeriod.low, "First ADHD Medication Prescribed During Intake Period".authorDatetime),
IPSDAndContinuationMaintenancePhase: Interval[IPSD, IPSD + 300 days]
return CMD."MedicationOrderPeriod" ( ADHDMedication )
intersect IPSDAndContinuationMaintenancePhase
define "ADHD Medication Prescribed During Intake Period":
["Medication, Order": "ADHD Medications"] ADHDMedicationOrder
[…]
define "Previously on ADHD Medication":
["Medication, Active": "ADHD Medications"] ActiveADHDMedication
[…]
//Logic - after
define "ADHD Medications Taken on IPSD or During Continuation and Maintenance Phase":
( CMD."RolloutIntervals"(["Medication, Order": "Atomoxetine"] AtomoxetineMed
return all CMD."MedicationOrderPeriod"(AtomoxetineMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Clonidine"] ClonidineMed
return all CMD."MedicationOrderPeriod"(ClonidineMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Dexmethylphenidate"] DexmethylphenidateMed
return all CMD."MedicationOrderPeriod"(DexmethylphenidateMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Dextroamphetamine"] DextroamphetamineMed
return all CMD."MedicationOrderPeriod"(DextroamphetamineMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Lisdexamfetamine"] LisdexamfetamineMed
return all CMD."MedicationOrderPeriod"(LisdexamfetamineMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Methylphenidate"] MethylphenidateMed
return all CMD."MedicationOrderPeriod"(MethylphenidateMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Guanfacine"] GuanfacineMed
return all CMD."MedicationOrderPeriod"(GuanfacineMed) )
union CMD."RolloutIntervals"(["Medication, Order": "methamphetamine hydrochloride 5 MG Oral Tablet"] MethamphetamineMed
return all CMD."MedicationOrderPeriod"(MethamphetamineMed) ) ) ADHDMedication
let […]
return all ADHDMedication
intersect IPSDAndContinuationMaintenancePhase
define "ADHD Medication Prescribed During Intake Period...":
( ["Medication, Order": "Atomoxetine"]
union ["Medication, Order": "Clonidine"]
union ["Medication, Order": "Dexmethylphenidate"]
union ["Medication, Order": "Dextroamphetamine"]
union ["Medication, Order": "Lisdexamfetamine"]
union ["Medication, Order": "methamphetamine hydrochloride 5 MG Oral Tablet"]
union ["Medication, Order": "Methylphenidate"]
union ["Medication, Order": "Guanfacine"] ) ADHDMedicationOrder
[…] ( ["Medication, Active": "Atomoxetine"]
union ["Medication, Active": "Clonidine"]
union ["Medication, Active": "Dexmethylphenidate"]
union ["Medication, Active": "Dextroamphetamine"]
union ["Medication, Active": "Lisdexamfetamine"]
union ["Medication, Active": "methamphetamine hydrochloride 5 MG Oral Tablet"]
union ["Medication, Active": "Methylphenidate"]
union ["Medication, Active": "Guanfacine"] ) ActiveADHDMedication
//Function - before
define function "RolloutIntervals"(intervals List<Interval<Date>>):
intervals I aggregate R starting ( null as List<Interval<Date>>): R
union ( { I X
let S: Max({
end of Last(R) + 1 day, start of X }
),
E: S + duration in days of X
return Interval[S, E]}
)
//Function - after
define function "RolloutIntervals"(intervals List<Interval<Date>> ):
intervals I aggregate all R starting ( null as List<Interval<Date>>): R
union ( { I X
let S: Max({
end of Last(R)+ 1 day, start of X }
),
E: S + Quantity { value: Coalesce(duration in days of X, 0), unit: 'day' }
return Interval[S, E]}
)
Rationale for change:
The updated method takes into account patient behavior in taking medications. This update will harmonize the measure with the calculation approach in the HEDIS parent measure.
Show
Proposed solution:
//Header - before
Description: Percentage of children who remained on ADHD medication for at least 210 days…
Initial Population 2: … and remained on the medication for at least 210 days…
Definition: […]
//Header - after
Description: Percentage of children who remained on ADHD medication for at least 210 treatment days…
Initial Population 2: … and remained on the medication for at least 210 treatment days…
Definition:
Treatment days (covered days): The actual number of calendar days covered with prescriptions during the 301-day period.
Use the following steps to identify and calculate covered days.
Step 1: For same medications that are prescribed on the same day or on different days with overlapping days supply, the days supply is summed. The start and end dates are then identified. The start date is the date of service of the earliest prescription event and the first covered day. The end date is the calendar day when the days supply runs out. The start date through the end date are considered covered days. This rule assumes that the patient will take one prescription at a time (and start taking the next prescription after exhausting the previous prescription).
Step 2: For all other events (multiple prescriptions for the same medication on different days without overlap, multiple prescriptions for different medications on the same or different days, with or without overlap), the covered days are identified by the start and end dates for each prescription event individually. The start date through the end date are considered covered days. This rule assumes the member will take the different medications concurrently.
Step 3: Each calendar day covered by one or more medications is considered one covered day.
//Terminology - before
valueset "ADHD Medications": 'urn:oid:2.16.840.1.113883.3.464.1003.196.12.1171'
//Terminology - after
valueset "Atomoxetine": 'urn:oid:2.16.840.1.113883.3.464.1003.1170'
valueset "Clonidine": 'urn:oid:2.16.840.1.113883.3.464.1003.1171'
valueset "Dexmethylphenidate": 'urn:oid:2.16.840.1.113883.3.464.1003.1172'
valueset "Dextroamphetamine": 'urn:oid:2.16.840.1.113883.3.464.1003.1173'
valueset "Lisdexamfetamine": 'urn:oid:2.16.840.1.113883.3.464.1003.1174'
valueset "Methylphenidate": 'urn:oid:2.16.840.1.113883.3.464.1003.1176'
valueset "Guanfacine": 'urn:oid:2.16.840.1.113883.3.464.1003.196.11.1252'
code "methamphetamine hydrochloride 5 MG Oral Tablet": '977860' from "RXNORM" display 'methamphetamine hydrochloride 5 MG Oral Tablet'
//Logic - before
define "ADHD Medications Taken on IPSD or During Continuation and Maintenance Phase":
"ADHD Medication Prescribed During Intake Period" ADHDMedication
let IPSD: date from Coalesce("First ADHD Medication Prescribed During Intake Period".relevantPeriod.low, "First ADHD Medication Prescribed During Intake Period".authorDatetime),
IPSDAndContinuationMaintenancePhase: Interval[IPSD, IPSD + 300 days]
return CMD."MedicationOrderPeriod" ( ADHDMedication )
intersect IPSDAndContinuationMaintenancePhase
define "ADHD Medication Prescribed During Intake Period":
["Medication, Order": "ADHD Medications"] ADHDMedicationOrder
[…]
define "Previously on ADHD Medication":
["Medication, Active": "ADHD Medications"] ActiveADHDMedication
[…]
//Logic - after
define "ADHD Medications Taken on IPSD or During Continuation and Maintenance Phase":
( CMD."RolloutIntervals"(["Medication, Order": "Atomoxetine"] AtomoxetineMed
return all CMD."MedicationOrderPeriod"(AtomoxetineMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Clonidine"] ClonidineMed
return all CMD."MedicationOrderPeriod"(ClonidineMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Dexmethylphenidate"] DexmethylphenidateMed
return all CMD."MedicationOrderPeriod"(DexmethylphenidateMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Dextroamphetamine"] DextroamphetamineMed
return all CMD."MedicationOrderPeriod"(DextroamphetamineMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Lisdexamfetamine"] LisdexamfetamineMed
return all CMD."MedicationOrderPeriod"(LisdexamfetamineMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Methylphenidate"] MethylphenidateMed
return all CMD."MedicationOrderPeriod"(MethylphenidateMed) )
union CMD."RolloutIntervals"(["Medication, Order": "Guanfacine"] GuanfacineMed
return all CMD."MedicationOrderPeriod"(GuanfacineMed) )
union CMD."RolloutIntervals"(["Medication, Order": "methamphetamine hydrochloride 5 MG Oral Tablet"] MethamphetamineMed
return all CMD."MedicationOrderPeriod"(MethamphetamineMed) ) ) ADHDMedication
let […]
return all ADHDMedication
intersect IPSDAndContinuationMaintenancePhase
define "ADHD Medication Prescribed During Intake Period...":
( ["Medication, Order": "Atomoxetine"]
union ["Medication, Order": "Clonidine"]
union ["Medication, Order": "Dexmethylphenidate"]
union ["Medication, Order": "Dextroamphetamine"]
union ["Medication, Order": "Lisdexamfetamine"]
union ["Medication, Order": "methamphetamine hydrochloride 5 MG Oral Tablet"]
union ["Medication, Order": "Methylphenidate"]
union ["Medication, Order": "Guanfacine"] ) ADHDMedicationOrder
[…] ( ["Medication, Active": "Atomoxetine"]
union ["Medication, Active": "Clonidine"]
union ["Medication, Active": "Dexmethylphenidate"]
union ["Medication, Active": "Dextroamphetamine"]
union ["Medication, Active": "Lisdexamfetamine"]
union ["Medication, Active": "methamphetamine hydrochloride 5 MG Oral Tablet"]
union ["Medication, Active": "Methylphenidate"]
union ["Medication, Active": "Guanfacine"] ) ActiveADHDMedication
//Function - before
define function "RolloutIntervals"(intervals List<Interval<Date>>):
intervals I aggregate R starting ( null as List<Interval<Date>>): R
union ( { I X
let S: Max({
end of Last(R) + 1 day, start of X }
),
E: S + duration in days of X
return Interval[S, E]}
)
//Function - after
define function "RolloutIntervals"(intervals List<Interval<Date>> ):
intervals I aggregate all R starting ( null as List<Interval<Date>>): R
union ( { I X
let S: Max({
end of Last(R)+ 1 day, start of X }
),
E: S + Quantity { value: Coalesce(duration in days of X, 0), unit: 'day' }
return Interval[S, E]}
)
Rationale for change:
The updated method takes into account patient behavior in taking medications. This update will harmonize the measure with the calculation approach in the HEDIS parent measure.