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  1. eCQM Issue Tracker
  2. CQM-5601

CRP: Revise calculation method of medication treatment days

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    • Other
    • Resolution: Unresolved
    • Moderate
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    • Hide
      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)" currently uses a different method for calculating AHDH medication treatment days.​​For the eCQM, the Measure Developer would like to incorporate an updated method for calculating ADHD medication treatment days in the following Initial Population 2 criteria: "Children... who were prescribed an ADHD medication during the Intake Period and remained on the medication for at least 210 days during the 301-day period, beginning on the IPSD [Index Prescription Start Date] through 300 days after the IPSD, and who had a visit during the measurement period."

      ​This updated method assumes that, for the same ADHD medications, the patient will take one prescription at a time (and start taking the next prescription after exhausting the previous prescription), and that the patient will take different medications concurrently.

      Goal of review:
      Obtain clinical and technical 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)" currently uses a different method for calculating AHDH medication treatment days.​​For the eCQM, the Measure Developer would like to incorporate an updated method for calculating ADHD medication treatment days in the following Initial Population 2 criteria: "Children... who were prescribed an ADHD medication during the Intake Period and remained on the medication for at least 210 days during the 301-day period, beginning on the IPSD [Index Prescription Start Date] through 300 days after the IPSD, and who had a visit during the measurement period." ​This updated method assumes that, for the same ADHD medications, the patient will take one prescription at a time (and start taking the next prescription after exhausting the previous prescription), and that the patient will take different medications concurrently. Goal of review: Obtain clinical and technical feedback
    • Hide
      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.

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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