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  2. CQM-5611

CRP: Change timing of encounter to anchor with the index prescription start date instead of measurement period

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    • Other
    • Resolution: Unresolved
    • Moderate
    • None
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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 denominator qualifying encounter is not currently tied to the denominator prescription event. This means that in cases where the qualifying encounter and prescription event are performed by different providers, it is unclear to whom the measure result should be attributed.

      The measure developer proposes revising the timing anchor of the encounter that is currently the measurement period, to the 6 months prior to the index prescription start date (IPSD) or on the IPSD. Tying the qualifying encounter to 6 months prior to the prescription date would enable the measure to attribute patients to providers who have a greater chance of interacting with the patient and/or prescribing the medication.

      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 denominator qualifying encounter is not currently tied to the denominator prescription event. This means that in cases where the qualifying encounter and prescription event are performed by different providers, it is unclear to whom the measure result should be attributed. The measure developer proposes revising the timing anchor of the encounter that is currently the measurement period, to the 6 months prior to the index prescription start date (IPSD) or on the IPSD. Tying the qualifying encounter to 6 months prior to the prescription date would enable the measure to attribute patients to providers who have a greater chance of interacting with the patient and/or prescribing the medication. Goal of review Obtain clinical and technical feedback
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      Proposed solution
      //Header – before
      Initial Population 1: Children 6-12 years of age as of the Intake Period who […] and who had a visit during the measurement period. […]
      Initial Population 2: Children 6-12 years of age as of the Intake Period who […], and who had a visit during the measurement period. […]

      //Header – after
      Initial Population 1: Children 6-12 years of age as of the Intake Period who […] and who had a visit within 6 months prior to the IPSD including the IPSD. […]
      Initial Population 2: Children 6-12 years of age as of the Intake Period who […], and who had a visit within 6 months prior to the IPSD including the IPSD. […]

      //Logic – before
      define "Qualifying Encounter":
       ( ["Encounter, Performed": "Office Visit"]
         union ["Encounter, Performed": "Home Healthcare Services"]
         union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
         union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"] ) ValidEncounters
         where ValidEncounters.relevantPeriod during "Measurement Period"

      //Logic – after
      define "Qualifying Encounter":
       ( ["Encounter, Performed": "Office Visit"]
         union ["Encounter, Performed": "Home Healthcare Services"]
         union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
         union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"] ) ValidEncounters
         let IPSD: date from Coalesce("First ADHD Medication Prescribed During Intake Period".relevantPeriod.low, "First ADHD Medication Prescribed During Intake Period".authorDatetime)
         where ValidEncounters.relevantPeriod during day of Interval[IPSD - 6 months, IPSD]

      Rationale for change
      This approach is similar to CMS128, where the qualifying encounter visit is tied to 60 days prior to through 60 days after the antidepressant prescription event. The 6-month timeframe is used as ADHD medication prescriptions may last up to 6 months.
      Show
      Proposed solution //Header – before Initial Population 1: Children 6-12 years of age as of the Intake Period who […] and who had a visit during the measurement period. […] Initial Population 2: Children 6-12 years of age as of the Intake Period who […], and who had a visit during the measurement period. […] //Header – after Initial Population 1: Children 6-12 years of age as of the Intake Period who […] and who had a visit within 6 months prior to the IPSD including the IPSD. […] Initial Population 2: Children 6-12 years of age as of the Intake Period who […], and who had a visit within 6 months prior to the IPSD including the IPSD. […] //Logic – before define "Qualifying Encounter":  ( ["Encounter, Performed": "Office Visit"]    union ["Encounter, Performed": "Home Healthcare Services"]    union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]    union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"] ) ValidEncounters    where ValidEncounters.relevantPeriod during "Measurement Period" //Logic – after define "Qualifying Encounter":  ( ["Encounter, Performed": "Office Visit"]    union ["Encounter, Performed": "Home Healthcare Services"]    union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]    union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"] ) ValidEncounters    let IPSD: date from Coalesce("First ADHD Medication Prescribed During Intake Period".relevantPeriod.low, "First ADHD Medication Prescribed During Intake Period".authorDatetime)    where ValidEncounters.relevantPeriod during day of Interval[IPSD - 6 months, IPSD] Rationale for change This approach is similar to CMS128, where the qualifying encounter visit is tied to 60 days prior to through 60 days after the antidepressant prescription event. The 6-month timeframe is used as ADHD medication prescriptions may last up to 6 months.

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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