PQA Measures
PQA develops measures to assess the quality of how medications are used, focusing on appropriate use, safety, adherence and medication management services.
Measure Domains
PQA measures fall into four domains aligned with patient-centered, team-based care: appropriate use, safety, adherence and medication management services. These domains include the fundamental principles that support optimal medication management and the full range of services aimed at ensuring people take their medications safely and effectively.
Appropriate Use ensures medication therapy aligns with evidence-based guidelines, best practices, and individual needs and preferences.
Adherence addresses the behavior of taking medications as prescribed and is essential for achieving optimal health outcomes.
Safety addresses medication use that may be otherwise appropriate but unsafe if potential risks, including side effects and interactions, are not considered.
Medication Management Services address a range of services to achieve optimal health outcomes, including comprehensive medication review, medication reconciliation and coordination of care, and medication therapy monitoring and evaluation.
Level of Analysis
Measures must be developed and tested for a specific level of analysis for accountability purposes, and appropriate attribution is essential to accurately identify which provider or organization is responsible for the care delivered and outcomes measured. Most PQA quality measures are developed for health plan assessment, where the health plan is the measured entity, although some are specifically developed for pharmacy assessment, where the pharmacy is the measured entity.
PQA Health Plan Measures
The health plan appropriate medication use measures focus on chronic obstructive pulmonary disease (COPD), anticoagulation, migraine therapy and diabetes.
- Chronic Obstructive Pulmonary Disease Treatment Ratio (CTR)
- International Normalized Ratio Monitoring for Individuals on Warfarin (INR)
- Migraine Preventive Therapy (MPT)
- Statin Use in Persons with Diabetes (SUPD)
The Chronic Obstructive Pulmonary Disease Treatment Ratio (CTR) measure assesses the percentage of individuals ≥40 years of age whose CTR was ≥0.7 during the treatment period. The Statin Use in Persons with Diabetes (SUPD) measure assesses the percentage of individuals ages 40 to 75 years with prescription claims for diabetes medications and a statin medication.
Medication safety is addressed through measures focused on opioid prescribing, polypharmacy in older adults, and antipsychotic use in persons with dementia.
- Annual Monitoring for Persons on Long-Term Opioid Therapy (AMO)
- Antipsychotic Use in Persons with Dementia (APD)
- Concurrent Use of Opioids and Benzodiazepines (COB)
- Initial Opioid Prescribing for Long Duration (IOP-LD)
- Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (POLY-ACH)
- Polypharmacy: Use of Multiple CNS-Active Medications in Older Adults (POLY-CNS)
- Use of Opioids at High Dosage in Persons Without Cancer (OHD)
The initial opioid prescribing measure evaluates new prescriptions for long duration (>7 days), which is associated with an increased risk of chronic use, misuse, and in some cases, overdose. Two other measures focus on opioid prescribing associated with an increased risk of opioid overdose, including use at high dosage and concurrent use with benzodiazepines.
The polypharmacy in older adults measures are based on the American Geriatrics Society Beers Criteria®. Use of multiple anticholinergics in older adults is associated with an increased risk of cognitive decline and use of multiple CNS-active medications in older adults is associated with an increased risk of falls.
The concept of adherence encompasses many interrelated aspects of medication-taking behaviors, including consistently taking medications as prescribed, continuing medications without interruption, and completing prescribed treatment regimens.
- Adherence to Direct-Acting Oral Anticoagulants (PDC-DOAC)
- Adherence to Long-Acting Inhaled Bronchodilator Agents in COPD (PDC-COPD)
- Adherence to Non-infused Biologic Medications Used to Treat Rheumatoid Arthritis (PDC-RA)
- Adherence to Non-infused Disease Modifying Agents Used to Treat Multiple Sclerosis (PDC-MS)
- Persistence to Basal Insulin (PST-INS)
- Proportion of Days Covered Composite (PDC-CMP)
- Proportion of Days Covered: Antiretroviral Medications (PDC-ARV)
- Proportion of Days Covered: Beta-Blockers (PDC-BB)
- Proportion of Days Covered: Calcium Channel Blockers (PDC-CCB)
- Proportion of Days Covered: Diabetes All Class (PDC-DR)
- Proportion of Days Covered: Renin Angiotensin System Antagonists (PDC-RASA)
- Proportion of Days Covered: Statins (PDC-STA)
- Treatment of Chronic Hepatitis C: Completion of Therapy (HCV)
PQA uses the Proportion of Days Covered (PDC) measurement methodology to assess patients’ adherence to important chronic medication therapies. PDC reflects the percentage of days within the measurement year that individuals covered by prescription claims for the same medication or another medication in the same therapeutic class. The PDC threshold represents the level at which a medication likely to achieve optimal clinical benefit. Clinical evidence supports a standard threshold of 80%, except for the Proportion of Days Covered: Antiretroviral Medications (PDC-ARV), which requires a 90% threshold. The PQA composite adherence measure assesses adherence to medications for diabetes, hypertension, and cholesterol.
PQA uses additional measurement methodologies to assess adherence and persistence for acute therapies of shorter duration or for therapies in which prescription claims may not accurately reflect the days’ supply. The Persistence to Basal Insulin (PST-INS) measure assesses the percentage of individuals who were treatment persistent to basal insulin during the measurement year. The Treatment of Chronic Hepatitis C: Completion of Therapy (HCV) measure assesses the percentage of individuals who initiated antiviral therapy for treatment of chronic hepatitis C, and who completed the minimum intended duration of therapy with no significant gap(s) in therapy.
Medication management services are a spectrum of patient-centered, pharmacist-provided and team-based services that focus on medication appropriateness, effectiveness, safety and adherence, with the goal of improving health outcomes. The Completion Rate for Comprehensive Medication Review (CMR) measure assesses the extent to which Medication Therapy Management (MTM)-eligible patients receive a comprehensive medication review during their MTM-eligibility period.
- Completion Rate for Comprehensive Medication Review (CMR)
The PQA Medication Therapy Problem Categories Framework is a tool used to identify medication therapy problems by assessing each medication for appropriateness (indication), effectiveness, safety and adherence using a standard care process. Constistent implementation of the framework promotes standardized documentation of medication therapy problems, medication therapy recommendations and associated resolution and outcomes.
PQA Pharmacy Measures
PQA has several pharmacy measures, where pharmacies are the measured entity, to assess medication adherence.
- Proportion of Days Covered Composite [Pharmacy] (PDC-CMP-PH)
- Proportion of Days Covered: Renin Angiotensin System Antagonists [Pharmacy] (PDC-RASA-PH)
- Proportion of Days Covered: Statins [Pharmacy] (PDC-STA-PH)
- Proportion of Days Covered: Antiretroviral Medications [Pharmacy] (PDC-ARV-PH)
A composite pharmacy measure evaluates adherence to medications for diabetes, hypertension and cholesterol. Three individual medication class-specific adherence measures assess adherence to medications for hypertension, cholesterol, and HIV within the Medicare line of business.
The Specialty Pharmacy Turnaround Time measure assesses the average number of days between a specialty pharmacy receiving a new prescription for a specialty medication and the prescription being ready for pick-up or scheduled for delivery.
- Specialty Pharmacy Turnaround Time [Pharmacy] (SP-TAT-PH)
Resources
Explore PQA resources to evaluate medication use quality, support quality improvement and boost your organization’s performance.
Medication Therapy Problem Categories Framework
The PQA Medication Therapy Problem Categories Framework provides a standard approach for categorizing medication therapy problems identified during medication management services encounters and the interventions to resolve those problems.
Measure Questions
& Support
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Risk Adjustment Frequently Asked Questions
Learn more about PQA’s risk adjustment recommendations for adherence measures used in the Medicare Part D Star Ratings.