PQA Subcommittee of the Patient Safety Cluster Group

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PQA Subcommittee of the Patient Safety Cluster
Group

• Brad Tice, PharmD
• Subcommittee Chair

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PQA Subcommittee of the Patient Safety Cluster
Group

• Charge To identify a list or sub-set of lists
  that are already developed for use within the PQA
  patient safety measures.
• Key point The intent was to use a list already
  developed, not for the PQA to develop and
  maintain its own list.

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Example of Measure for list application
Definitions Target medication Medication that
appears on the list of potentially inappropriate
medications for use in the population, age 65
years and older.
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Background

• Methods
• Subcommittee of Patient Safety Cluster Group
  formed
• Identify lists already in existence/use
• Through committee
• Through request for input from PQA membership
• Establish criteria and review lists

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Lists Identified

• Beers list
• Zhan criteria
• NCQAs Use of High Risk Medications List

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Review Criteria

• Development methods
• Current Use
• Update/Maintenance
• Completeness

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Note Rankings are for descriptive purposes only
and do not represent actual or specific rankings
of committee
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NCQA- High Risk MedicationsDevelopment

• Field-test with Health Plans
• Captured data on all drugs on Beers and Zhan
  lists
• Examined prevalence according to Beer or Zhan
  classification
• Goal
• Identify prevalence of high risk medications
  prescribed
• Reduce the list so that targeted quality
  improvement is possible

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NCQA- High Risk MedicationsDevelopment

• Technical Expert Panel
• Reviewed field test results
• Identified Zhan categories never appropriate
  and rarely appropriate as basis for list
• For Beers high severity drugs not classified by
  Zhan conducted modified-Delphi process for
  inclusion in measure

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NCQA- High Risk MedicationsDevelopment

• Released for Public Comment
• Approval by Geriatric Measurement Advisory Panel
  (GMAP)
• Approval by Committee on Performance Measurement
  (CPM) for inclusion into HEDIS 2006

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NCQA- High Risk MedicationsMaintenance

• Analysis of first year data
• Review with TEP and GMAP
• Approval by CPM for public-reporting in HEDIS
  2007
• Continually receive comments through NCQAs
  Policy Clarification Support
• Review new medications every year and make
  updates
• Decisions for updates based upon Beers and
  Zhans classifications

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NCQA- Use of High Risk MedicationsMaintenance

• Re-evaluate measure every three years
• Review data
• Solicit public comment
• Updates as necessary
• Review with TEP and GMAP
• Approval by CPM

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Recommendation

• The PQA Patient Safety Cluster Group Subcommittee
  recommends using the NCQA Use of High Risk
  Medications List (formerly known as the Drugs to
  be Avoided in the Elderly List) as the list to
  be used when developing technical specifications.
• Rationale
• List is developed by a Technical Expert Panel
  consisting of 3 physicians and 3 pharmacists whom
  each have excellent background in area of
  geriatrics
• List is maintained and therefore will be updated,
  also allowing for open comment period
• List is a part of HEDIS measures and therefore
  will be used across health care settings,
  allowing for equivalent comparisons

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PQA Action Needed

• Questions?
• Call for Endorsement of the NCQA List to be used
  as technical specifications are developed on
  patient safety.