Use of High-Risk Medications in the Elderly

Percentage of patients 66 years of age and older who were ordered high-risk medications.  Two rates are reported.

• Percentage of patients who were ordered at least one high-risk medication
• Percentage of patients who were ordered at least two different high-risk medications

Denominator:    All patients aged 66 years and older who had a visit during the reporting period.

• Patient’s age is calculated based on the patient’s Date of Birth, which is entered when you created the patient’s account.

Numerator #1:  Patients who were ordered at least one high-risk medication during the measurement period.

• High risk medications are prescribed under Medications.  See Prescribe/ePrescribe a Medication.

Numerator #2:  Patients who were ordered at least two different high-risk medications during the measurement period.

• High risk medications are prescribed under Medications.  See Prescribe/ePrescribe a Medication.

Office Visit Documentation:

• Create a Note detailing the patient’s office visit.  See Create a Note.
• Make sure to include an E&M code under “Procedure Codes” on the Superbill.  See Create a Superbill.
• Sign the Note.  See Sign Notes.  Once the note is signed, the measure will be added to the Quality Report. 

Definition:

• A high-risk medication is identified by either of the following:
  • A prescription for medications classified as high risk at any dose and for any duration
  • Prescriptions for medications classified as high risk at any dose with greater than a 90 day cumulative medication duration
• Cumulative Medication Duration is an individual’s total number of medication days over a specific period; the period counts multiple prescriptions with gaps in between, but does not count the gaps during which a medication was not dispensed.  To determine the cumulative medication duration, determine first the number of the Medication Days for each prescription in the period the number of doses divided by the dose frequency per day.  Then add the Medication Days for each prescription without counting any days between the prescriptions.
• High-risk Medications at any Dose or Duration:
  • Anticholinergics (excludes TCAs), first-generation antihistamines
  • Anticholinergics (excludes TCAs), anti-Parkinson agents
  • Antithrombotics
  • Cardiovascular, alpha agonists, central
  • Cardiovascular, other
  • Central nervous system, tertiary TCAs
  • Central nervous system, barbiturates
  • Central nervous system, vasodilators
  • Central nervous system, other
  • Endocrine system, estrogens with or without progestins; oral and topical patch only
  • Endocrine system, sulfonylureas, long-duration
  • Endocrine system, other
  • Gastrointestinal system, other
  • Pain medications, skeletal muscle, relaxants
  • Pain medications, other
• High-risk Medications with Days Supply Criteria
  • Anti-infectives, other
  • Nonbenzodiazepine hypnotics
• High-risk Medications with Average Daily Dose Criteria
  • Reserpine (>0.1 mg/day)
  • Digoxin (>0.125 mg/day)
  • Doexpin (>6 mg/day)