Medication Management in Older Adults (DDE/DAE)

These HEDIS Measures

Potentially Harmful Drug-Disease Interactions in Older Adults: Assesses adults 65 and older who have a specific disease or condition (chronic kidney disease, dementia, history of falls) and were dispensed a prescription for a medication that could exacerbate it.

Use of High-Risk Medications in Older Adults: Assesses adults 67 and older who had at least two dispensing events for the same high-risk medication. Three rates are reported:

  • The percentage of older adults who had at least two dispensing events for high-risk medications from the same drug class where any use is inappropriate.
  • The percentage of older adults who had at least two dispensing events for high-risk medications to avoid from the same drug class(i.e., antipsychotics and benzodiazepines) where use under all but specific indications is potentially inappropriate.
  • Total rate, which is the sum of the two numerators divided by the denominator, deduplicating for members in both numerators.

THE BOTTOM LINE

Prescription drug use by older adults can often result in adverse drug events that contribute to hospitalization, increased duration of illness, nursing home placement, falls and fractures. Despite widely accepted medical consensus that certain drugs increase the risk of harm to older adults,1,2 these drugs continue to be prescribed. Because older adults are more likely to take multiple medications for multiple conditions, they are also at higher risk of potentially harmful drug-disease interactions. In addition, older adults are more likely to use medications long term, increasing their risk of physical and mental harm.3 Avoiding the use of high-risk drugs is an important, simple and effective strategy to reduce medication-related problems and adverse drug events in older adults.4

Results

Potentially Inappropriate Medications for Patients with Chronic Renal Failure

YearMedicare HMOMedicare PPO
20209.97.5
2019§§
201810.88.0
201710.97.9

Potentially Inappropriate Medications for Patients with Dementia

YearMedicare HMOMedicare PPO
202037.837.6
2019§§
201845.744.8
201746.745.8

Potentially Inappropriate Medications for Patients with Falls

YearMedicare HMOMedicare PPO
202034.934.8
2019§§
201848.848.4
201748.148.4

Overall Rate

YearMedicare HMOMedicare PPO
202031.431.0
2019§§
201841.240.9
201741.341.2

At Least One High-Risk Medication

YearMedicare HMOMedicare PPO
201814.613.5
201715.114.3

At Least Two High-Risk Medications

YearMedicare HMOMedicare PPO
202013.112.6
2019§§
20189.79.2
201710.09.5

§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.

References

  1. Fick, D.M., et al.2003. “Updating the Beers criteria for potentially inappropriate medication use in older adults.” Arch Intern Med, 163:2716–24.
  2. American Geriatrics Society. 2019. “American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767
  3. Steinhagen, K.A., and Friedman, M.B. 2008. “Substance Abuse and Misuse in Older Adults.” Aging Well, 3:20
  4. Radcliff, S., Yue, J., Rocco, G., Aiello, S.E., Ickowicz, E., Hurd, Z., Samuel, M.J. and Beers, M.H. 2015. “American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults.” Journal of the American Geriatrics Society, 63(11): 2227-2246.

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