![](media/image1.png){width="5.972916666666666in"
height="0.4791666666666667in"}

Top of Form

## Complete Summary

#### TITLE

Non-steroidal anti-inflammatory drug (NSAID) selection: percentage of
patients who take coumadin and are prescribed an NSAID who receive
either a cyclooxygenase 2 (COX-2)-selective NSAID or a nonacetylated
salicylate.

#### SOURCE(S)

MacLean CH, Saag KG, Solomon DH, Morton SC, Sampsel S, Klippel JH.
Measuring quality in arthritis care: methods for developing the
Arthritis Foundation\'s quality indicator set. Arthritis Rheum2004 Apr
15;51(2):193-202.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15077259)

Saag KG, Olivieri JJ, Patino F, Mikuls TR, Allison JJ, MacLean CH.
Measuring quality in arthritis care: the Arthritis Foundation\'s quality
indicator set for analgesics. Arthritis Rheum2004 Jun 15;51(3):337-49.
\[89 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15188317)

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients who take
coumadin and are prescribed an non-steroidal anti-inflammatory drug
(NSAID) who receive either a cyclooxygenase 2 (COX-2)-selective NSAID or
a nonacetylated salicylate.

#### RATIONALE

Patients using coumadin in conjunction with a non-steroidal
anti-inflammatory drug (NSAID) are at higher risk of gastrointestinal
(GI) bleeding, thus agents that reduce the risk of GI bleeding should be
utilized.

#### PRIMARY CLINICAL COMPONENT

Coumadin; non-steroidal anti-inflammatory drug (NSAID); gastrointestinal
(GI) prophylaxis; cyclooxygenase 2 (COX-2)-selective NSAID;
nonacetylated salicylate

#### DENOMINATOR DESCRIPTION

Patients who take coumadin and are prescribed an non-steroidal
anti-inflammatory drug (NSAID)

#### NUMERATOR DESCRIPTION

Patients who receive either a cyclooxygenase 2 (COX-2)-selective NSAID
or a nonacetylated salicylate

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A formal consensus procedure involving experts in relevant clinical,
    methodological, and organizational sciences

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses\
Physician Assistants\
Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Unspecified

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

The concomitant use of anticoagulants (such as coumadin) and
nonselective non-steroidal anti-inflammatory drugs (NSAIDs) has been
associated with an increased risk of clinically relevant upper
gastrointestinal (GI) adverse events in both cohort and case-control
studies.

#### EVIDENCE FOR BURDEN OF ILLNESS

Saag KG, Olivieri JJ, Patino F, Mikuls TR, Allison JJ, MacLean CH.
Measuring quality in arthritis care: the Arthritis Foundation\'s quality
indicator set for analgesics. Arthritis Rheum2004 Jun 15;51(3):337-49.
\[89 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15188317)

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness\
Safety

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients who take coumadin and are prescribed an non-steroidal
anti-inflammatory drug (NSAID)

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients who take coumadin and are prescribed an non-steroidal
anti-inflammatory drug (NSAID)

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Unspecified

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients who receive either a cyclooxygenase 2 (COX-2)-selective NSAID
or a nonacetylated salicylate

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Episode of care

#### DATA SOURCE

Administrative data\
Medical record\
Pharmacy data

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

A multidisciplinary expert panel comprised of nationally recognized
experts discussed and rated the validity of each of the proposed
measures based on the evidence and their expert opinion using a
modification of the RAND/UCLA Appropriateness Method.

#### EVIDENCE FOR RELIABILITY/VALIDITY TESTING

MacLean CH, Saag KG, Solomon DH, Morton SC, Sampsel S, Klippel JH.
Measuring quality in arthritis care: methods for developing the
Arthritis Foundation\'s quality indicator set. Arthritis Rheum2004 Apr
15;51(2):193-202.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15077259)

Saag KG, Olivieri JJ, Patino F, Mikuls TR, Allison JJ, MacLean CH.
Measuring quality in arthritis care: the Arthritis Foundation\'s quality
indicator set for analgesics. Arthritis Rheum2004 Jun 15;51(3):337-49.
\[89 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15188317)

### Identifying Information

#### ORIGINAL TITLE

Quality indicator 8. NSAID selection: concomitant use of coumadin.

#### MEASURE COLLECTION

[The Arthritis Foundation\'s Quality Indicator
Project](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1796&doc=9691)

#### MEASURE SET NAME

[The Arthritis Foundation\'s Quality Indicator Set for
Analgesics](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1796&doc=11085)

#### SUBMITTER

Arthritis Foundation

#### DEVELOPER

Arthritis Foundation\
RAND Health\
University of Alabama at Birmingham

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2004 Jun

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

MacLean CH, Saag KG, Solomon DH, Morton SC, Sampsel S, Klippel JH.
Measuring quality in arthritis care: methods for developing the
Arthritis Foundation\'s quality indicator set. Arthritis Rheum2004 Apr
15;51(2):193-202.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15077259)

Saag KG, Olivieri JJ, Patino F, Mikuls TR, Allison JJ, MacLean CH.
Measuring quality in arthritis care: the Arthritis Foundation\'s quality
indicator set for analgesics. Arthritis Rheum2004 Jun 15;51(3):337-49.
\[89 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15188317)

#### MEASURE AVAILABILITY

The individual measure, \"Quality Indicator 8. NSAID Selection:
Concomitant Use of Coumadin,\" is published in \"Measuring Quality in
Arthritis Care: The Arthritis Foundation\'s Quality Indicator Set for
Analgesics.\"

For more information contact:\
Arthritis Foundation\
P.O. Box 7669\
Atlanta, GA 30357-0669\
Telephone: 404-872-7100 or 1-800-568-4045\
Web site: [www.arthritis.org](http://www.arthritis.org/)\
\
OR\
\
RAND Health\
1776 Main Street\
P.O. Box 2138\
Santa Monica, CA 90407-2138\
Telephone: (310) 393-0411, ext. 7775\
Web site: [www.rand.org/health](http://www.rand.org/health)\
E-mail: <RAND_Health@rand.org>

#### NQMC STATUS

This NQMC summary was completed by ECRI on August 7, 2007. The
information was verified by the measure developer on September 10, 2007.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

### Disclaimer

#### NQMC DISCLAIMER

The National Quality Measures Clearinghouse™ (NQMC) does not develop,
produce, approve, or endorse the measures represented on this site.

All measures summarized by NQMC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public and private organizations, other government
agencies, health care organizations or plans, individuals, and similar
entities.

Measures represented on the NQMC Web site are submitted by measure
developers, and are screened solely to determine that they meet the NQMC
Inclusion Criteria which may be found at
<http://www.qualitymeasures.ahrq.gov/about/inclusion.aspx>.

NQMC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or its reliability and/or validity of the quality
measures and related materials represented on this site. The inclusion
or hosting of measures in NQMC may not be used for advertising or
commercial endorsement purposes.

Readers with questions regarding measure content are directed to contact
the measure developer.

Bottom of Form

© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008