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## Complete Summary

#### TITLE

Low-dose aspirin: percentage of patients prescribed low-dose aspirin
(less than or equal to 325 mg/day) who are advised of the associated GI
bleeding risks.

#### 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 prescribed
low-dose aspirin (less than or equal to 325 mg/day) who are advised of
the associated gastrointestinal (GI) bleeding risks.

#### RATIONALE

The risks of gastrointestinal (GI) bleeding are increased in users of
low-dose aspirin compared to non-users.

Gastrointestinal risks of low-dose aspirin have been identified in
meta-analyses and numerous observational studies. There is no evidence
of renal toxicity in low-dose aspirin users; however, observational data
suggest an association between aspirin use and renal toxicities among
higher dose users.

#### PRIMARY CLINICAL COMPONENT

Low-dose aspirin (less than 325 mg/day); Gastrointestinal (GI) bleeding
risks

#### DENOMINATOR DESCRIPTION

Patients prescribed low-dose aspirin (less than or equal to 325 mg/day)

#### NUMERATOR DESCRIPTION

Patients who are advised of the associated gastrointestinal (GI)
bleeding risks

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

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

-   A systematic review of the clinical literature

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

### 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

*Gastrointestinal (GI) risks of low-dose aspirin*. The measure developer
identified 3 meta-analyses and 3 case-control studies that assessed the
GI toxicities of low-dose aspirin. All but 1 of these studies
demonstrated an increased risk of GI bleeding with low-dose aspirin use
(relative risk ranging from 1.5 to 3.2).

#### 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 prescribed low-dose aspirin (less than or equal to 325 mg/day)

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients prescribed low-dose aspirin (less than or equal to 325 mg/day)

**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 are advised of the associated gastrointestinal (GI)
bleeding risks

**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

Medical record

#### 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 2. Low-dose aspirin: informing patients about bleeding
risks.

#### 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 2. Low-dose Aspirin:
Informing Patients About Bleeding Risks,\" 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

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008