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

Top of Form

## Complete Summary

#### TITLE

Annual monitoring for patients on persistent medications: percentage of
members 18 years of age and older who received at least a 180-days
supply of ambulatory medication therapy for anticonvulsants during the
measurement year and at least one drug serum concentration level
monitoring test for the prescribed drug in the measurement year.

#### SOURCE(S)

National Committee for Quality Assurance (NCQA). HEDIS 2008: Healthcare
Effectiveness Data & Information Set. Vol. 2, Technical Specifications.
Washington (DC): National Committee for Quality Assurance (NCQA); 2007
Jul. various p.

### 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 members 18 years of age
and older who received at least a 180-days supply of ambulatory
medication therapy for anticonvulsants (phenobarbital, carbamazepine,
phenytoin, divalproex sodium, valproic acid) during the measurement year
and at least one serum potassium and either a serum creatinine or a
blood urea nitrogen therapeutic monitoring test in the measurement year.

This measure is a component of a composite measure. For each product
line, four separate rates and a combined rate are reported. The other
three rates pertain to:

-   annual monitoring for members on angiotensin converting enzyme (ACE)
    inhibitors or angiotensin receptor blockers (ARBs) (see the related
    National Quality Measures Clearinghouse \[NQMC\] summary of the
    National Committee for Quality Assurance \[NCQA\] measure [Annual
    monitoring for patients on persistent medications: percentage of
    members 18 years of age and older who received at least a 180-days
    supply of ambulatory medication therapy for ACEIs or ARBs during the
    measurement year and at least one serum potassium and either a serum
    creatinine or a blood urea nitrogen therapeutic monitoring test in
    the measurement
    year](http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=10065&string=2790))

-   annual monitoring for members on digoxin (see the related National
    Quality Measures Clearinghouse \[NQMC\] summary of the National
    Committee for Quality Assurance \[NCQA\] measure [Annual monitoring
    for patients on persistent medications: percentage of members 18
    years of age and older who received at least a 180-days supply of
    ambulatory medication therapy for digoxin during the measurement
    year and at least one serum potassium and either a serum creatinine
    or a blood urea nitrogen therapeutic monitoring test in the
    measurement
    year](http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=10066&string=2791))

-   annual monitoring for members on diuretics (see the related NQMC
    summary of the NCQA measure [Annual monitoring for patients on
    persistent medications: percentage of members 18 years of age and
    older who received at least a 180-days supply of ambulatory
    medication therapy for diuretics during the measurement year and at
    least one serum potassium and either a serum creatinine or a blood
    urea nitrogen therapeutic monitoring test in the measurement
    year](http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=10067&string=2792))

#### RATIONALE

Patient safety is highly important, especially for patients at increased
risk of adverse drug events from long-term medication use. Persistent
use of these drugs warrants monitoring and follow-up by the prescribing
physician to assess for side-effects and adjust drug dosage/therapeutic
decisions accordingly. The drugs included in this measure also have more
deleterious effects in the elderly.

The costs of annual monitoring are offset by the reduction in health
care costs associated with complications arising from lack of monitoring
and follow-up of patients on long-term medications. The cost of annual
monitoring is more than offset by savings in the treatment of avoidable
drug reactions; over \$85 billion is spent per year to treat
drug-related problems caused by misuse in the ambulatory setting.

Appropriate monitoring of drug therapy remains a significant issue to
guide therapeutic decision making and provides largely unmet
opportunities for improvement in care for patients on persistent
medications.

#### PRIMARY CLINICAL COMPONENT

Persistent medication therapy; anticonvulsants (phenobarbital,
carbamazepine, phenytoin, divalproex sodium, valproic acid); annual
monitoring

#### DENOMINATOR DESCRIPTION

Members 18 years of age and older as of December 31 of the measurement
year on anticonvulsants (phenobarbital, carbamazepine, phenytoin,
divalproex sodium, valproic acid) \-- defined as members who received at
least a 180-days supply of ambulatory medication in the measurement year
(see the \"Description of Case Finding\" and \"Denominator
Inclusions/Exclusions\" fields in the Complete Summary)

#### NUMERATOR DESCRIPTION

Members from the denominator with at least one drug serum concentration
level monitoring test for the prescribed drug in the measurement year
(refer to Table MPM-E in the original measure documentation for codes to
identify drug serum concentration monitoring tests). If a member
received only one type of anticonvulsant, the drug serum concentration
level test must be for the specific drug taken as a persistent
medication (i.e., a member on phenytoin received a drug serum test for
phenytoin).

If a member persistently received multiple types of anticonvulsants,
each anticonvulsant medication and drug monitoring test combination is
counted as a unique event (i.e., a member on both phenytoin and valproic
acid with at least a 180-days supply for each drug in the measurement
year must separately show evidence of receiving drug serum concentration
tests for each drug \[Table MPM-E\] to be considered numerator-compliant
for each drug).

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

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

-   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

Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

National Committee for Quality Assurance (NCQA). The state of health
care quality 2007: industry trends and analysis. Washington (DC):
National Committee for Quality Assurance (NCQA); 2007. 93 p.

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Accreditation\
Decision-making by businesses about health-plan purchasing\
Decision-making by consumers about health plan/provider choice\
External oversight/Medicaid\
External oversight/Medicare\
External oversight/State government program\
Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Managed Care Plans

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Measure is not provider specific

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### 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

Eighty-seven percent of all hospitalizations from unintentional drug
overdoses among those 65 and older are due to drugs that commonly
require outpatient monitoring.

#### EVIDENCE FOR ASSOCIATION WITH VULNERABLE POPULATIONS

Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ,
Annest JL. National surveillance of emergency department visits for
outpatient adverse drug events. JAMA2006 Oct 18;296(15):1858-66.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17047216)

#### BURDEN OF ILLNESS

Patients with long-term use of certain medications are at higher risk
for experiencing harmful side effects and drug-related toxicities.

See also the \"Utilization\" field.

#### EVIDENCE FOR BURDEN OF ILLNESS

National Committee for Quality Assurance (NCQA). The state of health
care quality 2007: industry trends and analysis. Washington (DC):
National Committee for Quality Assurance (NCQA); 2007. 93 p.

#### UTILIZATION

Adverse drug events cause an estimated 1 in 400 Americans to visit an
emergency room yearly; of those, 1 in 6 require hospitalization. Drugs
that commonly require monitoring in outpatient settings account for over
half of all unintentional drug overdoses resulting in an emergency room
visit.

#### EVIDENCE FOR UTILIZATION

Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ,
Annest JL. National surveillance of emergency department visits for
outpatient adverse drug events. JAMA2006 Oct 18;296(15):1858-66.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17047216)

#### COSTS

See the \"Rationale\" and \"Utilization\" fields.

### 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

Members 18 years of age and older as of December 31 of the measurement
year on anticonvulsants (phenobarbital, carbamazepine, phenytoin,
divalproex sodium, valproic acid) \-- defined as members who received at
least a 180-days supply of ambulatory medication in the measurement
year. Include members who were enrolled as of December 31 of the
measurement year with no more than one gap in enrollment of up to 45
days (commercial, Medicare) or not more than a one-month gap in coverage
(Medicaid).

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Members 18 years of age and older as of December 31 of the measurement
year on anticonvulsants (phenobarbital, carbamazepine, phenytoin,
divalproex sodium, valproic acid) \-- defined as members who received at
least a 180-days supply of ambulatory medication in the measurement year

**Note**:

-   To determine continuity of treatment during the 365-day period, sum
    the number of treatment days (days supply from all the scripts
    filled during the year) for a total of 180 days.

-   Refer to Table MPM-D in the original measure documentation in order
    to identify anticonvulsants. Members who are on multiple
    anticonvulsant drugs count toward the denominator multiple times if
    they meet the persistent medications criteria for **each** drug
    taken during the measurement year (i.e., a member who received at
    least 180 days of phenytoin and 180 days of valproic acid will be
    counted twice in the denominator, once for each drug).

**Exclusions**\
Exclude members who had an inpatient stay (acute or nonacute) in the
measurement year. Count any visit with an inpatient facility code or use
DRGs or UB Type of Bill codes from Tables IPU-A, FUH-B, MPT-A and IAD-A
in the original measure documentation to identify acute and nonacute
inpatient care.

#### 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

Time window is a fixed period of time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Members from the denominator with at least one drug serum concentration
level monitoring test for the prescribed drug in the measurement year
(refer to Table MPM-E in the original measure documentation for codes to
identify drug serum concentration monitoring tests). If a member
received only one type of anticonvulsant, the drug serum concentration
level test must be for the specific drug taken as a persistent
medication (i.e., a member on phenytoin received a drug serum test for
phenytoin).

If a member persistently received multiple types of anticonvulsants,
each anticonvulsant medication and drug monitoring test combination is
counted as a unique event (i.e., a member on both phenytoin and valproic
acid with at least a 180-days supply for each drug in the measurement
year must separately show evidence of receiving drug serum concentration
tests for each drug \[Table MPM-E\] to be considered numerator-compliant
for each drug).

**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

Fixed time period

#### DATA SOURCE

Administrative data\
Laboratory data\
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

Analysis by subgroup (stratification on patient factors, geographic
factors, etc.)

#### DESCRIPTION OF ALLOWANCE FOR PATIENT FACTORS

This measure requires that separate rates be reported for commercial,
Medicare, and Medicaid product lines.

#### STANDARD OF COMPARISON

External comparison at a point in time\
External comparison of time trends\
Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Annual monitoring for patients on persistent medications (MPM).

#### MEASURE COLLECTION

[HEDIS® 2008: Healthcare Effectiveness Data and Information
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=8&doc=11336)

#### MEASURE SET NAME

[Effectiveness of
Care](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=8&doc=10142)

#### MEASURE SUBSET NAME

[Medication
Management](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=8&doc=12481)

#### DEVELOPER

National Committee for Quality Assurance

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

National Committee for Quality Assurance\'s (NCQA\'s) Measurement
Advisory Panels (MAPs) are composed of clinical and research experts
with an understanding of quality performance measurement in the
particular clinical content areas.

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

In order to fulfill National Committee for Quality Assurance\'s
(NCQA\'s) mission and vision of improving health care quality through
measurement, transparency and accountability, all participants in
NCQA\'s expert panels are required to disclose potential conflicts of
interest prior to their participation. The goal of this Conflict Policy
is to ensure that decisions which impact development of NCQA\'s products
and services are made as objectively as possible, without improper bias
or influence.

#### ENDORSER

National Quality Forum

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2005 Jan

#### REVISION DATE

2007 Jul

#### MEASURE STATUS

**Please note**: This measure has been updated. The National Quality
Measures Clearinghouse is working to update this summary.

#### SOURCE(S)

National Committee for Quality Assurance (NCQA). HEDIS 2008: Healthcare
Effectiveness Data & Information Set. Vol. 2, Technical Specifications.
Washington (DC): National Committee for Quality Assurance (NCQA); 2007
Jul. various p.

#### MEASURE AVAILABILITY

The individual measure, \"Annual Monitoring for Patients on Persistent
Medications (MPM),\" is published in \"HEDIS® 2008. Healthcare
Effectiveness Data & Information Set. Vol. 2, Technical
Specifications.\"

For more information, contact the National Committee for Quality
Assurance (NCQA) at 1100 13th Street, N.W., Suite 1000, Washington, DC
20005; Telephone: 202-955-3500; Fax: 202-955-3599; Web site:
[web.ncqa.org](http://web.ncqa.org/).

#### COMPANION DOCUMENTS

The following is available:

-   National Committee for Quality Assurance (NCQA). The state of health
    care quality 2007: industry trends and analysis. Washington (DC):
    National Committee for Quality Assurance (NCQA); 2007. 93 p.

For more information, contact the National Committee for Quality
Assurance (NCQA) at 1100 13th Street, N.W., Suite 1000, Washington, DC
20005; Telephone: 202-955-3500; Fax: 202-955-3599; Web site:
[web.ncqa.org](http://web.ncqa.org/).

#### NQMC STATUS

This NQMC summary was completed by ECRI on June 6, 2006. This NQMC
summary was revised by ECRI on January 31, 2007. The updated information
was not verified by the measure developer. This NQMC summary was updated
again by ECRI Institute on April 18, 2008. The information was verified
by the measure developer on May 30, 2008.

#### COPYRIGHT STATEMENT

This NQMC summary is based on the original measure, which is subject to
the measure developer\'s copyright restrictions.

For detailed specifications regarding the National Committee on Quality
Assurance (NCQA) measures, refer to *HEDIS Volume 2: Technical
Specifications*, available from the NCQA Web site at
[web.ncqa.org](http://web.ncqa.org/).

### 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