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## Complete Summary

#### TITLE

Geriatrics: percentage of female patients aged 65 years and older with a
diagnosis of urinary incontinence who were prescribed a medication to
treat the urinary incontinence who had a trial of behavioral therapy
documented.

#### SOURCE(S)

American Geriatrics Society, Physician Consortium for Performance
Improvement®, National Committee for Quality Assurance. Geriatrics
physician performance measurement set. Chicago (IL): American Medical
Association, National Committee for Quality Assurance; 2007 Aug. 41 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 female patients aged 65
years and older with a diagnosis of urinary incontinence who were
prescribed a medication to treat the urinary incontinence who had a
trial of behavioral therapy documented.

#### RATIONALE

Patients should have a trial of behavioral therapy before
pharmacological therapy.\*

\*The following clinical recommendation statements are quoted
[verbatim]{.underline} from the referenced clinical guidelines and
represent the evidence base for the measure:

Behavioral therapy, including bladder training and prompting voiding,
improves symptoms of urge and mixed incontinence and can be recommended
as a noninvasive treatment in many women. (American College of
Obstetricians and Gynecologists \[ACOG\])

Antimuscarinic agents for urgency or mixed incontinence should be
considered in properly selected frail elderly who have had a full trial
of behavioral interventions yet have not met their continence goal.
(International Consultation on Incontinence \[ICI\])

#### PRIMARY CLINICAL COMPONENT

Geriatrics; urinary incontinence; pharmacologic therapy; behavioral
interventions (bladder training, pelvic floor muscle training, prompted
voiding)

#### DENOMINATOR DESCRIPTION

All female patients aged 65 years and older with a diagnosis of urinary
incontinence who were prescribed a medication to treat the urinary
incontinence (see the related \"Denominator Inclusions/Exclusions\"
field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients who had a trial of behavioral therapy\* documented

\*Behavioral interventions may include bladder training, pelvic floor
muscle training, or prompted voiding.

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Urinary incontinence in
    women.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10931)

### 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

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Age greater than or equal to 65 years

#### TARGET POPULATION GENDER

Female (only)

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All female patients aged 65 years and older with a diagnosis of urinary
incontinence who were prescribed a medication to treat the urinary
incontinence

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All female patients aged 65 years and older with a diagnosis of urinary
incontinence who were prescribed a medication to treat the urinary
incontinence

**Exclusions**

-   Documentation of medical reasons(s) for no behavioral therapy trial
    (e.g., severe functional impairment)

-   Documentation of patient reasons(s) for no behavioral therapy trial

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

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

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Patient Characteristic\
Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients who had a trial of behavioral therapy\* documented

\*Behavioral interventions may include bladder training, pelvic floor
muscle training, or prompted voiding.

**Exclusions**\
None

#### 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

Encounter or point in time

#### DATA SOURCE

Administrative data\
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

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Measure #9: urinary incontinence \-- medication overuse in women aged 65
years and older.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1919&doc=178)

#### MEASURE SET NAME

[Geriatrics Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1919&doc=10271)

#### SUBMITTER

American Medical Association on behalf of the American Geriatrics
Society, the National Committee for Quality Assurance, and the Physician
Consortium for Performance Improvement®

#### DEVELOPER

American Geriatrics Society\
National Committee for Quality Assurance\
Physician Consortium for Performance Improvement®

#### FUNDING SOURCE(S)

Unspecified

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

Caroline Blaum, MD (*Co-Chair*); Carol M. Mangione, MD (*Co-Chair*);
Chris Alexander, III, MD, FACP; Ronald Bangasser, MD; Patricia P. Barry,
MD, MPH; Frederick W. Burgess, MD, PhD; Gary S. Clark, MD, MMM, CPE;
Eric Coleman, MD, MPH; Stephen R. Connor, PhD; Gail A. Cooney, MD; Roger
Dmochowski, MD; Catherine DuBeau, MD; Joyce Dubow; Mary Fermazin, MD,
MPA; Sanford I. Finkel, MD ; Terry Fulmer, PhD; Peter Hollmann, MD;
David P. John, MD; Peter Johnstone, MD, FACR; Flora Lum, MD; Diane E.
Meier, MD; Alvin \"Woody\" H. Moss, MD; Jaya Rao, MD, MHS; Sam J. W.
Romeo, MD, MBA; David J. Satin, MD; Gregory B. Seymann, MD; Knight
Steel, MD; Eric Tangalos, MD; Joan M. Teno, MD, MS; David J. Thurman,
MD, MPH; Mary Tinetti, MD; Laura Tosi, MD; Gregg Warshaw, MD; Neil S.
Wenger, MD

*American Geriatrics Society*: Jill Epstein

*National Committee for Quality Assurance*: Min Gayles Kim, MPH; Phil
Renner, MBA

*American Medical Association*: Karen Kmetik, PhD; Heidi Bossley, MSN,
MBA; Joanne Schwartzberg, MD; Patricia Sokol, RN, JD

*Facilitators*: Timothy F. Kresowik, MD; Rebecca A. Kresowik

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

Conflicts, if any, are disclosed in accordance with the Physician
Consortium for Performance Improvement® conflict of interest policy.

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2006 Nov

#### REVISION DATE

2007 Aug

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Geriatrics Society, Physician Consortium for Performance
Improvement®, National Committee for Quality Assurance. Geriatrics
physician performance measurement set. Chicago (IL): American Medical
Association, National Committee for Quality Assurance; 2007 Aug. 41 p.

#### MEASURE AVAILABILITY

The individual measure, \"Measure #9: Urinary Incontinence \--
Medication Overuse in Women Aged 65 Years and Older,\" is published in
the \"Geriatrics Physician Performance Measurement Set.\" This document
and technical specifications are available in Portable Document Format
(PDF) from the American Medical Association (AMA)-convened Physician
Consortium for Performance Improvement® Web site:
[www.physicianconsortium.org](http://www.physicianconsortium.org/).

For further information, please contact AMA staff by e-mail at
<cqi@ama-assn.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on August 13, 2008.
The information was verified by the measure developer on September 30,
2008.

#### COPYRIGHT STATEMENT

© Measures including specifications

© 2007 American Medical Association and National Committee for Quality
Assurance

CPT® Copyright 2006 American Medical Association

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/17/2008