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## Complete Summary

#### TITLE

Low-dose aspirin use: percentage of patients treated with a low-dose
aspirin daily who have 2 or more risk factors for GI bleeding who are
treated concomitantly with either misoprostol or proton pump inhibitor
(PPI).

#### 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 treated with a
low-dose aspirin daily who have 2 or more risk factors for
gastrointestinal (GI) bleeding who are treated concomitantly with either
misoprostol or proton pump inhibitor (PPI).

#### RATIONALE

Gastrointestinal (GI) prophylaxis can reduce the risk of GI bleeding in
users of daily low-dose aspirin who also have GI risk factors.

Limited endoscopic evidence exists for the efficacy of proton pump
inhibitors (PPIs) and misoprostol in reducing GI ulceration in aspirin
users.

#### PRIMARY CLINICAL COMPONENT

Low-dose aspirin; gastrointestinal (GI) bleeding risk factors;
gastrointestinal prophylaxis; misoprostol; proton pump inhibitor (PPI)

#### DENOMINATOR DESCRIPTION

Patients treated with a low-dose aspirin daily who have 2 or more risk
factors for gastrointestinal (GI) bleeding\*

\***Note**: For the purpose of this measure, heightened risk for GI
bleeding is defined as age greater than or equal to 75 years, history of
peptic ulcer disease, history of GI bleeding, or glucocorticoid use.

#### NUMERATOR DESCRIPTION

Patients who are treated concomitantly with either misoprostol or proton
pump inhibitor (PPI)

### 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

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 treated with a low-dose aspirin daily who have 2 or more risk
factors for gastrointestinal (GI) bleeding

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients treated with a low-dose aspirin daily who have 2 or more risk
factors for gastrointestinal (GI) bleeding\*

\***Note**: For the purpose of this measure, heightened risk for GI
bleeding is defined as age greater than or equal to 75 years, history of
peptic ulcer disease, history of GI bleeding, or glucocorticoid use.

**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 treated concomitantly with either misoprostol or proton
pump inhibitor (PPI)

**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 6. Low-dose aspirin use: GI prophylaxis.

#### 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 6. Low-dose Aspirin Use: GI
Prophylaxis,\" 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.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008