Getting Involved in PQA’s Measure Development
Q: How does PQA determine the measure concepts that will be developed each year?
A: In the third quarter of the year, PQA staff completes a review of national priorities and creates an initial list of potential measure concepts to address important measure gaps. Also added to the list are measure ideas that have been forwarded to PQA staff, typically from our membership. PQA then convenes a Measure Advisement Group composed of leaders engaged in the measure development process to review and provide input on measure concept ideas that meet clinical needs, align with the National Quality Strategy, and that fill measure gaps based on literature review and environmental scans. The Advisement Group discusses each concept, considers where the measure might be implemented and prioritizes the list. Selected measure concepts are developed by Measure Development Teams, with the work beginning in the first quarter of the following year.
Q: How can I participate in PQA measure development?
A: Measure Development Teams (MDTs) meet monthly to develop measure concepts. The number of MDTs will vary from year to year and each MDT is responsible for one specific measure concept. Once PQA determines the concepts for development, PQA members are invited to apply for the MDTs. Individuals apply for specific MDTs based on their experience, knowledge and expertise aligned with the particular measure concept. Teams are finalized in late January. Check the PQA website for announcements about the application process and timeline in mid-December.
In addition to the MDTs, PQA member organizations can identify a representative to participate on each Strategic Advisory Panel (SAP) to provide oversight and comment on the development of all measure concepts. SAPs meet four times a year by phone or webinar, with one of the four meetings (aligned with the PQA Annual Meeting) having the option of in-person participation. Each SAP has the responsibility for reviewing and contributing to two to three measure concepts under development. For more information about the MDTs and SAPs, please visit the PQA website at http://pqaalliance.org/mdg/default.asp.
Finally, PQA also uses the Measure Development Taskforce structure to focus in on a particular disease state area or a prevention/wellness area. For example, PQA had a Long Term Care Taskforce at one time, it currently has an Immunization Taskforce, and it also had a Specialty Pharmacy Taskforce. Generally speaking, a Taskforce may be “set in motion” outside of the normal calendar cycle, and in most instances, PQA may need to reach beyond its membership to identify the subject matter experts to serve on such a taskforce. PQA Taskforces may receive external funding in order to pull the resources necessary to launch such an effort outside of the normal calendar year cycle or to support a live meeting of the Taskforce to jump start a particular initiative.
Q: How can I introduce a new measure concept for development within the Measure Development Teams?
A: Any PQA member is able to recommend a new idea for a measure concept by emailing PQA staff (contact information listed below). Ideas are compiled, reviewed by PQA staff, and then shared with the Measure Advisement Group each fall to consider for development during the following year.
Using the PQA Measures
Q: How can I get a list of the PQA measure specifications?
A: The PQA Measure Manual that includes all the measure specifications is provided on request to PQA members for non-commercial purposes. For clarity around the definition of non-commercial purposes, PQA staff is happy to schedule a call to discuss.
Non-members can request individual measure specifications for quality improvement purposes. Requests can be sent to JKuhle@PQAalliance.org.
Q: How can my company use PQA measures in a commercial product?
A: Organizations interested in using the PQA measures, as part of a commercial product, will need to license the measures. More information about what measure use requires a license and how to obtain a license can be found at the PQA website http://pqaalliance.org/measures/licensing.asp or by contacting Jackie Green at JGreen@PQAalliance.org
Q: What’s the difference between a quality improvement indicator and a performance measure?
A: PQA performance measures use pre-established, fully specified criteria. This allows a performance measure to be used to compare rates across organizations since the measure is calculated the exact same way. A quality improvement indicator is more flexible and some of the measure criteria may not be fully specified. Quality improvement indicators are used internally to improve a process and are not intended for comparative use. For more information, visit the PQA website at http://pqaalliance.org/measures/quality_improvement.asp.
Measure Specific Questions
Q: How often are the PQA measures updated?
A: The PQA Measure Manual and the supporting NDC files are updated twice annually, in February and July, by adding new medications and NDCs within therapeutic categories for each measure. The Measure Update Panel reviews all PQA measures annually and makes recommendations to the Quality Metrics Expert Panel for their review and recommendation. Measure changes that do not significantly alter the measure are included in the February Measure Manual. Measure changes that significantly alter a measure will result in a new measure and that measure will go through the PQA testing and endorsement process.
Q: Where can I find the list of high-risk medications to avoid in the elderly?
A: The PQA measure, Use of High-risk Medications in the Elderly, is posted on the PQA website at http://pqaalliance.org/measures/default.asp (via the link on the left sidebar). The list of medications is included in the measure.
Q: Why does the HRM measure (high risk medications in the elderly) require two prescription fills before the person is included in the numerator?
A: CMS requires plan sponsors to continue medications for newly enrolled Medicare beneficiaries or as a member transfers from one plan to another (i.e., the new plan sponsor must provide the beneficiary with one fill). Requiring two fills avoids penalizing plan sponsors that fill the first prescription of the HRM to meet their contractual obligation.
Q: How did PQA determine which drug-drug pairs to include in the drug-drug interaction (DDI) measure?
A: The list of drug-drug pairs in the measure is intended to be a subset of important DDIs and not a complete list of all interactions. The subset was compiled after a review of the literature to identify significant interactions. The purpose of this performance measure is for the evaluation of prescription drug plans and ambulatory/community pharmacies. Ideally, the performance measure will be used to provide feedback to plans and pharmacies for benchmarking of their performance and for tracking improvement as quality improvement initiatives are implemented.
Q: Why does PQA use the adherence methodology, proportion of days covered (PDC), rather than medication possession ratio (MPR) for the adherence measures?
A: PQA adherence measures use the proportion of days covered (PDC) methodology. Both methodologies, MPR and PDC, have pros and cons. Based on analyses, PQA believes that: 1) the PDC and MPR will provide nearly identical results when examining adherence to a single drug (e.g., only levothyroxine); and 2) the PDC will provide a more conservative estimate of adherence when examining adherence to a class of drugs that are prone to frequent switching and concomitant therapy with multiple drugs within the class (as with antipsychotic drugs, for example). After reviewing the extant literature and conducting tests of draft measure specifications, PQA chose to endorse the PDC methodology.
For information that describes both methods please see the paper, Proportion of Days Covered (PDC) as a Preferred Method of Measuring Medication Adherence, written by Dr. David Nau. This article is available at the PQA website under Resources/Adherence, http://pqaalliance.org/resources/adherence.asp
Q: Why are persons who use insulin excluded from the Diabetes Adherence Measure?
A: Days supply information attributed to multi-dose vials such as insulin is not very accurate. Insulin dosing is also adjusted frequently, making days supply inaccurate, so the measure doesn’t include insulin. The PQA measure specifications for Proportion of Days Covered: Diabetes Medications exclude from the denominator any patient that has one or more claims for insulin. If an individual were included in the measure and switched from an oral hypoglycemic medication to insulin, they would appear to be non-adherent (since the numerator does not include insulin). Therefore, excluding any patient that receives a claim for insulin during the measurement year mitigates this issue.
If you have questions about PQA measures and/or the measure development process, please contact any of the following: