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Johns Hopkins Health Plans

PCE - Pharmacotherapy Management of COPD Exacerbation

Product Lines:
Advantage MD, Dual Eligible Special Needs Plans (D-SNP), EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31

Description:
The percentage of COPD exacerbations for persons 40 years of age and older who had an acute inpatient discharge or ED visit on or between January 1 and November 30 of the measurement period and were dispensed appropriate medications. Two rates are reported:

  1. Dispensed a systemic corticosteroid (or there was evidence of an active prescription) on or within 14 days of the event.
  2. Dispensed a bronchodilator (or there was evidence of an active prescription) within 30 days of the event.

Measure Reporting:
HealthChoice Performance Measure reporting for Priority Partners. 

Improvement Notation:
Increased score indicates improvement.

Data Collection:

  • Administrative.
  • Supplemental.

Initial Population:

  • Measure Item Count: Episode. 
  • Age: 40 years of age or older as of the first day of the measurement period.
  • Benefits: Medical and pharmacy.
  • Continuous Enrollment: Episode date through 30 days after the episode date. 
  • Allowable gap: None.  

Definition: 
Active prescription: A prescription is considered active if the “days supply” indicated on the date when the person was dispensed the prescription is the number of days or more between that date and the relevant date.
For an acute inpatient stay, the relevant date is the date of admission.
For an ED visit, the relevant date is the date of service.

Direct transfer: When the discharge date from the first inpatient setting precedes the admission date to a second inpatient setting by 1 calendar day or less.

Episode date: The date of service for any acute inpatient discharge or ED visit during the intake period with a principal diagnosis of COPD. 
For an acute inpatient discharge, the episode date is the date of discharge.
For direct transfers (to acute or nonacute settings), the episode date is the discharge date from the transfer admission. 
For an ED visit, the episode date is the date of service.

Intake period: January 1 of the measurement period to November 30 of the measurement period. The intake period captures eligible episodes of treatment.

Denominator:
COPD exacerbation. 

  • An ED visit with a principal diagnosis of COPD, emphysema or chronic bronchitis.
  • An acute inpatient discharge with a principal diagnosis of COPD, emphysema or chronic bronchitis on the discharge claim. To identify acute inpatient discharges:

Numerator:
Numerator 1 - Systemic corticosteroid.
Persons who were dispensed a prescription for systemic corticosteroid (Systematic Corticosteroid Medications List) on or 14 days after the episode date. Count systemic corticosteroids that are active on the relevant date.

Numerator 2 - Bronchodilator.
Persons who were dispensed a prescription for a bronchodilator (Bronchodilator Medications List) on or 30 days after the episode date. Count bronchodilators that are active on the relevant date. 

Best Practice and Measure Tips

  • Members with active prescriptions for these medications are administratively compliant with the measure.
  • An active prescription is one that’s noted as having available medication left in the “days’ supply” through the episode date or further.
  • The “episode date” for an acute inpatient stay is the admission date.
  • The “episode date” for the emergency department visit is the date of service. 
  • Follow up with members to make sure any new prescriptions are filled post-discharge.
    • Schedule a follow-up appointment after discharge and confirm that the patient has the appropriate medications. 
    • Reconcile patients’ medications with those prescribed at discharge when you receive the discharge summary.
  • Vaccinations help protect against respiratory viruses. Make sure our members are up to date with their vaccination such as COVID-19, flu, pneumonia vaccinations pertussis (whooping cough), respiratory syncytial virus (RSV) and tuberculosis (TB).
  • Provide a COPD action plan for patient:

Measure Exclusions

Denominator Exclusions:

  • Persons in hospice or using hospice services any time during the measurement period.
  • Persons who died any time during the measurement period.

Measure Medications

Systemic Corticosteroid Medications on or 14 days after the Episode Date.

  • Cortisone 
  • Dexamethasone  
  • Hydrocortisone 
  • Methylprednisolone
  • Prednisolone    
  • Prednisone

Bronchodilator Medications on or 30 days after the Episode Date.

  • Aclidinium bromide
  • Albuterol
  • Albuterol-ipratropium
  • Arformoterol
  • Budesonide-formoterol
  • Fluticasone-salmeterol
  • Fluticasone-vilanterol
  • Fluticasone furoate-umeclidinium-vilanterol
  • Formoterol
  • Formoterol-aclidinium
  • Formoterol-glycopyrrolate
  • Formoterol-mometasone
  • Ipratropium
  • Levalbuterol
  • Metaproterenol
  • Olodaterol
  • Olodaterol-tiotropium
  • Salmeterol
  • Tiotropium
  • Umeclidinium
  • Umeclidinium-vilanterol