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Adherence to Oral Diabetes Agents for Individuals with Diabetes Mellitus

CBE ID
2468
1.4 Project
Primary Care and Chronic Illness
Endorsement Status
Endorsement Removed
1.1 New or Maintenance
Maintenance
Previous Endorsement Cycle
Spring 2018
Is Under Review
No
1.3 Measure Description

The measure addresses adherence to oral diabetes agents (ODA). The measure is reported as the percentage of eligible individuals with diabetes mellitus who had at least two prescriptions for a single oral diabetes agent or at least two prescriptions for multiple agents within a diabetes drug class and who have a Proportion of Days Covered (PDC) of at least 0.8 for at least one diabetes drug class during the measurement period (12 consecutive months)

    • 1.14 Numerator

      Individuals in the denominator with at least two prescriptions for oral diabetes agents, in any diabetes drug class, with a PDC of at least 0.8 for at least one diabetes drug class.

    • 1.15 Denominator

      Individuals at least 18 years of age as of the beginning of the measurement period with diabetes mellitus and at least two prescriptions for a single oral diabetes agent or at least two prescriptions for multiple agents within a diabetes drug class during the measurement period (12 consecutive months).

    • Exclusions

      We excluded the following individuals from the denominator:
      Individuals with polycystic ovaries, gestational diabetes, or steroid-induced diabetes who do not have a face-to-face visit with a diagnosis of diabetes in any setting during the measurement period.
      Exclusion 1
      Individuals with a diagnosis of polycystic ovaries who do not have a visit with a diagnosis of diabetes in any setting during the measurement period*; and,

      Exclusion 2
      Individuals with a diagnosis of gestational diabetes or steroid-induced diabetes who do not have a visit with a diagnosis of diabetes mellitus in any setting during the measurement period.

      *Adapted from NCQA HEDIS 2013 (2013). Note: HEDIS uses a look-back period of one year prior to the measurement period for both the prescription data and diagnosis.

    • Most Recent Endorsement Activity
      Measure Retired and Endorsement Removed Primary Care and Chronic Illness Spring Cycle 2018
      Initial Endorsement
      Last Updated
      Removal Date
    • Steward
      Centers for Medicare & Medicaid Services
      Steward Organization POC Email
      [email protected]
      Steward Organization Copyright

      Limited proprietary coding is contained in the measure specifications for user convenience. Use of these codes may require permission from the code owner or agreement to a license.

      ICD-10 codes are copyright © World Health Organization (WHO), Fourth Edition, 2010. CPT® 2010 American Medical Association; CPT is a registered trademark of the American Medical Association. All rights reserved.