PQA Developing Health Plan Measure for COPD Treatment Ratio
PQA, the Pharmacy Quality Alliance, has begun developing a health plan performance measure for chronic obstructive pulmonary disease (COPD).
Chronic lower respiratory disease, primarily COPD, is the fourth leading cause of death in the United States. Almost 15.7 million Americans have been diagnosed with COPD. The actual number is likely higher, as half of adults with low pulmonary function are not aware they have COPD.
COPD is a high-burden and expensive condition, so ensuring effective, high-quality treatment is a priority for patients and those who care for them.
The COPD Treatment Ratio (CTR) is the ratio of controller medications to all COPD medications, which includes both controller and rescue medications. Incremental increases in CTR have been associated with reduced risk of severe COPD exacerbations.
Validating CTR as a Measure of COPD Exacerbation Risk
PQA conducted a study last year that validated the use of the CTR as a measure of exacerbation risk within a large commercial and Medicare population when adjusted for several other risk factors.
The study also determined that a CTR threshold of 0.7 is optimal and significantly associated with a reduced risk of any, moderate and severe exacerbations in the total population and when stratified by line of business. In other words, the study found that a useful target to reduce the risk of adverse outcomes is ensuring that at least 70 percent of a patient’s COPD medications are controller medications.
The study was supported by GlaxoSmithKline and presented at AMCP Nexus 2021. A total of 132,960 patients were included in the analysis, which builds on a previous study that reached a similar conclusion.
Consensus-Based Measure Prioritization and Development
With this evidence, PQA’s staff and Health Plan Measure Concept Advisory Group (MCAG) recommended this concept advance to measure development. That recommendation was supported by public comments PQA received last October 25-November 19.
PQA’s MCAGs are composed of individuals with clinical, measurement and implementation expertise that is directly applicable to the concepts being considered. MCAGs represent the diverse health care stakeholders among PQA member organizations who are held accountable for or impacted by measures.
PQA is accepting nominations for a Technical Expert Panel (TEP) that will launch in October to refine the measure specifications and consider its implications for implementation and meaningful use. Visit PQA’s Member Resources Library for information and nomination instructions. Nominations will be accepted through September 9.
The draft measure then would advance to additional testing where the specifications are applied to data that is representative of the intended measure population to determine the measure’s scientific acceptability.
These steps are part of PQA’s rigorous measure development and testing process. PQA has a two-page overview of its measure development process that provides more information.
It all began with the identification of an important measurement gap for COPD and research to validate our proposed approach. We’re hopeful that this consensus-based process, which is responsive to industry and the needs of our care system, will lead to a measure our members will endorse and use.