Chronic obstructive pulmonary disease (COPD) is a serious global health concern impacting millions of individuals. Despite being the third leading cause of mortality worldwide, COPD remains underdiagnosed and undertreated. Quality measures are a vital component of value-based payment models, but there are few COPD measures in current U.S. quality reporting programs, despite the established burden of COPD.

A new article published in the September issue of the American Journal of Managed Care (AJMC) details a study conducted by PQA that aimed to further test and validate COPD treatment ratio (CTR) as a measure of moderate and severe COPD exacerbation risk amongst commercial and Medicare populations.

CTR is defined as the ratio of COPD maintenance medications to all COPD medications (maintenance and rescue).  The measure can be used to inform public health and quality improvement efforts by identifying patients who may benefit from interventions.

Validating CTR as a Measure of COPD Exacerbation Risk

The study aimed to validate CTR as a measure of COPD exacerbation risk separately within Medicare Advantage and commercially insured populations and evaluate CTR as a predictor of COPD exacerbation risk. The retrospective cohort study used administrative claims from 2016 - 2019 to evaluate CTR values over a 12-month baseline period, with exacerbations measured the following year. Patients 40 years or older with Medicare Advantage or commercial insurance and with a COPD diagnosis were included.

Results demonstrated that higher CTR values were significantly associated with reduced risk of any, moderate, and severe exacerbations in the total population and when stratified by insurance type. This supports the validity of CTR as a predictor of COPD exacerbation risk within Medicare Advantage and commercial lines of business.

Notable takeaway points from the study include:

• The use of CTR in population health and quality initiatives could decrease costs for health plans and patients, support health outcomes, improve medication management, and increase the use of evidence-based practices in COPD care.
• CTR is a suitable metric to monitor progress on national and global COPD policies, action plans, and initiatives.
• The study results add to the evidence base that support the development of a CTR quality measure that can be implemented to advance COPD value-based care programs.

PQA’s Next Steps and the Measure Development Process

PQA’s CTR quality measure concept is being tested currently. Once testing is completed, the PQA Quality Metrics Expert Panel (QMEP) will review the results and consider whether to approve the measure concept to move forward for endorsement consideration by PQA members in 2025. QMEP will assess the measure concept and testing results against our standard measure criteria. 

Read the full AJMC article for additional information and full results. For more information about PQA's work to develop a health plan performance measure for COPD, see our August 2022 blog, which includes information about PQA's consensus-based measure prioritization and development processes.