AGS Collaborates With Leading Organizations to Revise Quality Measures

This summer Annals of Long-Term Care^® spoke with AGS leaders and directors of the National Committee for Quality Assurance and the Pharmacy Quality Alliance about the process by which the two organizations revised their quality measures based on the newly updated American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
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In February of this year, the American Geriatrics Society (AGS) updated the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults and published the new 2012 AGS Beers Criteria in the Journal of the American Geriatrics Society (https://www.ncbi.nlm.nih.gov/pubmed/22375952). The update was essential—the criteria have long been one of the most consulted sources of information about safe prescribing for older adults.

A few months later, the National Committee for Quality Assurance (NCQA) and the Pharmacy Quality Alliance (PQA)—two leading organizations involved in developing and implementing quality measures—updated two of their three important measures to reflect the 2012 AGS Beers Criteria. The update of the Beers criteria and the incorporation of these updated criteria into the NCQA and PQA measures illustrate how the efforts of the AGS and other organizations, such as the NCQA and PQA, can complement one another.

“Once the AGS decided to update the criteria, we made sure that the directors of these organizations were in the loop,” says AGS Chief Executive Officer Jennie Chin Hansen.

The AGS Executive Committee approved the Beers Criteria update project in 2011, after a number of members suggested that the society do so, given that it had been 8 years since the criteria had last been revised. Mark Beers, MD, a geriatrician and active member of the society, first published the criteria in 1999 with the help of a team of experts. He and colleagues updated and expanded the criteria twice before his death in 2009, but the most recent update had been completed back in 2003.

To get started, the AGS appointed a panel, including 11 experts with recognized expertise in geriatrics, nursing, pharmacy practice, and research, who would focus on the needs of individual clinicians when updating the Beers Criteria. The NCQA, PQA, and the Centers for Medicare & Medicaid Services (CMS) were invited to send representatives to the panel as ex officio members because AGS leaders were aware of the importance of the criteria in informing key quality measures.

“Having Bob Rehm and David Nau join our Beers Update Panel in an ex officio capacity really helped us with our update of the criteria, which had long been used to support both NCQA and PQA quality measures,” says Hansen. “Throughout the process, the focus of the update was on meeting the needs of individual clinicians.”

Two of the NCQA’s measures have been based, in part, on the criteria: the Potentially Harmful Drug-Disease Interactions in the Elderly measure and the Use of High-Risk Medications in the Elderly measure. The latter measure is also among the PQA’s quality measures.

“Because there are new findings about existing drugs over time, and because new drugs continue to be introduced, you need to update regularly,” notes Rehm. “In light of this, our Geriatrics Measures Advisory Panel discussed how best to approach revising the criteria given their importance to our measure set. We were delighted that AGS had undertaken the update based on the most current evidence.”

The panelists started work immediately, following a process that included a systematic literature review to identify relevant research and meta-analyses published since 2003. The panel used a modified Delphi method and followed the Institute of Medicine’s (IOM) 2011 recommendations for developing clinical practice guidelines, which call for transparency, external review, and a period for public comment. In addition, the panelists provided both ratings for the quality of the evidence supporting their recommendations and for their assessment of the strength of the recommendations.

“After we convened the panel, we got started immediately, beginning with drug and condition reviews,” says AGS Deputy Executive Vice President and Chief Operating Officer Nancy Lundebjerg. “Though the NCQA and PQA were nonvoting members, they were very helpful in guiding us through some of the processes that were new to the AGS.”

Among other things, the NCQA and PQA sat in on drug and condition reviews, and offered information and assistance when appropriate. The NCQA, for example, provided helpful advice for soliciting public comment, in keeping with the IOM’s recommendation.

“We helped the AGS set up a website to solicit and manage public comment,” explains Rehm. “We also encouraged the society to put the full evidence review on the website so everyone could see it.”

“When the AGS released its draft recommendations for public comment, we notified our member organizations and encouraged them to submit comments,” adds Nau.

“Once the draft recommendations were made public, the NCQA and PQA began amending their measures,” explains NCQA senior healthcare analyst Jeremy Gottlich.

“The AGS shared draft recommendations with our Quality Metric Expert Panel so it could begin identifying how to incorporate the society’s recommendations into our measure,” notes Nau.

As the society continued to fine tune its recommendations for the measure, the PQA and NCQA likewise refined their revisions to the Use of High-Risk Medications in the Elderly measure. Both organizations were able to finalize updates to their respective measures in June.

“Throughout the process, members of the AGS panel reviewed draft changes, and this really helped us make our measure better and make the guidelines clearer,” says Rehm. “It worked very well and there was wide confidence that the AGS was the right group do be doing this work.”

Because NCQA and PQA were able to stay abreast of the discussions and decisions of the AGS panel, they were able to efficiently move through their multi-step processes for measure updates and secured their internal approvals by June for the Use of High-Risk Medications measure, notes Nau. As this issue of Annals of Long-Term Care^® went to press in mid-August, the NCQA anticipated that it would have its second measure, Potentially Harmful Drug-Disease Interactions, revised and ready for review and approval next summer.

What’s next? “We are going to update the 2012 AGS Beers Criteria on a regular basis,” says Hansen. “And we look forward to including the NCQA and PQA again.”