Metric 35

Average Number of Concurrent Medications Per Older Patient

Metric Category: Appropriateness

About the Metric

Definition

The average number of concurrent medications prescribed per older patient. 

Background

The total number of medication prescriptions in the US has increased by 85% over the last two decades. In particular, prescription drug use in patients aged 65 years or older has increased dramatically. Older patients are at a particularly high risk for drug-related injuries such as falls and medication interactions. Polypharmacy has been associated with increased medical cost, increased hospitalizations, and increased mortality.

Metric Ratings

Evidence
4/5
Expert Consensus
4.5/5
Clinician Buy-in
3/5
Economic Impact
5/5
Reduction in Avoidable Harm
4.5/5
Applicability to Medicare Data
5/5
Applicability to Medicaid
1/5

Applicable to EHR Data?

Requires Pharmacy Data?

How It Works

Numerator

The total number of concurrent medications summed across the patients from the denominator. For each patient, the number of concurrent medications is defined as the maximum number of concurrent medications in use on any day during the study period. The fill date and days of supply should be used to calculate the days of medication use. Overlapping days of the same medication should be credited by shifting the start date of the subsequent prescription to the day after the previous prescription was completed. Medications of the same generic name and different dosage strength should be considered the same medication. Only prescription medications with at least 30 days of supply should be included.

Denominator

The number of patients aged 65 years or older who filled any prescription by a given primary care physician during the study period. 

Inclusion Criteria

All patients aged 65 years or older who filled any prescription during the study period. 

Exclusion Criteria

Patients who have undergone organ transplantation, chemotherapy, or have a diagnosis of HIV

  • All chemotherapy codes = J9000-J9999
  • Status post organ removal [transplantation] = Z98.85
  • Status awaiting organ transplant = Z76.82
  • Transplant organ and tissue status = Z94.0 – Z94.9
  • Encounter for administration of chemotherapy = Z51.11
  • Personal history of antineoplastic chemotherapy = Z92.21
  • HIV positive with complications = ICD-10-CM: B20
  • HIV asymptomatic = Z21

Attribution

None.

GAM Thresholds™

GAM establishes clinical thresholds using the input of key physician leaders within a specialty and the GAM clinical team. GAM utilizes an elaborate consensus building process with final adjudication by our leadership team.

  • Sample Size: 11+

    This threshold applies to a clinician with a minimum of 11 cases.

  • Pattern of Concern: 6 - 7.7

    This constitutes the clinical threshold for a "pattern of concern".

  • Outlier: >7.7

    This constitutes the clinical threshold for an "outlier".

Cases Pattern of Concern Outlier
11+
6 - 7.7
>7.7