sign in sign up
<<
Home , Antithyroid agent, ATC code D02, ATC code D07, ATC code G02, ATC code M04, ATC code N04

Online supplementary table S7. List of quality indicators for RUM Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka # of essential emergency available within the EU 1 Broccoli et al. 1 2018 Africa # of essential emergency listed % of essential medications available in the EU S Ge 6 N/A N/A at time of assessment 2 Broccoli et al. 1 2018 Africa # of EUs within the region # of EUs with clinical guidelines for emergency care % of EUs with clinical guidelines for emergency care S Ge 9 N/A N/A 3 Broccoli et al. 1 2018 Africa # of EUs within the region # of EUs with protocol % of EUs with sepsis protocol S Me 9 J01 J 4 Broccoli et al. 1 2018 Africa # of EUs within the region # of EUs with reactive airway disease protocol % of EUs with reactive airway disease protocol S Me 9 R03 R # of EUs with regular audits of EU diagnostics and/or % of EUs with regular audits of EU diagnostics and/or 5 Broccoli et al. 1 2018 Africa # of EUs within the region S Ge 9 N/A N/A treatment compliance as dictated by local priority treatment compliance as dictated by local priority # of patients < 5 with pneumonia given antibiotics during EU % of patients < 5 with pneumonia given antibiotics during EU 6 Broccoli et al. 1 2018 Africa # of patients < 5 with pneumonia P Me 1 J01 J length of stay length of stay # of patients with documentation of who receive % of patients with documentation of asthma who receive 7 Broccoli et al. 1 2018 Africa # of patients with documentation of asthma P Me 1 R03 R treatment bronchodilator treatment # of adult patients with pneumonia given antibiotics during EU % of adult patients with pneumonia given antibiotics during EU 8 Broccoli et al. 1 2018 Africa # of adult patients with pneumonia P Me 1 J01 J length of stay length of stay 9 Broccoli et al. 1 2018 Africa # of adult patients with SBP < 90 mmHg # of adult patients with SBP < 90 mmHg given IV fluids % of adult patients with SBP < 90 given IV fluids P Me 1 B05 B # of patients with postpartum haemorrhage who receive % of patients with postpartum haemorrhage who receive 10 Broccoli et al. 1 2018 Africa # of patients with postpartum haemorrhage P Me 1 B05 B medication to control bleeding medication to control bleeding 11 Broccoli et al. 1 2018 Africa # of patients with glucose < 70 mg/dL # of patients with blood glucose < 70 mg/dL given glucose % of patients with blood glucose < 70 mg/dL given glucose P Me 1 B05 B # of patients with saturation < 92% with % of patients with oxygen saturation < 92% who had 12 Broccoli et al. 1 2018 Africa # of patients with oxygen saturation < 92 % P Me 1 V03 V documentation of supplemental O2 supplemental oxygen given # of patients with diagnosis of eclampsia or pre-eclampsia % of patients with diagnosis of eclampsia or pre-eclampsia 13 Broccoli et al. 1 2018 Africa # of patients with diagnosis of eclampsia or pre-eclampsia P Me 1 B05 B receiving receiving magnesium # of patients with active external bleeding who have physical % of patients with active external bleeding who have physical 14 Broccoli et al. 1 2018 Africa # of patients with active external bleeding P Me 1 B05 B manoeuvres applied to control haemorrhage documented manoeuvres applied to control haemorrhage # of patients meeting local transfusion criteria who receive % of patients meeting local transfusion criteria who receive 15 Broccoli et al. 1 2018 Africa # of patients meeting local transfusion criteria P Me 1 B05 B blood transfusion blood transfusion # of patients with a diagnosis of sepsis given antibiotics during % of patients with diagnosis of sepsis given antibiotics during 16 Broccoli et al. 1 2018 Africa # of patients with sepsis P Me 1 J01 J EU length of stay EU length of stay # of patients with documentation of asthma who receive % of patients with documentation of asthma who receive 17 Broccoli et al. 1 2018 Africa # of patients with documentation of asthma P Me 1 R03 R treatment corticosteroid treatment # of patients with documentation of pain who receive pain % of patients with documentation of pain who receive pain 18 Broccoli et al. 1 2018 Africa # of patients with documentation of pain PMe1 M01 M02 N02 MN medications medications # of patients age > 18 with open wound and documentation of % of patients age > 18 with open wound and documentation 19 Broccoli et al. 1 2018 Africa # of patients age > 18 with open wound tetanus vaccination given (or patient’s reported recent of tetanus vaccination given (or patient’s reported recent P Me 1 J07 J vaccination) vaccination) Number of patients 65 years of age and older who fall during Number of patients 65 years of age and older who fall during hospitalisation in whom presence or absence of prodromal 20 Tropea et al. 2 2011 Australia P Ge 7 N/A N/A hospitalisation symptoms and review of medications or potentially contributing to the fall is documented Number of patients aged 65 years and older whose current 21 Tropea et al. 2 2011 Australia Number of patients aged 65 years and older in sample P Ge 6 N/A N/A medications are documented and reconciled at admission Number of discharge summaries, of patients aged 65 years Number of discharge summaries in sample of patients aged 22 Tropea et al. 2 2011 Australia and older, that include medication changes and P Ge 6 N/A N/A 65 years and older explanations for changes Number of patients aged 65 years and older receiving Number of patients aged 65 years and older receiving 23 Tropea et al. 2 2011 Australia PMe1 N05 N at discharge sedatives at discharge that were not taking them at admission Number of regular clients during the reference period who The percentage of regular clients whose medicines have been 24 2012 Australia Number of regular clients during the reference period. have had their medicines reviewed according to locally agreed reviewed by a healthcare practitioner in accordance with P Ge 7 N/A N/A ACSQHC3 timeframes. locally agreed guidelines. Number of clients in the population or sample whose The percentage of clients whose medication list has been 25 2012 Australia All clients in the population or sample. medication list has been reconciled against the service’s P Ge 6 N/A N/A reconciled against the service’s patient health record. ACSQHC3 patient health record. Number of patient records in the sample where known The percentage of clients whose known adverse 26 2012 Australia Number of patient records in the sample. adverse drug reactions and medication are reactions and medication allergies are documented in the P Ge 7 N/A N/A ACSQHC3 documented. service’s patient health record. Number of adult patients receiving VTE prophylaxis Percentage of hospitalised adult patients that receive venous 27 2014 Australia Number of adult patients in sample PMe1 B01 B appropriate to their level of risk thromboembolism prophylaxis appropriate to their level of risk ACSQHC4, Number of patients prescribed enoxaparin whose dosing Percentage of patients prescribed enoxaparin whose dosing 28 4, 2014 Australia Number of patients prescribed enoxaparin in sample PMe3 B01 B ACSQHC schedule is appropriate schedule is appropriate Percentage of patients prescribed hospital initiated Number of patients on hospital initiated warfarin whose 29 2014 Australia Number of patients on hospital initiated warfarin in sample whose loading doses are consistent with a drug and PMe3 B01 B loading doses are consistent with a DTC approved protocol ACSQHC4, therapeutics committee approved protocol Number of patients with INR above 4 whose dosage has been Percentage of patients with an INR above 4 whose dosage 30 2014 Australia Number of patients with INR above 4 in sample PMe7 B01 B adjusted or reviewed prior to the next warfarin dose has been adjusted or reviewed prior to the next warfarin dose ACSQHC4, Number of patients with AF that are discharged on an oral Percentage of patients with atrial fibrillation that are 31 4, 2014 Australia Number of patients discharged with AF in sample PMe1 B01 B ACSQHC discharged on oral Percentage of patients undergoing specified surgical Number of patients who had a specified surgical procedure in Number of patients undergoing specified surgical procedures 32 2014 Australia procedures that receive an appropriate prophylactic PMe1 J01 J sample that receive an appropriate prophylactic antibiotic regimen ACSQHC4, regimen Percentage of prescriptions for restricted antibiotics that are Number of prescriptions for restricted antibiotics that are 33 2014 Australia Number of prescriptions for restricted antibiotics in sample concordant with drug and therapeutics committee approved PMe1 J01 J concordant with DTC approved criteria ACSQHC4, criteria Number of patients who received therapy Number of patients who received doses of empirical Percentage of patients in whom doses of empirical 34 4, 2014 Australia PMe1 J01 J ACSQHC beyond 48 hours in sample aminoglycoside therapy beyond 48 hours aminoglycoside therapy are continued beyond 48 hours Percentage of patients presenting with community acquired Number of patients presenting with CAP that are prescribed 35 2014 Australia Number of patients presenting with CAP in sample pneumonia that are prescribed guideline concordant antibiotic PMe1 J01 J guideline concordant antibiotic therapy ACSQHC4, therapy Number of patients whose current medicines are documented Percentage of patients whose current medicines are 36 4, 2014 Australia Number of patient records in sample P Ge 6 N/A N/A ACSQHC and reconciled at admission documented and reconciled at admission Number of patients whose known ADRs are documented on Percentage of patients whose known adverse drug reactions 37 4, 2014 Australia Number of patients in sample P Ge 7 N/A N/A ACSQHC the current medication chart are documented on the current medication chart Number of medication orders that include error-prone Percentage of medication orders that include error-prone 38 4, 2014 Australia Number of medication orders in sample P Ge 6 N/A N/A ACSQHC abbreviations abbreviations Number of paediatric medication orders that include the Percentage of paediatric medication orders that include the 39 2014 Australia Number of medication orders in sample correct dose per kilogram (or body surface area) AND an correct dose per kilogram (or body surface area) AND an P Ge 3 N/A N/A ACSQHC4, effective and safe total dose effective and safe total dose Number of medication orders for intermittent therapy in Number of medication orders for intermittent therapy that are Percentage of medication orders for intermittent therapy that 40 4, 2014 Australia PMe3 M05 N02 L04 MN L ACSQHC sample prescribed safely are prescribed safely Percentage of patients receiving cytotoxic Number of patients starting a cycle of chemotherapy in Number of patients starting a cycle of chemotherapy whose 41 2014 Australia whose treatment is guided by a hospital approved PMe1 L01 L sample treatment was guided by a hospital approved protocol ACSQHC4, chemotherapy treatment protocol Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Number of postoperative patients whose pain intensity is Percentage of postoperative patients whose pain intensity is 42 2014 Australia Number of postoperative patients in sample PMe7 N02 N documented using an appropriate validated assessment tool documented using an appropriate validated assessment tool ACSQHC4, Number of postoperative patients that were given a written Percentage of postoperative patients that are given a written 43 2014 Australia Number of postoperative patients in sample plan at discharge AND a copy was pain management plan at discharge AND a copy is PMe6 N02 N ACSQHC4, communicated to the primary care clinician communicated to the primary care clinician Number of patients with ACS who are prescribed appropriate Percentage of patients with acute coronary syndrome that are 44 4, 2014 Australia Number of patients with ACS in sample PMe1 B01 C07 C09 C10 BC ACSQHC medicines at discharge prescribed appropriate medicines at discharge Number of patients with systolic HF that are prescribed Percentage of patients with systolic heart failure that are 45 4, 2014 Australia Number of patients with systolic HF in sample PMe1 C07 C09 C ACSQHC appropriate medicines at discharge prescribed appropriate medicines at discharge Number of discharge summaries that include medication Percentage of discharge summaries that include medication 46 2014 Australia Number of discharge summaries in sample P Ge 6 N/A N/A therapy changes and explanations for changes therapy changes and explanations for changes ACSQHC4, Percentage of patients discharged on warfarin that receive Number of patients discharged on warfarin that receive written 47 2014 Australia Number of patients discharged on warfarin in sample written information regarding warfarin management prior to PMe5 B01 B information regarding warfarin management prior to discharge ACSQHC4, discharge Number of patients with a new ADR that were given written Percentage of patients with a new ADR that are given written 48 2014 Australia Number of patients with a new ADR in sample ADR information at discharge AND a copy was communicated ADR information at discharge AND a copy is communicated to P Ge 5 6 N/A N/A ACSQHC4, to the primary care clinician the primary care clinician Number of patients with asthma that were given a written Percentage of patients with asthma that are given a written 49 2014 Australia Number of patients with asthma in sample asthma action plan at discharge AND a copy was asthma action plan at discharge AND a copy is communicated PMe56 R03 R ACSQHC4, communicated to the primary care clinician to the primary care clinician Number of patients receiving sedatives at discharge that were Percentage of patients receiving sedatives at discharge that 50 4, 2014 Australia Number of patients receiving sedatives at discharge in sample PMe1 N05 N ACSQHC not taking them at admission were not taking them at admission Number of patients taking medicine(s) at discharge whose Percentage of patients whose discharge summaries contain a 51 2014 Australia Number of patients taking medicines at discharge in sample discharge summaries contain a current, accurate and P Ge 5 N/A N/A current, accurate and comprehensive list of medicines ACSQHC4, comprehensive medicines list Percentage of patients who receive a current, accurate and Number of patients who received a current, accurate and 52 2014 Australia Number of discharged patients taking medicines in sample comprehensive medication list at the time of hospital P Ge 5 N/A N/A comprehensive medication list at hospital discharge ACSQHC4, discharge Number of medication storage areas outside pharmacy in Number of medication storage areas outside pharmacy where Percentage of medication storage areas outside pharmacy 53 4, 2014 Australia SMe6 A12 A ACSQHC sample potassium ampoules are available where potassium ampoules are available Number of patients reviewed by a clinical pharmacist within Percentage of patients that are reviewed by a clinical 54 4, 2014 Australia Number of patients in sample P Ge 7 N/A N/A ACSQHC one day of admission pharmacist within one day of admission Total number of parenteral dosage units requisitioned Percentage of parenteral opioid dosage units that are 55 2014 Australia Number of parenteral opioid dosage units that are PMe1 N02 N from pharmacy (including pethidine) in sample pethidine ACSQHC4, Percentage of submissions for formulary listing of new Number of submissions for formulary listing of new chemical chemical entities for which the drug and therapeutics 56 2014 Australia All formulary submissions for new chemical entities in sample entities for which the DTC had access to adequate S Ge 6 N/A N/A committee has access to adequate information for appropriate information for appropriate decision making ACSQHC4, decision making Number of as required psychotropic medication orders with Percentage of as required (PRN) psychotropic medication Number of as required psychotropic medication orders in documented indication, dose (including basis for dose 57 2014 Australia orders with documented indication, dose (or dose range), PMe6 N05 N sample calculation for paediatric patients), frequency and maximum frequency and maximum daily dose specified ACSQHC4, daily dose specified Number of patients taking lithium who receive appropriate Percentage of patients taking lithium who receive appropriate 58 4, 2014 Australia Number of patients taking lithium in sample PMe7 N05 N ACSQHC monitoring monitoring during their inpatient episode Number of patients who received written and verbal Percentage of patients who receive written and verbal Number of patients in sample initiated on one or more new 59 2014 Australia information on the last newly initiated regular psychotropic information on regular psychotropic medicines initiated during PMe5 N05 N regular psychotropic medicines during their hospital admission ACSQHC4, medicine initiated during their hospital admission their admission Number of patients taking regular medicines Percentage of patients taking antipsychotic medicines who 60 2014 Australia Number of patients receiving regular antipsychotic medicines who receive appropriate monitoring for development of receive appropriate monitoring for the development of PMe7 N05 N ACSQHC4, metabolic side effects metabolic side effect Number of patients prescribed two or more regular Percentage of patients prescribed two or more regular 61 4, 2014 Australia Number of discharged patients in sample PMe1 N05 N ACSQHC at discharge antipsychotic medicines at hospital discharge Not on , β-blocker, ACEI or ARB and (in 3 62 5 2014 Australia History of MI (in 2 years prior to admission) PMe1 B01 C07 C09 C10 BC Caughey et al. months prior to admission) Patient has coronary artery stent (in 1 years prior to No use of aspirin or clopidogrel (in 12 months prior to 63 5 2014 Australia PMe1 B01 B Caughey et al. admission) admission) 64 Caughey et al. 5 2014 Australia History of CHF (in 2 years prior to admission) Not on an ACEI or ARB (in 3 months prior to admission) P Me 1 C09 C History of CHF with heart block or advanced bradycardia (in 2 65 5 2014 Australia Use of (in 6 months prior to admission) PMe1 C01 C Caughey et al. years prior to admission) History of chronic AF or ischaemic stroke (in 2 years prior to 66 5 2014 Australia No use of warfarin or aspirin (in 3 months prior to admission) P Me 1 B01 B Caughey et al. admission) 1. History of asthma 67 5 2014 Australia No use of inhaled PMe1 R03 R Caughey et al. 2. Use of SABA more than 3 times/week or use of LABA 1. Moderate-to-severe COPD with frequent exacerbation 68 5 2014 Australia No use of inhaled corticosteroids PMe1 A03N04R03S01 ANRS Caughey et al. 2. Use of long-acting β- or 1. History of asthma or COPD 69 5 2014 Australia No influenza vaccination in the previous year PMe1 J07 J Caughey et al. 2. No contraindication to influenza 1. Patient aged ≥65 years 70 5 2014 Australia No influenza vaccine in the previous year PMe1 J07 J Caughey et al. 2. No contraindication to influenza vaccine 1. Patient aged ≥65 years 71 5 2014 Australia No pneumococcal vaccine in the previous 6 years PMe1 J07 J Caughey et al. 2. No contraindication to pneumococcal vaccine 1. History of GI ulcer or bleeding 72 5 2014 Australia No use of gastroprotective agent (eg, PPI) PMe1 A02 M01 M02 AM Caughey et al. 2. NSAID use for at least 1 month Regular use of a strong opioid (fentanyl, 73 5 2014 Australia No concurrent use of a PMe1 A06 N02 AN Caughey et al. oxycodone, morphine) 74 Caughey et al. 5 2014 Australia Patient with dyspepsia PPI not prescribed PMe1 A02 A Not prescribed H pylori eradication therapy (PPI twice daily, 500 mg twice daily and amoxycillin 1 g twice daily for 7 days; OR PPI twice daily, clarithromycin 500 mg 75 2014 Australia Patient with a positive test for Helicobacter pylori PMe1 A02 A twice daily and 400 mg twice daily for 7 days; PPI twice daily, amoxycillin 500 mg three times a day and metronidazole 400 mg three times a day for 14 days) Caughey et al. 5 76 Caughey et al. 5 2014 Australia Patient with osteoarthritis Dispensed long-term NSAIDs (including COX-2) therapy P Me 1 M01 M02 M No osteoporosis prophylaxis (women: no use of HRT, , teriparatide, selective oestrogen 77 2014 Australia Use of systemic corticosteroids for at least 3 months PMe1 G03 H02 H05 M05 GHM modulators or strontium; men: no use of bisphosphonate or Caughey et al. 5 teriparatide) 1. Female patient No use of HRT, bisphosphonate, teriparatide, selective 78 5 2014 Australia PMe1 G03 H05 M05 GHM Caughey et al. 2. History of osteoporosis or fracture oestrogen receptor modulators or strontium 1. Male patient 79 5 2014 Australia No use of bisphosphonate or teriparatide PMe1 H05 M05 HM Caughey et al. 2. History of osteoporosis or fracture 1. Patient aged ≥65 years 80 5 2014 Australia Patient not receiving adequate levels of and D P Me 1 A11 A12 A Caughey et al. 2. History of osteoporosis Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Use of a falls-risk medicine (eg, long-acting or 81 5 2014 Australia Patient aged ≥65 years PMe1 N05 N06 N Caughey et al. , tricyclic ) 1. 82 2014 Australia 2. Microalbuminuria and plasma creatinine not monitored in Patient not on ACEI or ARB PMe1 C09 C Caughey et al. 5 the previous 12 months 83 Caughey et al. 5 2014 Australia NSAID use for >3 months Serum creatinine not monitored in the previous 12 months P Me 7 M01 M02 M 84 Caughey et al. 5 2014 Australia Use of an oral hypoglycaemic agent HbA1c level not monitored in the previous 6 months PMe7 A10 A Use of a long-acting oral hypoglycaemic agent (glibenclamide 85 5 2014 Australia HbA1c level not monitored in the previous 6 months PMe7 A10 A Caughey et al. or glimepiride) 86 Caughey et al. 5 2014 Australia Use of insulin HbA1c level not monitored in the previous 6 months PMe7 A10 A 1. Use of insulin or oral hypoglycaemic medicines 87 2014 Australia 2. Use of medicines that may increase or decrease blood HbA1c level not monitored in the previous 6 months PMe7 A10 A Caughey et al. 5 glucose concentration 88 Caughey et al. 5 2014 Australia Use of glibenclamide or glimepiride Renal function not monitored in the previous year PMe7 A10 A 89 Caughey et al. 5 2014 Australia History of diabetes Not on lipid lowering drug PMe1 C10 C Victorian 90 2015 Australia Number of residents whose charts were audited Number of residents using nine or more different medicines Nine or more medicines per 1,000 occupied bed days P Ge 1 N/A N/A Government6 Date of commencement of neoadjuvant androgen deprivation (Time from biopsy-confirmed diagnosis to first treatment) All 91 2016 Australia therapy, radiotherapy, or radical prostatectomy minus date of PMe1 L02 L patients with high-risk disease diagnosis >90 d for patients with high-risk disease Nag et al. 7 The number of patients whose psychotropics are documented at the time of admission with information in the clinical record (Medication history) The number of psychotropics prescribed 92 2017 Australia regarding the prescription source; treatment duration; PMe7 N05 N just prior to admission treatment effectiveness, and adverse effects as perceived by O'Connor et al. 8 the informant ( cessation) Number of regular Number of regular benzodiazepine prescriptions ceased at, or 93 8 2017 Australia PMe1 N05 N O'Connor et al. benzodiazepine prescriptions started during admission prior to, discharge Number of patients not discharged on two or more regular 94 8 2017 Australia (Avoidance of multiple antipsychotics) All patients PMe1 N05 N O'Connor et al. antipsychotics (As needed (PRN) psychotropic orders) Number of PRN Number of PRN orders that specify indication, dose or dose 95 8 2017 Australia PMe13 N05 N O'Connor et al. orders range, frequency or maximum daily dose Number of occasions throughout admission on which a 96 2017 Australia (Adverse reactions) Number of serious adverse reactions psychotropic linked to a serious adverse reaction is listed on PMe8 N05 N O'Connor et al. 8 all or most subsequent medication sheets Number of discharge summaries that specify new 97 2017 Australia (Medication handover) Number of discharge psychotropics psychotropics; new medications’ recommended duration; PMe5 N05 N O'Connor et al. 8 reason for ceasing medications (Appropriate prescribing for acute otitis media) Number and proportion of episodes of acute otitis media with or without 98 2017 Australia perforation among regular clients 0–2 years who are PMe1 J01 J Indigenous recorded in the previous 12 months for which an appropriate oral antibiotic was prescribed at time of diagnosis. Sibthorpe et al. 9 (Appropriate prescribing for chronic suppurative otitis media) Number and proportion of episodes of chronic suppurative otitis media among regular clients aged 0–14 years who are 99 2017 Australia PMe1 J01 J Indigenous recorded in the previous 12 months for which an appropriate topical antibiotic was prescribed at time of Sibthorpe et al. 9 diagnosis. Proportion of operable cT2-T3 women who received 100 10 2012 Belgium PMe1 L01 L02 L Stordeur et al. neoadjuvant systemic therapy Proportion of women with a breast who are receiving intravenous chemotherapy for whom the planned 101 2012 Belgium chemotherapy regimen (which includes, at a minimum: drug[s] PMe134L01 L prescribed, dose, and duration) is documented prior to the initiation, and at each administration of the treatment regimen Stordeur et al. 10 Proportion of women receiving adjuvant systemic therapy after 102 10 2012 Belgium PMe1 L01 L02 L Stordeur et al. breast for invasive Proportion of women with hormone receptor positive invasive 103 2012 Belgium breast cancer or DCIS who received adjuvant endocrine PMe1 L02 L Stordeur et al. 10 treatment (Tamoxifen/AI) Proportion of women with HER2 positive, node positive or high-risk node negative breast cancer (tumour size > 1 cm), 104 2012 Belgium PMe1 L01 L having a left ventricular ejection fraction of > or = 50-55% who Stordeur et al. 10 received chemotherapy and Proportion of women treated by Trastuzumab in whom cardiac 105 10 2012 Belgium PMe7 L01 L Stordeur et al. function is monitored every 3 months Proportion of women with HER2 positive metastatic breast cancer who received Trastuzumab with/without non- 106 2012 Belgium PMe1 L01 L02 L based chemotherapy or endocrine therapy as Stordeur et al. 10 first-line treatment Proportion of metastatic breast cancer women who receive 107 10 2012 Belgium PMe1 L01 L Stordeur et al. systemic therapy as 1st and/or 2nd line treatment Proportion of women with metastatic breast cancer and lytic 108 10 2012 Belgium PMe1 M05 M Stordeur et al. metastases who received If a patient is clinically diagnosed with knee OA and suffering from pain resistant to conservative treatment with acetaminophen and/or NSAID, then a radiography (weight- bearing, semiflexed PA, plus lateral and skyline view) of the 109 2014 Belgium PMe7 M01 M02 N02 MN symptomatic knee should be taken for the morphological assessment and grading of knee OA (especially to detect Grypdonck et unicompartmental OA, for which treatment modalities may differ). CT and MRI scan should not be used. al. 11 Grypdonck et If a patient has knee OA, then acetaminophen up to 3 g/day 110 2014 Belgium PMe13 N02 N al. 11 should be used as the initial oral analgesic. If a patient has knee OA and there is no adequate response 111 Grypdonck et 2014 Belgium on acetaminophen, or there is severe pain and/or PMe1 M01 M02 N02 MN al. 11 inflammation, then oral NSAID should be used. If a patient has knee OA, then chondroitin and glucosamine- 112 Grypdonck et 2014 Belgium PMe1 M01 M chondroitin combination products should not be used. al. 11 If NSAID are used in a patient with knee OA, then they should 113 Grypdonck et 2014 Belgium be used intermittently (max 3 weeks sustained use) and at the PMe34 M01 M02 M al. 11 lowest effective dose. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka If a patient with knee OA and a history of bleeding gastric ulcers has a need for NSAID, then either a COX-2 selective 114 2014 Belgium agent or a non-selective NSAID with coprescription of a PMe1 A02 M01 M02 AM Grypdonck et proton pump inhibitor/ should be used instead of a al. 11 non-selective NSAID. If a patient with knee OA has heart failure grade 2–4, ischemic heart disease, or renal insufficiency with a GFR < 40 ml/min, 115 2014 Belgium then NSAID should not be used. In case of other PMe1 M01 M02 M Grypdonck et cardiovascular risk factors (e.g., , …), NSAID al. 11 should be used with caution. If a patient has knee OA, then strong (oxymorphone, 116 Grypdonck et 2015 Belgium PMe1 N02 N oxycodone, fentanyl, morphine ) should not be used. al. 11 Proportion of patients with oesophageal cancer beyond the 117 2015 Belgium mucosa (T2–4 NAny M0-1a) who received neoadjuvant PMe1 L01 L Stordeur et al. 12 treatment Proportion of patients with a Gastric cancer beyond the 118 2015 Belgium PMe1 L01 L mucosa (T2–4 NAny M0) who received neoadjuvant treatment Stordeur et al. 12 Proportion of patients with any stage of OC treated with 119 12 2015 Belgium PMe1 L01 L Stordeur et al. primary chemoradiotherapy Proportion of patients with metastatic GC who received 120 12 2015 Belgium PMe1 L01 L Stordeur et al. combination chemotherapy De Schreye et (People with Alzheimer’s disease) Number of people who died Number of people who died with Alzheimer’s disease who 121 2017 Belgium PMe1 B05 B al. 13 with Alzheimer’s disease received blood transfusion in the last month prior to death Number of people who died with Alzheimer’s disease who (People with Alzheimer’s disease) Number of people who died 122 De Schreye et 2017 Belgium received and did not have declining statin use in the PMe1 C10 C with Alzheimer’s disease and received statins al. 13 last [12, 6, 1] months prior to death Number of people who died with Alzheimer’s disease who (People with Alzheimer’s disease) Number of people who died 123 2017 Belgium received two or more prescriptions of gastric protectors in the PMe1 A02 A De Schreye et with Alzheimer’s disease last 6 months prior to death (i.e. prescription until death) al. 13 Number of people who died with Alzheimer’s disease who (People with Alzheimer’s disease) Number of people who died 124 De Schreye et 2017 Belgium received antihypertensives in the last [6, 3, 1] months prior to PMe1 C02C03C07C08C09 C with Alzheimer’s disease al. 13 death Number of people who died with Alzheimer’s disease who (People with Alzheimer’s disease) Number of people who died 125 De Schreye et 2017 Belgium received calcium or vitamin D in the last [6, 3, 1] months prior PMe1 A11 A12 A with Alzheimer’s disease al. 13 to death Number of people who died with Alzheimer’s disease who (People with Alzheimer’s disease) Number of people who died received a prescriptions for novel oral anticoagulants OR 126 2017 Belgium PMe1 B01 B De Schreye et with Alzheimer’s disease antagonists in the last 3 months prior to death (i.e. al. 13 prescription until death) Number of people who died with Alzheimer’s disease who (People with Alzheimer’s disease) Number of people who died 127 De Schreye et 2017 Belgium received a prescriptions for prophylactic medication in PMe1 M04 M with Alzheimer’s disease al. 13 the last 3 months prior to death Number of people who died with Alzheimer’s disease who (People with Alzheimer’s disease) Number of people who died 128 De Schreye et 2017 Belgium received serotonin inhibitors in the last 3 months PMe1 N06 N with Alzheimer’s disease al. 13 prior to death Number of people who died with Alzheimer’s disease who had (People with Alzheimer’s disease) Number of people who died 129 De Schreye et 2017 Belgium a cancer diagnosis and received chemotherapy in the [12, 6] PMe1 L01 L with Alzheimer’s disease and had a cancer diagnosis al. 13 months prior to death Number of people who died with Alzheimer’s disease who (People with Alzheimer’s disease) Number of people who died 130 De Schreye et 2017 Belgium received neuropathic medication when receiving morphine in PMe1 N02 N with Alzheimer’s disease al. 13 the last 2 years prior to death Number of people who died with cancer who received blood 131 De Schreye et 2017 Belgium Number of people who died with cancer transfusion in the last month before death (for people with a PMe1 B05 B al. 13 haematologic condition in the last 2 weeks) Number of people who died with cancer who received one or 132 De Schreye et 2017 Belgium Number of people who died with cancer more chemotherapy treatments in the last month prior to PMe1 L01 L al. 13 death De Schreye et Number of days between last chemotherapy treatment and 133 2017 Belgium Number of people who died with cancer PMe4 L01 L al. 13 death Number of people who died with cancer who had a new 134 De Schreye et 2017 Belgium Number of people who died with cancer PMe1 L01 L chemotherapy line initiated in the last 3 months prior to death al. 13 De Schreye et Number of people who died with cancer and were age 80 or Number of people who died with cancer who received 135 2017 Belgium PMe1 L01 L al. 13 older and were age 80 years or older Number of people who died with cancer who had initiation of a 136 De Schreye et 2017 Belgium Number of people who died with cancer new anti- treatment in the last 2 months prior to PMe1 N06 N al. 13 death De Schreye et Number of people who died with cancer who received opioids 137 2017 Belgium Number of people who died with cancer PMe1 N02 N al. 13 in the last [6, 3, 1] months prior to death Number of people who died with cancer who received 138 De Schreye et 2017 Belgium Number of people who died with cancer neuropathic medication when receiving morphine in the last 2 PMe1 N02 N al. 13 years prior to death Number of people who died with cancer who received strong Number of people who died with cancer and received 139 De Schreye et 2017 Belgium anti-emetics when receiving chemotherapy in the last 2 years PMe1 A04 L01 AL chemotherapy al. 13 prior to death De Schreye et Number of people who died with COPD who received blood 140 2017 Belgium Number of people who died with COPD PMe1 B05 B al. 13 transfusion in the last month prior to dealth Number of people who died with COPD who received anti- 141 De Schreye et 2017 Belgium Number of people who died with COPD in the last month prior to death and did not PMe1 N06 N al. 13 receive anti-depressants before De Schreye et Number of people who died with COPD who received opioids 142 2017 Belgium Number of people who died with COPD PMe1 N02 N al. 13 in the last [6, 3, 1] months prior to death Number of people who died with COPD who received 143 De Schreye et 2017 Belgium Number of people who died with COPD inhalation conrticosteroids OR OR beta-2- PMe1 A03N04R03S01 ANRS al. 13 memetrics in the last [6, 3, 1] months prior to dealth Number of patients who, after treatment, experienced 144 2017 Belgium Total number of patients treated for pain OMe9 N02 N Leemans et al. 14 significant improvement in pain Number of patients whose shortness of breath was relieved 145 2017 Belgium Total number of patients with shortness of breath OMe9 N01 N within 48 hours after admission or starting palliative care Leemans et al. 14 Total number of patients for whom this indicator was Number of patients who received the right amount of 146 2017 Belgium PMe5 N01 N02 N Leemans et al. 14 measured information on palliative care options Total number of family carers for whom this indicator was Number of family carers who received the right amount of 147 2017 Belgium PMe5 N01 N02 N Leemans et al. 14 measured information about the patient’s condition and treatments Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka de Carvalho et 148 2017 Brazil Availability of a written protocol or routine for glycemic control S Me 9 A10 A al. 15 de Carvalho et Availability of a written protocol or routine for pain 149 2017 Brazil SMe9 M01 M02 N02 MN al. 15 management de Carvalho et 150 2017 Brazil Availability of a written protocol or routine for sedation S Me 9 N05 N al. 15 de Carvalho et Availability of a written protocol or routine for the use of blood 151 2017 Brazil SMe9 B05 B al. 15 components de Carvalho et Availability of a written protocol or routine for the use of 152 2017 Brazil SMe9 J01 J al. 15 antibiotics de Carvalho et Availability of written protocol or routine for gastrointestinal 153 2017 Brazil SMe9 A02 A al. 15 bleeding caused by stress de Carvalho et Availability of a written protocol or routine for the prevention of 154 2017 Brazil SMe9 B01 B al. 15 venous thromboembolism 1. Over 65 years of age 2. NSAID (e.g., , , ketoprofen, etc.) use for / hematocrit/CBC not done within 30 days of start 155 2002 Canada PMe7 A02 M01 M02 AM Mackinnon and at least one month of therapy or not done at least every 3 months thereafter 3. No concurrent use of a cytoprotective agent (misoprostol) Hepler16 1. Over 65 years of age 156 Mackinnon and 2002 Canada 2. NSAID (e.g., diclofenac, ibuprofen, ketoprofen, etc.) use for BUN/serum creatinine not done at least every 3 months P Me 7 M01 M02 M Hepler16 at least 3 months Mackinnon and 1. Over 65 years of age Use of a long-acting benzodiazepine (e.g., , 157 2002 Canada PMe1 N05 N Hepler16 2. History/diagnosis of depression , etc.) Mackinnon and Use of a (e.g., , 158 2002 Canada Over 65 years of age PMe1 N06 N Hepler16 , etc.) 1. Over 65 years of age 2. Diagnosis/history of moderate to severe renal impairment BUN/serum creatinine not done within 30 days of initiation of 159 2002 Canada PMe7 J01 J Mackinnon and and/or history of disease therapy and at least every 6 months Hepler16 3. Use of Mackinnon and 1. Over 65 years of age 160 2002 Canada Electrolytes/CBC not done at least every 6 months PMe7 C09 C Hepler16 2. Use of an ACEI (e.g., captopril, enalapril, etc.) Electrolytes/CBC not done before therapy initiated, at least 1. Over 65 years of age weekly during the first month of therapy, at least monthly 161 2002 Canada PMe7 N03 N Mackinnon and 2. Use of carbamazepine during the next 5 months of therapy, and at least every 6 Hepler16 months thereafter Mackinnon and 1. Over 65 years of age 162 2002 Canada BUN/serum creatinine not done at least every 3 months P Me 7 N05 N Hepler16 2. Use of lithium Mackinnon and 1. Over 65 years of age 163 2002 Canada Drug level not done at least every 6 months PMe7 R03 R Hepler16 2. Use of 1. Over 65 years of age 164 Mackinnon and 2002 Canada 2. Diagnosis/history of bipolar disorder Drug level not done at least every 3 months PMe7 N05 N Hepler16 3. Use of lithium Mackinnon and 1. Over 65 years of age 165 2002 Canada PTT not done at least every day PMe7 B01 B Hepler16 2. Use of IV 1. Over 65 years of age NSAID (e.g., diclofenac, ibuprofen, ketoprofen, etc.) use for at 166 Mackinnon and 2002 Canada PMe4 M01 M02 M 2. History/diagnosis of ulcers and/or gastrointestinal bleeding least one month Hepler16 1. Over 65 years of age Use of an oral corticosteroid (e.g., ) for at least 3 167 Mackinnon and 2002 Canada PMe4 H02 H 2. History/diagnosis of ulcers and/or gastrointestinal bleeding months Hepler16 Mackinnon and 1. Over 65 years of age 168 2002 Canada Use of a (e.g., butalbital) PMe1 N05 N Hepler16 2. History/diagnosis of depression Mackinnon and 1. Over 65 years of age Use of a antihypertensive (e.g., reserpine, 169 2002 Canada PMe1 C02 C Hepler16 2. History/diagnosis of depression , , etc.) 1. Over 65 years of age 170 Mackinnon and 2002 Canada 2. History/diagnosis of congestive heart failure with heart Use of digoxin PMe1 C01 C Hepler16 block or advanced bradycardia Mackinnon and Use of a long-half-life hypnotic-anxiolytic (e.g., flurazepam, 171 2002 Canada Over 65 years of age PMe1 N05 N Hepler16 diazepam, chlordiazepoxide, etc.) Mackinnon and 1. Over 65 years of age BUN/serum creatinine not done at initiation of therapy and at 172 2002 Canada PMe7 C09 C Hepler16 2. Use of an ACEI (e.g., captopril, enalapril, etc.) least every 3 months thereafter 1. Over 65 years of age Drug level not done upon initiation of therapy and at least 173 Mackinnon and 2002 Canada 2. Use of an requiring drug level monitoring PMe7 N03 N every 6 months thereafter Hepler16 (e.g., , carbamazepine, valproic acid) Mackinnon and 1. Over 65 years of age 174 2002 Canada Lithium level not done at least every month PMe7 N05 N Hepler16 2. Use of lithium 1. Over 65 years of age 175 Mackinnon and 2002 Canada 2. Use of an oral hypoglycemic agent (e.g., chlorpropamide, HbA1c level not done at least every six months PMe7 A10 A Hepler16 etc.) Mackinnon and 1. Over 65 years of age Prothrombin time not done before therapy starts and at least 176 2002 Canada PMe7 B01 B Hepler16 2. Use of warfarin every month thereafter 1. Over 65 years of age T4/TSH not done within six weeks after initiation of therapy 177 Mackinnon and 2002 Canada 2. Use of a or (e.g., , PMe7 H03 H and at least every 12 months thereafter Hepler16 , etc.) Mackinnon and 1. Over 65 years of age 178 2002 Canada No use of ASA and/or a beta-blocker (e.g., , etc.) P Me 1 B01 C07 BC Hepler16 2. History/diagnosis of 1. Over 65 years of age 179 Mackinnon and 2002 Canada 2. Concurrent use of trimethoprim/ sulfamethoxazole and WBC//CBC not done at least every four weeks P Me 7 J01 L04 JL Hepler16 1. Over 65 years of age 180 Mackinnon and 2002 Canada 2. Warfarin use PT not done within 10 days PMe7 B01 M01 M02 BM 3. NSAID (e.g., diclofenac, ibuprofen, ketoprofen, etc.) use Hepler16 Mackinnon and 1. Over 65 years of age 181 2002 Canada TSH not done at least every six months PMe7 N05 N Hepler16 2. Lithium use for at least six months 1. Over 65 years of age 182 Mackinnon and 2002 Canada 2. Warfarin use PT not done within five days PMe7 B01 J01 BJ Hepler16 3. Antibiotic use Mackinnon and Use of two or more NSAIDs concurrently for at least two 183 2002 Canada Over 65 years of age PMe4 M01 M02 M Hepler16 weeks Mackinnon and 1. Over 65 years of age CBC/platelets not done at baseline, within two weeks of start 184 2002 Canada PMe7 B01 B Hepler16 2. Use of ticlopidine of therapy and within two months Mackinnon and Use of a long-acting nasal spray (e.g., ) for 185 2002 Canada Over 65 years of age PMe4 R01 R Hepler16 more than three days Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Mackinnon and 1. Over 65 years of age 186 2002 Canada Use of imipramine PMe1 N06 N Hepler16 2. Diagnosis/ history of bladder atony due to diabetes Mackinnon and 1. Over 65 years of age 187 2002 Canada Use of a medium to long-acting benzodiazepine PMe1 N05 N Hepler16 2. History/diagnosis of severe COPD Mackinnon and 1. Over 65 years of age 188 2002 Canada Use of an anticholinergic agent PMe1 A03N04R03S01 ANRS Hepler16 2. History/diagnosis of benign prostatic hypertrophy Liver function tests not done at baseline and at least monthly 1. Over 65 years of age 189 Mackinnon and 2002 Canada for the first 8 months of therapy and at least every 2 months PMe7 A10 A 2. Use of troglitazone Hepler16 for the remainder of the first year 1. Over 65 years of age NSAID (e.g., diclofenac, indomethacin, ketoprofen, etc.) use 190 Mackinnon and 2002 Canada 2. History/diagnosis of high blood pressure (over 140/90) PMe4 M01 M02 M for at least 3 months Hepler16 and/or congestive heart failure Mackinnon and 1. Over 65 years of age Use of a beta- blocking agent (e.g., , 191 2002 Canada PMe1 C07 C Hepler16 2. History/diagnosis of diabetes nadolol, etc.) Mackinnon and 1. Over 65 years of age Use of a moderate to high lipophilic beta-adrenergic blocking 192 2002 Canada PMe1 C07 C Hepler16 2. History/diagnosis of depression agent (e.g., propranolol, pindolol, etc.) 1. Over 65 years of age 2. Use of a potassium-wasting (e.g., 193 2002 Canada Electrolytes not checked at least every 2 months PMe7 A12 C03 AC Mackinnon and hydrochlorothiazide, etc.) Hepler16 3. No concurrent use of potassium chloride supplement 1. Over 65 years of age 194 Mackinnon and 2002 Canada 2. Use of an anticonvulsant requiring drug level monitoring Drug level not done at least every 6 months PMe7 N03 N Hepler16 (e.g., phenytoin, carbamazepine, valproic acid) 1. Over 65 years of age T4/TSH not done before therapy starts and at least every 12 195 Mackinnon and 2002 Canada 2. Use of a thyroid or antithyroid agent (e.g., levothyroxine, PMe7 H03 H months thereafter Hepler16 propylthiouracil, etc.) Mackinnon and 1. Over 65 years of age Use of a beta-adrenergic blocking agent (e.g., propranolol, 196 2002 Canada PMe1 C07 C Hepler16 2. History/diagnosis of systolic heart failure nadolol, etc.) Mackinnon and 1. Over 65 years of age Use of an (e.g., , 197 2002 Canada PMe1 C01 C Hepler16 2. History/diagnosis of congestive heart failure , etc.) Mackinnon and Use of an antipsychotic (e.g., , , 198 2002 Canada Over 65 years of age PMe1 N05 N Hepler16 , etc.) 1. Over 65 years of age No use of a maintenance corticosteriod (e.g., 199 Mackinnon and 2002 Canada 2. Diagnosis of asthma PMe1 R03 R beclomethasone, etc.) Hepler16 3. Use of a bronchodilator 1. Over 65 years of age 2. Diagnosis/history of moderate to severe renal impairment/ BUN/serum creatinine not done within 30 days of initiation of 200 2002 Canada history of kidney disease PMe7 J01 J therapy and at least every 6 months Mackinnon and 3. Use of a select urinary antiinfective agent (nalidixic acid, Hepler16 nitrofurantoin or methenamine complexes) Mackinnon and 1. Over 65 years of age 201 2002 Canada Not on an ACEI (e.g., captopril, enalapril, etc.) PMe1 C09 C Hepler16 2. Diagnosis/history of congestive heart failure 1. Over 65 years of age 2. Use of an aminoglycoside 202 2002 Canada At least one drug level not done PMe7 J01 J Mackinnon and 3. Serum creatinine not done before and after therapy (and if therapy longer than 7 days, not done at least every 7 days) Hepler16 Mackinnon and 1. Over 65 years of age 203 2002 Canada Use of a calcium (e.g., , etc.) P Me 1 C08 C Hepler16 2. History/diagnosis of congestive heart failure Mackinnon and 1. Over 65 years of age 204 2002 Canada Use of a beta-blocker (e.g., propranolol, etc.) PMe1 C07 C Hepler16 2. Diagnosis/history of COPD Mackinnon and 1. Over 65 years of age 205 2002 Canada HbA1c level not done at least every 6 months PMe7 A10 A Hepler16 2. Use of insulin Mackinnon and 206 2002 Canada Over 65 years of age Use of an anticholinergic agent PMe1 A03N04R03S01 ANRS Hepler16 1. Over 65 years of age 2. No contraindications to influenza vaccine (anaphylactic 207 2002 Canada Has not received annual influenza vaccine PMe1 J07 J Robertson and to eggs, Guillain-Barre syndrome following previous MacKinnon17 influenza vaccine) Robertson and 1. Over 65 years of age 208 2002 Canada Has not received pneumococcal vaccine within past 6 years P Me 1 J07 J MacKinnon17 2. No contraindications to pneumococcal vaccine Robertson and 1. Over 65 years of age 209 2002 Canada No use of warfarin or ASA PMe1 B01 B MacKinnon17 2. History of chronic atrial fibrillation Robertson and 1. Over 65 years of age 210 2002 Canada No INR measured in past 30 days PMe7 B01 B MacKinnon17 2. Use of warfarin Robertson and 1. Over 65 years of age Use of an NSAID (including COX-2 specific agents) without an 211 2002 Canada PMe7 B01 M01 M02 BM MacKinnon17 2. Use of warfarin INR within 10 days 1. Over 65 years of age 212 Robertson and 2002 Canada 2. Use of a long-acting antihyperglycemic agent (eg, No glucose monitoring done within past 6 months PMe7 A10 A MacKinnon17 chlorpropamide) Robertson and 1. Over 65 years of age 213 2002 Canada No use of pharmacologic treatment PMe1 C02C03C07C08C09 C MacKinnon17 2. Diagnosis of isolated systolic hypertension Robertson and 1. Over 65 years of age 214 2002 Canada No use of pharmacologic treatment PMe1 C02C03C07C08C09 C MacKinnon17 2. Diagnosis of hypertension 1. Over 65 years of age 215 Robertson and 2002 Canada 2. Female No use or consideration of HRT and/or bisphosphonate P Me 1 G03 M05 GM MacKinnon17 3. Diagnosis of osteoporosis 1. Over 65 years of age 216 Robertson and 2002 Canada 2. Male No use of bisphosphonate PMe1 M05 M MacKinnon17 3. Diagnosis of osteoporosis Robertson and Use of 2 or more agents with low to moderate anticholinergic 217 2002 Canada 1. Over 65 years of age PMe1 A02 A03 A07 B01 C01 C02 C03 C07 C09 H02 M03 M04 N01 N02 N03 N04 N05 N06 R03 R05 R06 A B C H M N R MacKinnon17 activity Robertson and 218 2002 Canada 1. Over 65 years of age Use of an agent with high anticholinergic activity PMe1 A03 A04 G04 M03 N02 N04 N05 N06 R06 S01 A G M N R S MacKinnon17 Robertson and Use of 2 or more agents with low to moderate anticholinergic 219 2002 Canada 1. Over 65 years of age PMe1 A02 A03 A07 B01 C01 C02 C03 C07 C09 H02 M03 M04 N01 N02 N03 N04 N05 N06 R03 R05 R06 A B C H M N R MacKinnon17 activity Robertson and 220 2002 Canada 1. Over 65 years of age Use of an agent with high anticholinergic activity PMe1 A03 A04 G04 M03 N02 N04 N05 N06 R06 S01 A G M N R S MacKinnon17 Robertson and Use of 2 or more agents with low to moderate anticholinergic 221 2002 Canada 1. Over 65 years of age PMe1 A02 A03 A07 B01 C01 C02 C03 C07 C09 H02 M03 M04 N01 N02 N03 N04 N05 N06 R03 R05 R06 A B C H M N R MacKinnon17 activity Robertson and 222 2002 Canada 1. Over 65 years of age Use of an agent with high anticholinergic activity PMe1 A03 A04 G04 M03 N02 N04 N05 N06 R06 S01 A G M N R S MacKinnon17 Robertson and 1. Over 65 years of age Use of 2 or more agents with low to moderate anticholinergic 223 2002 Canada PMe1 A02 A03 A07 B01 C01 C02 C03 C07 C09 H02 M03 M04 N01 N02 N03 N04 N05 N06 R03 R05 R06 A B C H M N R MacKinnon17 2. History of activity Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Robertson and 1. Over 65 years of age 224 2002 Canada Use of a single agent with high anticholinergic activity PMe1 A03 A04 G04 M03 N02 N04 N05 N06 R06 S01 A G M N R S MacKinnon17 2. History of glaucoma Robertson and 1. Over 65 years of age CBC/platelets not measured within 2 weeks of initiation of 225 2002 Canada PMe7 B01 B MacKinnon17 2. Use of ticlopidine therapy 1. Over 65 years of age 226 Robertson and 2002 Canada 2. Diagnosis of congestive heart failure No follow-up within 1 week PMe7 M01 M02 M MacKinnon17 3. Use of an NSAID (including COX-2 agents) 1. Over 65 years of age 2. Concurrent use of corticosteroids/warfarin or diagnosis of 227 2002 Canada No use of cytoprotection (misoprostol or PPI) PMe1 A02 B01 H02 M01 M02 ABHM Robertson and multiple comorbid diseases or history of ulcer MacKinnon17 3. Use of an NSAID 1. Over 65 years of age 2. Concurrent use of corticosteroids/warfarin or diagnosis of 228 2002 Canada Use of an H2-antagonist (cytoprotection) PMe1 A02 B01 H02 M01 M02 ABHM Robertson and multiple comorbid diseases or history of ulcer MacKinnon17 3. Use of an NSAID 1. Over 65 years of age 2. Concurrent use of corticosteroids/warfarin or diagnosis of Use of an inadequate dose for cytoprotection (misoprostol, 229 2002 Canada PMe3 A02 B01 H02 M01 M02 ABHM Robertson and multiple comorbid diseases or history of ulcer 200 pg TID) MacKinnon17 3. Use of an NSAID Robertson and 230 2002 Canada 1. Over 65 years of age Use of 2 or more NSAIDs PMe1 M01 M02 M MacKinnon17 Robertson and Use of an NSAID at dose above maximum recommended 231 2002 Canada 1. Over 65 years of age PMe3 M01 M02 M MacKinnon17 daily dose Robertson and 1. Over 65 years of age No monitoring of T4/TSH at 3 to 6 months following initiation 232 2002 Canada PMe7 H03 H MacKinnon17 2. Use of a thyroid replacement agent of therapy or every 12 months thereafter Robertson and 1. Over 65 years of age 233 2002 Canada Use of beta-blocker PMe1 C07 C MacKinnon17 2. Diagnosis of asthma/COPD Robertson and 1. Over 65 years of age Electrolytes not monitored within 1 month of initiation of 234 2002 Canada PMe7 C09 C MacKinnon17 2. Use of ACEI therapy and every 6 months thereafter Robertson and 1. Over 65 years of age Electrolytes not monitored within 1 month of therapy being 235 2002 Canada PMe7 C03 C MacKinnon17 2. Use of a potassium-wasting diuretic initiated and every 6 months thereafter Robertson and 1. Over 65 years of age Electrolytes not monitored within 1 month of initiation of 236 2002 Canada PMe7 C03 C09 C MacKinnon17 2. Use of a potassium-sparing diuretic and ACEI therapy and every 6 months thereafter Robertson and 1. Over 65 years of age BUN/serum creatinine not performed at 3- to 6-month 237 2002 Canada PMe7 C09 C MacKinnon17 2. Use of ACEI intervals following initiation of therapy Robertson and 1. Over 65 years of age Digoxin levels and BUN/serum creatinine not performed at 6- 238 2002 Canada PMe7 C01 C MacKinnon17 2. Use of digoxin month intervals following initiation of therapy 1. Over 65 years of age Use of an ACEI in an outpatient setting at a high dose (eg, 239 2002 Canada 2. History of congestive heart failure PMe1 C03 C09 C Robertson and enalapril 10 mg BID) 3. Aggressive use of a diuretic (eg, furosemide 80 mg BID) MacKinnon17 1. Over 65 years of age 240 Robertson and 2002 Canada 2. Use of warfarin and antibiotic (eg, co-trimoxazole, No INR level done within 5 days of initiating antibiotic PMe7 B01 J01 BJ MacKinnon17 , ) concurrently Robertson and Use of repeated doses of meperidine by mouth (not injection) 241 2002 Canada 1. Over 75 years of age PMe4 N02 N MacKinnon17 for more than 2 days Robertson and 1. Over 65 years of age 242 2002 Canada Use of a sympatholytic antihypertensive (eg, reserpine) P Me 1 C02 C MacKinnon17 2. History/diagnosis of depression 1. Over 65 years of age Drug level not done upon initiation of therapy and at least 243 Robertson and 2002 Canada 2. Use of anticonvulsant requiring drug level monitoring (eg, PMe7 N03 N every 6 months thereafter MacKinnon17 phenytoin) 1. Over 65 years of age 244 Robertson and 2002 Canada 2. Use of a long-acting antihyperglycemic agent (eg, HbA1c level not measured at least every 6 months PMe7 A10 A MacKinnon17 chlorpropamide) 1. Over 65 years of age T4/TSH not done within 6 weeks after initiation of therapy and 245 Robertson and 2002 Canada 2. Use of a thyroid or antithyroid agent (eg, levothyroxine, PMe7 H03 H at least every 12 months thereafter MacKinnon17 propylthiouracil) Robertson and 1. Over 65 years of age 246 2002 Canada No use of ASA and/or a beta-blocker (eg, metoprolol) PMe1 B01 C07 BC MacKinnon17 2. History/diagnosis of myocardial infarction 1. Patient 75 years of age or older 2. Exhibits Parkinsonian features 247 2002 Canada Neuroleptic (eg, haloperidol) initiated PMe1 N05 N Robertson and 3. Has mild cognitive impairment MacKinnon17 4. Exhibits mild to moderate agitation in evening 1. Patient 75 years of age or older 248 Robertson and 2002 Canada 2. Has diagnosis of 1 mg BID initiated PMe13 N05 N MacKinnon17 3. Exhibiting agitation 1. Patient 75 years of age or older 249 Robertson and 2002 Canada 2. Has mild cognitive impairment -levodopa is initiated at a dose of 25/100 QID P Me 13 N04 N MacKinnon17 3. Exhibits Parkinsonian features 1. Patient at least 75 years of age 2. Has mild dementia 3. Had previously (at least 6 months ago) been hospitalized 250 2002 Canada Risperidone continued following discharge without follow-up P Me 7 N05 N for delirium Robertson and 4. Risperidone initiated at time of hospitalization for physically MacKinnon17 aggressive behavior Is not receiving adequate levels of calcium and vitamin D 1. Over 65 years of age 251 Robertson and 2002 Canada (either dietary or PMe1 A11 A12 A 2. Patient (male or female) has diagnosis of osteoporosis MacKinnon17 supplements) Robertson and Patient is prescribed a long-acting benzodiazepine (eg, 252 2002 Canada 1. Over 65 years of age PMe1 N05 N MacKinnon17 diazepam) 1. Over 65 years of age 253 Robertson and 2002 Canada 2. Patient has chronic pain Is receiving prn dosing only PMe3 M01 M02 N02 MN MacKinnon17 3. Is receiving an analgesic medication (NSAID or opioid) 1. Patient has diagnosis of gastric motility disorder 2. Is at least 70 years old 254 2002 Canada No follow-up within 7 days of initiating therapy PMe7 A03 A Robertson and 3. Treated with 10 mg one-half hour ac and MacKinnon17 qhs No aminoglycoside levels ordered 24 hours following initiation 1. Over 65 years of age of therapy or dose of aminoglycoside not changed following 255 2002 Canada PMe7 J01 J Robertson and 2. Aminoglycoside antibiotics initiated report of aminoglycoside level above recommended MacKinnon17 therapeutic range 1. Over 65 years of age 256 Robertson and 2002 Canada 2. Use of a long-acting benzodiazepine (eg, diazepam, No assessment of falls risk PMe7 N05 N MacKinnon17 chlordiazepoxide) Robertson and 1. Over 65 years of age 257 2002 Canada High dosage per day (eg, >4 mg/d) PMe3 N05 N MacKinnon17 2. Use of a benzodiazepine Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Use of multiple psychotropic medications (eg, benzodiazepine 258 Robertson and 2002 Canada 1. Over 65 years of age PMe1 N05 N06 N plus tricyclic antidepressant plus low-dose neuroleptic) MacKinnon17 Percentage of patients with an average systolic blood pressure of 160 mmHg or greater, or a diastolic blood 259 2007 Canada PMe1 C02C03C07C08C09 C pressure of 100 mmHg or greater with a recommendation for Burge et al. 18 drug recorded on the chart. Percentage of patients with an average diastolic blood pressure of 90 mmHg or greater with a recommendation for drug therapies recorded on the chart if target organ damage is 260 2007 Canada present or if they have independent cardiovascular risk factors PMe1 C02C03C07C08C09 C (elevated systolic blood pressure, cigarette smoking, abnormal lipids, family history of premature cardiovascular disease, truncal obesity, sedentary lifestyle). Burge et al. 18 Percentage of patient visits (for blood pressure follow-up) for those with hypertension whose blood pressure is above target (140/90 mmHg, or 130/80 mmHg for patients with diabetes or 261 2007 Canada renal disease) with a plan of care for hypertension recorded PMe13 C02C03C07C08C09 C on the chart that includes a change in dose or regimen of medications, and/or repeated education regarding lifestyle modification and/or planned reassessment. Burge et al. 18 The percentage of patients with ischemic heart disease who 262 2007 Canada are taking acetylsalicylic acid or have a contraindication to, or PMe1 B01 B side effects from, acetylsalicylic acid. Burge et al. 18 The percentage of patients with ischemic heart disease who have had a myocardial infarction and are taking a beta- 263 2007 Canada PMe1 C07 C blocker or have a contraindication to, or side effects from, a Burge et al. 18 beta-blocker. The percentage of patients with ischemic heart disease who are on an angiotensin-converting inhibitor, or have a 264 2007 Canada PMe1 C09 C contraindication to, or side effects from, an angiotensin- Burge et al. 18 converting . Percentage of patients with left ventricular systolic dysfunction (ejection fraction of less than 40%), whether symptomatic or asymptomatic, who are taking an angiotensin-converting 265 2007 Canada enzyme inhibitor or an angiotensin receptor II blocker, or have PMe1 C09 C a contraindication to, or side effects from, both an angiotensin- converting enzyme inhibitor and an angiotensin receptor II Burge et al. 18 blocker. Percentage of patients with left ventricular systolic dysfunction (ejection fraction of less than 40%) who are taking a beta- 266 2007 Canada PMe1 C07 C blocker or have a contraindication to, or side effects from, Burge et al. 18 beta-blockers. Percentage of patients with congestive heart failure on an angiotensin- converting enzyme inhibitor or an angiotensin 267 2007 Canada PMe7 C09 C receptor II blocker who have had potassium and creatinine Burge et al. 18 levels recorded on the chart in the past year. Percentage of patients with hyperlipidemia for whom a 268 2007 Canada therapeutic target, based on their global risk assessment and PMe7 C10 C Burge et al. 18 lipid profile, has been recorded on the chart. Percentage of patients with hyperlipidemia who are at high risk for ischemic heart disease, for whom it has been recorded 269 2007 Canada on the chart that pharmacological treatment was PMe1 C10 C recommended immediately, concomitant with dietary and Burge et al. 18 lifestyle changes. IF a vulnerable elder is admitted to the hospital for any acute or chronic illness or any surgical procedure, THEN the 270 2007 Canada P Ge 6 N/A N/A evaluation should include, within 24 hours, 1) diagnoses, 2) pre-hospital and current medications, and 3) cognitive status Kröger et al. 19 IF a vulnerable elder uses regularly, THEN he or she 271 2007 Canada should be offered counselling and/or pharmacological therapy PMe1 N07 N Kröger et al. 19 at least once to stop tobacco use IF a community-dwelling vulnerable elder has documented involuntary weight loss (greater than or equal to 10% of body 272 2007 Canada weight) or hypoalbuminemia (< 3.5 g/dl), THEN he or she P Ge 7 N/A N/A should receive an evaluation for potentially relevant co-morbid conditions, including medications that might be associated Kröger et al. 19 IF a vulnerable elder presents with symptoms of dementia, THEN the physician should review the patient's medication list 273 2007 Canada (prescriptions, over the counter or supplements) for initiation P Ge 7 N/A N/A of medications that might correspond chronologically to the onset of dementia symptoms Kröger et al. 19 IF a vulnerable elder presents with symptoms of dementia that correspond in time with the initiation of new medications 274 2007 Canada (prescriptions, over the counter or supplements) THEN the P Ge 7 N/A N/A physician should discontinue or justify the necessity of Kröger et al. 19 continuing these medications IF a vulnerable elder has a newly reported chronic painful condition, THEN a targeted history and physical examination 275 2007 Canada PMe17 M01 M02 N02 MN should be initiated within 1 month and treatment should be Kröger et al. 19 offered IF a vulnerable elder has mild to moderate Alzheimer disease, THEN the treating physician should discuss treatment with a 276 2007 Canada PMe5 N06 N inhibitor with the patient and the primary Kröger et al. 19 caregiver (if available) IF a vulnerable elder with dementia has cerebrovascular 277 2007 Canada disease, THEN he or she should be offered appropriate PMe1 B01 B Kröger et al. 19 prophylaxis against stroke ALL vulnerable elders should not be prescribed a medication 278 2007 Canada PMe1 A03 A04 G04 M03 N02 N04 N05 N06 R06 S01 A G M N R S with strong anticholinergic effects if alternatives are available Kröger et al. 19 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a vulnerable elder is prescribed a new drug, THEN the 279 2007 Canada prescribed drug should have a clearly defined indication P Ge 9 N/A N/A Kröger et al. 19 documented in the record IF a vulnerable elder is prescribed a new drug, THEN the patient (or, if incapable, a caregiver) should receive education 280 2007 Canada P Ge 5 N/A N/A about the purpose of the drug, how to take it, and the expected side effects or important adverse reactions Kröger et al. 19 IF a vulnerable elder with chronic pain is treated with opioids, THEN he or she should be offered a bowel regimen, or the 281 2007 Canada PMe1 A06 N02 AN medical record should document the potential for or explain why bowel treatment is not needed Kröger et al. 19 For ALL vulnerable elders, the patient’s medical record 282 2007 Canada (doctor’s office, CLSC, hospital and community pharmacy) P Ge 7 N/A N/A Kröger et al. 19 should contain an up-to-date medication list EVERY new drug that is prescribed to a vulnerable elder on an ongoing basis for a chronic medical condition should have 283 2007 Canada P Ge 7 N/A N/A a documentation of the response to therapy including side Kröger et al. 19 effects ALL vulnerable elders should have a drug regimen review at 284 19 2007 Canada P Ge 7 N/A N/A Kröger et al. least annually IF a vulnerable elder has been prescribed a cyclooxygenase non selective non steroidal anti-inflammatory drug for the treatment of chronic pain, THEN the medical record should 285 2007 Canada PMe7 M01 M02 M indicate whether he or she has a history of and, if a history is present, justification of NSAID use Kröger et al. 19 should be documented IF an outpatient vulnerable elder is started on a new prescription medication and he or she has a follow-up visit with the prescribing physician, THEN the medical record at the follow-up visit should document one of the following: 1) the 286 2007 Canada P Ge 5 N/A N/A medication is being taken and the physician asked about the medication (for example, side effects or adherence or availability), or 2) the medication was not started because it Kröger et al. 19 was not needed or was changed IF a vulnerable elder is discharged from a hospital to home and he or she received a new prescription medication or change in medication (medication termination or change in 287 2007 Canada P Ge 6 N/A N/A dosage) before discharge, THEN his medical record (doctor’s office, CLSC or long term care facility) should acknowledge the medication change within 6 weeks of discharge Kröger et al. 19 No person with dementia should be taking long-acting 288 2007 Canada sedatives (, ), unless there is an explicit PMe1 N05 N justification for this medication in the medical record Kröger et al. 19 In order to manage behavioural and psychological aspects of 289 2007 Canada dementia, no-drug management strategies should always be PMe1 N06 N Kröger et al. 19 considered before drug treatment is started All vulnerable elders with complex medication regimens who 290 2007 Canada are returning to community living should be evaluated whether P Ge 5 N/A N/A they are able to maintain a self-medication program Kröger et al. 19 A standardized protocol should be in place to ensure 291 20 2008 Canada SMe9 B01 B Ko et al. appropriate periprocedural antithrombin therapy during PCI Standardized discharge plans should be established for PCI 292 20 2008 Canada SMe9 B01 B Ko et al. patients Included: All PCI patients All PCI patients who received acetylsalicylic acid within 24 h 293 2008 Canada Excluded: Patients allergic to acetylsalicylic acid, documented PMe15 B01 B before procedure Ko et al. 20 reason for nonuse Included: All PCI patients and are alive at discharge All PCI patients who are prescribed acetylsalicylic acid at 294 2008 Canada Excluded: Patients allergic to acetylsalicylic acid, documented PMe1 B01 B hospital discharge Ko et al. 20 reason for nonuse Included: All PCI patients who received a BMS and are alive at discharge All PCI patients who received a BMS and who are prescribed 295 2008 Canada PMe14 B01 B Excluded: Patients allergic to clopidogrel, documented reason clopidogrel for at least one month at hospital discharge Ko et al. 20 for nonuse Included: All PCI patients who received a DES and are alive at discharge All PCI patients who received a DES and who are prescribed 296 2008 Canada PMe14 B01 B Excluded: Patients allergic to clopidogrel, documented reason clopidogrel for at least 12 months at hospital discharge Ko et al. 20 for nonuse Included: All PCI patients and are alive at discharge All PCI patients who are prescribed a statin at hospital 297 2008 Canada Excluded: Documented reason for nonuse of statin (eg, PMe1 C10 C discharge Ko et al. 20 rhabdomyolysis, or patient refusal) • Patient has congestive heart failure • Use of a thiazolidinedione alone or in combination with 298 2008 Canada PMe7 A10 A MacKinnon et insulin al. 21 • No follow-up within 4 weeks of starting medication(s) • Inadequate glycemic control (i.e., HbA1C > 7%) • Inadequate blood pressure control (target < 130/80 mmHg) • Statin therapy not initiated (e.g., simvastatin) 299 2008 Canada PMe7 B01 C10 BC • Not on daily ASA therapy MacKinnon et • A fasting lipid profile was not carried out upon diagnosis and/or was not repeated every 1 to 3 years as indicated al. 21 MacKinnon et • Did not receive flu vaccine in last year 300 2008 Canada PMe1 J07 J al. 21 • Has never received pneumococcal vaccine • Has not seen physician in last 3 months • Has not had serum creatinine checked in last year 301 2008 Canada • Has not had checked for and microalbumin PMe1 C09 C MacKinnon et ratio in last year al. 21 • Not taking an ACEI or angiotensin II receptor blocker • Use of insulin or an insulin secretagogue • Self blood glucose monitoring not done at recommended 302 2008 Canada intervals PMe5 A10 A MacKinnon et • Patient has not been educated about prevention/treatment of al. 21 hypoglycemia Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka • Frequent blood glucose monitoring not done • was continued without recognizing that glucose 303 2008 Canada (food) intake was diminished PMe5 A10 A MacKinnon et • Lack of education regarding prevention and treatment of al. 21 hypoglycemic events • Patient treated with an insulin secretagogue or insulin • Patient taking acarbose in combination with an insulin secretagogue and not told that if a hypoglycemic event 304 2008 Canada PMe5 A10 A occurs, it should be treated with glucose (not sucrose) MacKinnon et • Lack of education regarding prevention and treatment of al. 21 hypoglycemic events • Patient on insulin therapy prescribed evening NPH taken 305 MacKinnon et 2008 Canada with 5:00-6:00 p.m. meal PMe7 A10 A al. 21 • Lack of follow-up to reassess insulin regimen MacKinnon et 306 2008 Canada • Providing an elderly patient with a prescription for glyburide P Me 1 A10 A al. 21 • Poor glycemic control (HbA1C > 7%) occurs despite multiple medications (i.e., metformin, glyburide, thiazolidinedione) 307 2008 Canada PMe1 A10 A MacKinnon et • Doctor/patient not willing to start insulin although targets are not reached in a timely manner al. 21 • Providing patient with a prescription for insulin, handing the patient a pen with cartridge of insulin with no instructions on 308 2008 Canada PMe5 A10 A MacKinnon et how to administer it, or failing to ask patient to demonstrate al. 21 use of an insulin pen •HbA1C> 7% • Patient has not been assessed for sexual dysfunction 309 2008 Canada PMe7 A10 G04 AG MacKinnon et • Patient has not been prescribed treatment • Not screened for medication-induced al. 21 Number of prescriptions/medication orders using potentially 310 2008 Canada dangerous medication abbreviations as a percentage of all P Ge 6 N/A N/A Nigam et al. 22 prescriptions/medication orders Number of prescriptions/medication orders using potentially 311 2008 Canada dangerous dose abbreviations as a percentage of all P Ge 6 N/A N/A Nigam et al. 22 prescriptions/medication orders Number of prescriptions/medication orders with “take as 312 2008 Canada directed” as the only instruction for use as a percentage of all P Ge 3 N/A N/A Nigam et al. 22 prescriptions/medication orders Number of prescriptions/medication orders with incorrect 313 2008 Canada leading and/or trailing zeros with decimal points as a P Ge 6 N/A N/A Nigam et al. 22 percentage of all prescriptions/ medication orders Number of pediatric prescriptions for medications with a narrow therapeutic index with dose/weight calculations 314 2008 Canada PMe3 B01 H02 J01 L01 BHJ L omitted as a percentage of all pediatric prescriptions for Nigam et al. 22 medications with a narrow therapeutic index Number of patient profiles in which allergy status is documented before dispensing the first prescription/ 315 2008 Canada P Ge 7 N/A N/A medication order to the patient as a percentage of all patient Nigam et al. 22 profiles Number of prescriptions/medication orders for high- alert medications using an administering protocol as a percentage 316 2008 Canada PMe1 A10 B01 B03 B05 C01 C02 C03 H01 H03 J05 L01 L04 N01 N02 N03 N05 R06 A B C H J L N R of all prescriptions/medication orders for high-alert Nigam et al. 22 medications Number of prescriptions/medication orders for high-alert medications that are double-checked and documented (with 317 2008 Canada initials) by pharmacist before administration as a percentage PMe6 A10 B01 B03 B05 C01 C02 C03 H01 H03 J05 L01 L04 N01 N02 N03 N05 R06 A B C H J L N R of all prescriptions/ medication orders for high-alert Nigam et al. 22 medications Number of doses administered with machine- readable coding 318 2008 Canada P Ge 6 N/A N/A (bar codes) as a percentage of all doses administered Nigam et al. 22 Number of ADE-related hospitalizations as a percentage of all 319 22 2008 Canada O Ge 8 N/A N/A Nigam et al. hospitalizations

320 22 2008 Canada Number ADE-related ER visits as a percentage of all ER visits O Ge 8 N/A N/A Nigam et al. Number of beds with daily pharmacist participation in 321 2008 Canada P Ge 5 N/A N/A interdisciplinary direct patient care as a percentage of all beds Nigam et al. 22 Number of high-alert prescription medications that are differentiated from other medications using flags, highlighting 322 2008 Canada SMe6 A10 B01 B03 B05 C01 C02 C03 H01 H03 J05 L01 L04 N01 N02 N03 N05 R06 A B C H J L N R or some other system as a percentage of all high-alert Nigam et al. 22 prescription medications Number of in-patients with complex high-risk medication regimens whose medication history was recorded on 323 2008 Canada PMe6 A10 B01 C01 L01 N03 N05 R03 ABCLNR admission as a percentage of all in-patients with complex high- Nigam et al. 22 risk medication regimens on admission Number of unintentional medication order discrepancies (e.g., 324 2008 Canada omission, commission, incorrect dose, incorrect frequency) as P Ge 6 N/A N/A Nigam et al. 22 a percentage of all medication orders Number of patients whose medication profiles are reconciled 325 2008 Canada within 24 hours of admission as a percentage of admitted P Ge 6 N/A N/A Nigam et al. 22 patients Number of patients whose medication profiles are reconciled 326 2008 Canada within 24 hours before hospital discharge as a percentage of P Ge 6 N/A N/A Nigam et al. 22 discharged patients Number of discharge medication summaries sent to 327 2008 Canada community physicians within 72 hours of hospital discharge as P Ge 6 N/A N/A a percentage of discharged patients on medications Nigam et al. 22 Number of discharge medication summaries sent to a 328 2008 Canada community pharmacy within 72 hours of hospital discharge as P Ge 6 N/A N/A a percentage of discharged patients on medications Nigam et al. 22 Number of hospitals that conduct an annual assessment of the processes used for compounding sterile medications (i.e., 329 2008 Canada PMe9 L01 L chemotherapy, intravenous medications) as a percentage of Nigam et al. 22 hospitals Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Inclusions 1) Confirmed acute myocardial infarction Exclusions Patients with acute myocardial infarction who received ASA Acetylsalicylic acid (ASA) within 24 hours before hospital 330 2008 Canada 1) Active bleeding on arrival within 24 hours before hospital arrival or within 3 hours after PMe15 B01 B arrival or within 3 hours after hospital arrival 2) Allergy to ASA hospital arrival 3) Documented reason for nonuse of ASA (e.g., high risk of Tu et al. 23 bleeding or patient refusal) Denominator Inclusions 1) Confirmed acute myocardial infarction and alive at discharge Exclusions 1) Evidence of: Patients with acute myocardial infarction who are prescribed 331 2008 Canada ASA prescribed at hospital discharge P Me 1 B01 B i. Active bleeding on arrival, or ASA at hospital discharge ii. Active bleeding during hospital stay 2) Allergy to ASA 3) Documented reason for nonuse of ASA (e.g., high risk of Tu et al. 23 bleeding or patient refusal) Inclusions 1) Confirmed acute myocardial infarction and alive at discharge Exclusions 1) Bradycardia (heart rate < 60 beats/min) on day of discharge or day before discharge while not taking β-blocker 2) Conduction disorder defined as a second- or third-degree Patients with acute myocardial infarction who are prescribed a 332 2008 Canada β-Blocker prescribed at hospital discharge P Me 1 C07 C heart block on ECG on arrival or during hospital stay while not β-blocker at hospital discharge on a pacemaker 3) Allergy or intolerance to β-blocker 4) Documented reason for nonuse of β-blocker (e.g., symptomatic , systolic blood pressure < 100 mm Hg, severe chronic obstructive pulmonary disease, asthma or patient refusal) Tu et al. 23 Inclusions 1) Patients with acute myocardial infarction alive at discharge and 2) Left ventricular ejection fraction < 40% and 3) Patients with diabetes, hypertension, heart failure or Exclusions Patients with acute myocardial infarction who are prescribed Angiotensin-converting-enzyme (ACE) inhibitor or angiotensin- 333 2008 Canada PMe1 C09 C 1) Severe aortic stenosis an ACEI or angiotensin-receptor blocker at hospital discharge receptor blocker prescribed at hospital discharge 2) Allergy or intolerance to ACEIs or angiotensin-receptor blockers 3) Documented reason for nonuse of an ACEI or angiotensin- receptor blocker at discharge (e.g., symptomatic hypotension, severe renal dysfunction, , bilateral renal artery stenosis or patient refusal) Tu et al. 23 Inclusions 1) Confirmed acute myocardial infarction and alive at discharge Patients with acute myocardial infarction who are prescribed a 334 2008 Canada Statin prescribed at hospital discharge P Me 1 C10 C Exclusions statin at hospital discharge 1) Documented reason for nonuse of statins (e.g., statin Tu et al. 23 intolerance, liver disease or patient refusal) Inclusions 1) Confirmed acute myocardial infarction and 2) ST-segment elevation or a new left bundle branch block on ECG and 3) Fibrinolytic therapy received within 6 hours after hospital arrival and Patients with acute myocardial infarction who received 335 2008 Canada Fibrinolytic therapy within 30 minutes after hospital arrival P Me 5 B01 B 4) Fibrinolytic therapy documented as primary reperfusion fibrinolytic therapy within 30 minutes after hospital arrival therapy Exclusions 1) Fibrinolytic therapy received in ambulance or in field 2) Documented reason for delay in receiving fibrinolytic Tu et al. 23 therapy (e.g., nondiagnostic ECG or patient refusal) Inclusions 1) Confirmed acute myocardial infarction and 2) ST-segment elevation or new left bundle branch block on ECG and 3) Fibrinolytic therapy within 6 hours after hospital arrival and Patients with acute myocardial infarction who were eligible for 4) Fibrinolytic therapy is primary reperfusion therapy Fibrinolytic therapy within 60 minutes after call for emergency 336 2008 Canada fibrinolytic therapy and received it within 60 minutes after call PMe5 B01 B 5) Call made to emergency medical services medical services for emergency medical services Exclusions 1) In-field fibrinolysis 2) Walk-in patients 3) Documented reason for delay in receiving fibrinolytic therapy (e.g., patient refusal) Tu et al. 23 (Pharmacologic process-of-care indicators for acute 337 2008 Canada myocardial infarction) Prescription for β-blocker filled within 30 PMe1 C07 C Tu et al. 23 days after discharge (Pharmacologic process-of-care indicators for acute 338 2008 Canada myocardial infarction) Prescription for β-blocker filled within 90 PMe1 C07 C Tu et al. 23 days after discharge (Pharmacologic process-of-care indicators for acute 339 2008 Canada myocardial infarction) Adherence to β-blocker therapy 1 year PMe5 C07 C Tu et al. 23 after discharge (Pharmacologic process-of-care indicators for acute 340 2008 Canada myocardial infarction) Prescription for ACEI or angiotensin- PMe1 C09 C Tu et al. 23 receptor blocker filled within 30 days after discharge (Pharmacologic process-of-care indicators for acute 341 2008 Canada myocardial infarction) Prescription for ACEI or angiotensin- PMe1 C09 C Tu et al. 23 receptor blocker filled within 90 days after discharge (Pharmacologic process-of-care indicators for acute 342 2008 Canada myocardial infarction) Adherence to ACEI or angiotensin- PMe5 C09 C Tu et al. 23 receptor blocker therapy 1 year after discharge (Pharmacologic process-of-care indicators for acute 343 2008 Canada myocardial infarction) Prescription for statin filled within 30 PMe1 C10 C Tu et al. 23 days after discharge Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Pharmacologic process-of-care indicators for acute 344 2008 Canada myocardial infarction) Prescription for statin filled within 90 PMe1 C10 C Tu et al. 23 days after discharge (Pharmacologic process-of-care indicators for acute 345 2008 Canada myocardial infarction) Adherence to statin therapy 1 year after PMe5 C10 C Tu et al. 23 discharge Proportion of patients who have undergone hepatic resection surgery and been referred for consideration of postoperative 346 2009 Canada PMe1 L01 L adjuvant systemic chemotherapy is 100% (referred to a Dixon et al. 24 medical oncologist). Preoperative and postoperative deep venous thrombosis prophylaxis should be provided with low-dose unfractionated heparin or low-molecular-weight heparin, in addition to 347 2009 Canada PMe1 B01 B mechanical prophylaxis (intermittent pneumatic compression, or graduated compression stockings, or both) according to the Seventh ACCP Conference on Therapy. Dixon et al. 24 (Asthma primary care) % of patients with uncontrolled asthma 348 2010 Canada PMe1 R03 R Teresato et al. 25 using inhaled corticosteroids (Asthma primary care) Number of prescriptions of inhaled 349 2010 Canada PMe1 R03 R Teresato et al. 25 corticosteroids filled per person per year (Asthma primary care) Number of short-acting beta2-agonist 350 2010 Canada PMe5 R03 R Teresato et al. 25 doses (2 puffs) per week in last 4 weeks (Asthma primary care) Number (or %) of beta2-agonist-free 351 2010 Canada PMe5 R03 R Teresato et al. 25 days in last 4 weeks (Asthma primary care) % of patients with asthma who 352 2010 Canada PMe5 R03 R Teresato et al. 25 demonstrated their inhaler technique regularly The percentage of patients with colon cancer who had a 353 Krzyzanowska et 2011 Canada consultation to consider adjuvant chemotherapy with a PMe5 L01 L al. 26 medical oncologist in the 4 months following surgery. The percentage of patients with non-small cell 354 Krzyzanowska et 2011 Canada PMe1 L01 L who received chemotherapy within 6 months of lung resection. al. 26 The percentage of patients diagnosed with small cell lung 355 Krzyzanowska et 2011 Canada cancer who received chemotherapy within 6 months of PMe1 L01 L al. 26 diagnosis. The percentage of women with who received 356 Krzyzanowska et 2011 Canada PMe1 L01 L postoperative chemotherapy within 4 months of surgery. al. 26 Krzyzanowska et The percentage of cancer patients who received 357 2011 Canada PMe1 L01 L al. 26 chemotherapy in the two weeks before they died. Time to first dose of analgesic in all painful conditions 358 27 2011 Canada PMe5 M02 N02 MN Schull et al. requiring analgesia Percentage of pediatric patients (aged 0–28 d) with fever who 359 27 2011 Canada PMe1 J01 J Schull et al. received broad-spectrum intravenous antibiotics Percentage of pediatric patients (aged 3 mo–3 yr) with croup 360 27 2011 Canada PMe1 H02 H Schull et al. who were treated with steroids Percentage of pediatric patients (aged 3 mo–3 yr) with 361 27 2011 Canada PMe1 J01 J Schull et al. bronchiolitis who were treated with antibiotics Percentage of eligible patients with AMI who received 362 27 2011 Canada PMe1 B01 B Schull et al. thrombolytic therapy or PCI Percentage of patients with AMI who were given ASA a) in the 363 2011 Canada 24 h before hospital arrival or b) within 3 h of hospital arrival PMe5 B01 B Schull et al. 27 (or 24 h of hospital arrival or during their ED stay) Percentage of patients with STEMI on first ECG who received 364 27 2011 Canada PMe5 B01 B Schull et al. fibrinolytic therapy within 30 min of ED arrival Percentage of patients with atrial fibrillation who were treated 365 2011 Canada with or received anticoagulation drug therapy or an antiplatelet PMe1 B01 B Schull et al. 27 therapy, if indicated Percentage of patients with asthma who received 366 2011 Canada corticosteroids in the ED and at discharge (if discharged) PMe1 H02 R03 HR Schull et al. 27 stratified by age Time from arrival in the ED to first documented beta-agonist- 367 2011 Canada type bronchodilator therapy for an acute exacerbation of PMe5 R03 R Schull et al. 27 asthma Percentage of patients with community-acquired pneumonia 368 2011 Canada who received initial antibiotic therapy within 4 h (or 6, or 8, or PMe5 J01 J Schull et al. 27 24 h) of arrival Percentage of patients with COPD who received 369 2011 Canada corticosteroid therapy in the ED and at discharge (if PMe1 H02 R03 HR Schull et al. 27 discharged) Percentage of eligible patients with acute stroke who received 370 27 2011 Canada PMe1 B01 B Schull et al. tPA Percentage of patients with acute stroke given tPA for whom 371 2011 Canada tPA best practice treatment protocol was followed for tPA PMe5 B01 B Schull et al. 27 administration 372 Schull et al. 27 2011 Canada Time to antibiotics in patients with bacterial meningitis P Me 5 J01 J Percentage of patients with severe sepsis or septic shock who 373 2011 Canada PMe5 J01 J were given broad- spectrum antibiotics within 4 h of ED arrival Schull et al. 27 Percentage of patients receiving antipsychotic medication for 374 Addington et 2012 Canada acute symptoms and continued medication for a 12-month PMe4 N05 N al. 28 period after stabilization of the acute episode Addington et Percentage of stable first-episode patients with a relapse 375 2012 Canada PMe7 N05 N al. 28 monitoring plan in place after medication discontinuation Addington et Percentage of patients on antipsychotic medication evaluated 376 2012 Canada PMe7 N05 N al. 28 for side effects Percentage of patients on antipsychotic medication who receive general medical monitoring at regular assessment 377 2012 Canada PMe7 N05 N Addington et intervals (weight, blood , ) either by the al. 28 program or by the family physician Addington et Proportion of patients with extrapyramidal side effects who 378 2012 Canada PMe1 N05 N al. 28 receive treatment for extrapyramidal symptoms Number of medication prescribing errors among patients with 379 Addington et 2012 Canada PMe6 N05 N divided by number of patient-treated years al. 28 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Number of patients with with documented administration of (by any route) in ED (or in 3 h % of patients with anaphylaxis who received epinephrine in 380 2013 Canada Total number of patients with anaphylaxis PMe15 C01 C before ED visit; ie, by emergency medical services [any route] ED Stang et al. 29 or self/bystander-administered epi-pen) Number of patients treated in ED with intramuscular Total number of patients with anaphylaxis treated with % of patients treated with epinephrine in ED who are treated 381 2013 Canada epinephrine (or IV for cardiovascular collapse or intramuscular PMe2 C01 C epinephrine in ED by any route by the appropriate route Stang et al. 29 refractory) Number of patients with DKA receiving IV fluids (any type or % of patients with DKA receiving IV fluids within the first 60 382 2013 Canada Total number of patients with DKA rate of fluid) within the first 60 min of ED arrival (first recorded PMe15 B05 B min of ED arrival Stang et al. 29 contact with ED) Time from triage to initiation of IV fluids (any type or rate of fluids) (median minutes with IQR) for patients with DKA 383 2013 Canada NA Time from triage to initiation of IV fluids for patients with DKA P Me 5 B05 B (based on ICD-10 codes) in whom IV fluids were initiated in Stang et al. 29 ED Numberof patientswith DKA treated initially with IV isotonic 384 29 2013 Canada Total number of patients with DKA % of patients with DKA treated initially with IV isotonic solution P Me 1 B05 B Stang et al. solution (0.9% saline or ringers lactate)

385 29 2013 Canada Total number of patients with DKA Numberof patients with DKA treated with IV insulin (any dose) % of patients administered IV insulin P Me 1 A10 A Stang et al. Time from arrival (first recorded contact with ED) to insulin administration (any route or dose) (median minutes with IQR) 386 2013 Canada NA Time from ED arrival to insulin administration P Me 5 A10 A for patients in DKA (based on ICD-10 codes) in whom insulin Stang et al. 29 was administered in ED Numberof patient swith DKA treated with appropriate initial % of patients with DKA treated with appropriate insulin dose 387 29 2013 Canada Total number of patients with DKA PMe123A10 A Stang et al. insulin dose and route and route Number of patients with DKA with documented receipt of IV 388 29 2013 Canada Total number of patients with DKA % of patients with DKA who receive potassium replacement P Me 1 B05 B Stang et al. potassium (any dose) while in ED Number of patients with DKA with documented receipt of IV 389 29 2013 Canada Total number of patients with DKA % of patients who receive bicarbonate P Me 1 B05 B Stang et al. bicarbonate (any dose) while in ED Number of patients with status epilepticus who had Number of patients receiving an antiepileptic drug within 10 %of patients receiving antiepileptic drug within 10 min of ED 390 29 2013 Canada PMe15 N03 N Stang et al. documentation of seizure activity at time of ED arrival min of ED arrival (first recorded contact with ED) arrival Number of patients in whom initial drug therapy in ED included % of patients in whom initial drug therapy in ED included a 391 29 2013 Canada Number of patients presenting to the ED in status epilepticus PMe1 N03 N Stang et al. a benzodiazepine benzodiazepine Time from ED arrival (first recorded contact with ED) to administration of second-line anticonvulsant in patients who Time from arrival to administration of second-line 392 2013 Canada NA PMe5 N03 N receive second-line (median minutes with anticonvulsant Stang et al. 29 interquartile range) Number of patients with status asthmaticus/severe asthma Total number of patients with status asthmaticus/severe who are discharged from the hospital from the ED with % of patients discharged from the hospital from the ED with a 393 2013 Canada PMe1 H02 H asthma discharged from the hospital from the ED documentation of a prescription/supply of oral steroids (any prescription/supply of oral steroids oral steroid; ie, prednisone, , ) Stang et al. 29 Total number of patients with status asthmaticus/severe Number of patients with status asthmaticus/severe asthma 394 2013 Canada % of patients receiving systemic corticosteroid during visit P Me 1 H02 H asthma who are treated with systemic corticosteroid during ED stay Stang et al. 29 Time from ED arrival (first recorded contact with ED) to systemic steroid administered (median minutes with IQR) in all 395 2013 Canada NA Time from arrival to systemic steroid administered P Me 5 H02 H patients with status asthmaticus/severe asthma who receive a systemic corticosteroid (based on ICD-10 codes) Stang et al. 29 Time from ED arrival (first recorded contact with ED) to first inhaled b2-agonist (MDI\spacer or nebulized) administered 396 2013 Canada NA Time from arrival to first inhaled beta2-agonist treatment P Me 5 R03 R (median minutes with IQR) in all patients with status asthmaticus/severe asthma who receive an inhaled b2 agonist Stang et al. 29 Number of patients with status asthmaticus/severe asthma Total number of patients with status asthmaticus/severe 397 2013 Canada who are treated with ≧1 dose of inhaled % of patients who received ipratropium bromide in ED P Me 1 R03 R asthma Stang et al. 29 in ED Number of patients with status asthmaticus/severe asthma Total number of patients with status asthmaticus/severe % of patients receiving combination beta2-agonist/ 398 2013 Canada who are treated with a combination of beta2- PMe1 R03 R asthma anticholinergic therapy Stang et al. 29 agonist/anticholinergic therapy in ED Time from arrival (first recorded contact with ED) (median minutes with IQR) to expert consultation for all patients with documented expert consultation and either impending Time from arrival to expert consultation for patients not 399 2013 Canada NA PMe5 R03 R respiratory arrest (based on severity score; ie, PRAM ≧12 at improving after conventional treatment any point during ED visit) or no improvement (ie, PRAM ≧9 after 3 doses of inhaled b2 and steroids) Stang et al. 29 Number of patients with no improvement (ie, PRAM ≧9 after Number of patients with no improvement (ie, PRAM ≧9 after receipt of 3 doses of inhaled beta2 agonist/ipratropium receipt of 3 doses of inhaled beta2 agonist/ipratropium % of patients not improving who receive at least 1 second-line 400 2013 Canada PMe1 H02 R03 HR bromide [MDI\spacer or nebulized] and systemic steroid [PO, bromide [MDI\spacer or nebulized] and systemic steroid [PO, therapy IV, IM]) IV, IM]) who receive at least 1 second-linetherapy in ED Stang et al. 29 Number of patients with status asthmaticus/severe asthma Total number of patients with status asthmaticus/severe who are discharged from the hospital from the ED with % of patients discharged from the hospital with a controller 401 2013 Canada PMe1 R03 R asthma discharged from the hospital from the ED documentation of a prescription/supply of controller medication Stang et al. 29 medication Time from arrival to isotonic fluid bolus administration for patients with suspected septic shock (median minutes with 402 2013 Canada NA Time from ED arrival to isotonic fluid bolus P Me 5 B05 B IQR) who receive an isotonic fluid bolus (0.9% saline or Stang et al. 29 ringers lactate) in ED Number of patients treated with appropriate fluid therapy in the first hour after suspected severe sepsis/septic shock (any % of patients treated with appropriate volume of isotonic fluid 403 2013 Canada Number of patients with suspected severe sepsis/septic shock volume of isotonic fluid that resulted in shock reversal (defined PMe15 B05 B in first hour as N systolic blood pressure(SBP) for age and cap refill ≦2s Stang et al. 29 or ≧60 cc/kg) Number of patients with fluid refractory (shock persists despite Patients with fluid refractory shock treated with appropriate 404 2013 Canada Number of patients with fluid refractory shock ≧60 cc/kg of fluid) shock treated with / dobutamine PMe1 B05 C01 BC vasopressor/inotrope Stang et al. 29 or nor-epi for warm shock in the ED Number of patients with refractory dopamine resistant shock Patients with dopamine-resistant shock treated with 405 2013 Canada Number of patients with refractory dopamine resistant shock (shock persists despite ≧60 cc/kg of fluid and dopamine to 10 PMe1 B05 C01 BC epinephrine/ norepinephrine mg/kg per min) treated with epinephrine/norepinephrine Stang et al. 29 Number of patients treated with pressors in the ED (any) Patients treated with pressors who have not received 60 cc/kg 406 29 2013 Canada Number of patients treated with pressors in the ED PMe1 B05 C01 BC Stang et al. before receiving 60 cc/kg of isotonic fluid fluid Time from arrival to antibiotics (any) received in suspected Time from ED arrival to antibiotic administration in suspected 407 2013 Canada NA severe sepsis/septic shock (median minutes with IQR) in PMe5 J01 J severe sepsis/septic shock Stang et al. 29 patients who receive antibiotics in ED Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Proportion of patients with completely resected stage II 408 2014 Canada NSCLC who received a consultation with a medical oncologist PMe5 L01 L Darling et al. 30 for consideration of adjuvant chemotherapy Patients who are hospitalized for the treatment of acute IBD (flare) should be offered pharmacological prophylaxis against 409 2014 Canada PMe1 B01 B venous thromboembolism or mechanical prophylaxis when the Nguyen et al. 31 former is contraindicated. In patients with corticosteroid-dependent IBD, an efficacious 410 2014 Canada PMe1 A07 L04 AL steroid-sparing therapy should be recommended. Nguyen et al. 31 Patients with IBD should be assessed for and 411 2014 Canada hepatitis B before initiation of tumour necrosis factor PMe7 L04 L Nguyen et al. 31 antagonists. In patients hospitalized for acute severe UC who have not responded to intravenous steroid therapy, implementation of 412 2014 Canada PMe1 H02 L04 HL salvage therapy should not be delayed beyond seven days Nguyen et al. 31 from the start of intravenous corticosteroids All IBD patients with risk factors for metabolic bone disease, 413 2014 Canada including prolonged steroid use, should be assessed for bone PMe7 A07 A Nguyen et al. 31 loss and treated if indicated. Pneumococcal vaccination and annual influenza vaccination should be administered to IBD patients, especially those on 414 2014 Canada PMe1 J07 L04 JL immunosuppressive therapies. Pneumococcal vaccination should be administered as early as possible after diagnosis. Nguyen et al. 31 All patients age 18 years and older admitted to hospital with a Number of patients with an open fracture receiving an All patients age 18 years and older admitted to hospital with a diagnosis of an open fracture AND administered guideline 415 2014 Canada agent within 1 hour of hospital arrival per 100 PMe15 J01 J diagnosis of an open fracture recommended intravenous antimicrobial agent within 1 hour of patients Santana et al. 32 hospital arrival Hospitals with a protocol to guide management of injured 416 2014 Canada Not applicable Hospitals with a protocol to guide massive transfusions S Me 9 B05 B patients age 18 years and older requiring massive transfusion Santana et al. 32 All injured patients age 18 years and older prescribed a All injured patients age 18 years and older prescribed a 417 2014 Canada massive transfusion AND with massive transfusion protocol Activations of massive transfusion protocol per 100 patients P Me 1 B05 B massive transfusion Santana et al. 32 activation All patients age 18 years and older with an injury diagnosis AND prescribed a massive transfusion who receive attempted Attempted definitive (laparotomy, thoracotomy or All patients age 18 years and older with an injury diagnosis 418 2014 Canada definitive bleeding control (laparotomy, thoracotomy, percutaneous therapy) bleeding control within 30 minutes of PMe9 B05 B AND prescribed a massive transfusion percutaneous therapy) within 30 minutes of the massive massive transfusion per 100 patients Santana et al. 32 transfusion prescription Time to disease-modifying antirheumatic drug therapy for 419 33 2015 Canada PMe5 L04 L Barber et al. patients with new-onset rheumatoid arthritis Percentage of rheumatoid arthritis patients treated with a 420 2015 Canada disease-modifying antirheumatic drug during the PMe1 L04 L Barber et al. 33 measurement year Proportion of patients who receive formal documented 421 Fernandes et 2015 Canada discharge medication reconciliation and resolution of identified P Ge 6 N/A N/A al. 34 discrepancies by a pharmacist Number (or proportion) of patients who receive formal documented admission medication reconciliation by a pharmacist (includes a pharmacist best-possible medication 422 2015 Canada P Ge 6 N/A N/A history or pharmacist best-possible medication history review Fernandes et as part of the medication reconciliation process as well as resolution of identified discrepancies) al. 34 Number (or proportion) of pharmacists who actively participate 423 Fernandes et 2015 Canada in interprofessional patient care rounds to improve medication P Ge 5 N/A N/A al. 34 management Number (proportion) of patients for whom clinical pharmacists 424 Fernandes et 2015 Canada have completed (executed/implemented) a pharmaceutical P Ge 5 N/A N/A al. 34 care plan Fernandes et Number of total drug therapy problems resolved by 425 2015 Canada P Ge 5 N/A N/A al. 34 pharmacists Number (or proportion) of patients receiving proactive 426 Fernandes et 2015 Canada comprehensive direct patient care by a pharmacist in P Ge 5 N/A N/A al. 34 collaboration with the health care team Fernandes et Number (or proportion) of hospital patients who receive 427 2015 Canada P Ge 5 N/A N/A al. 34 medication counseling by a pharmacist at discharge Number (or proportion) of patients who have received in- 428 Fernandes et 2015 Canada person education from a pharmacist about their disease(s) P Ge 5 N/A N/A al. 34 and medication(s) during their hospital stay (Breast cancer) Percentage of patients with receptor–negative invasive carcinoma (tumour > 1 cm or node- 429 2016 Canada PMe1 L01 L positive) who received adjuvant chemotherapy within 8 weeks Khare et al. 35 of surgical resection (Breast cancer) Percentage of patients with inflammatory breast cancer or locally advanced nonresectable estrogen 430 2016 Canada PMe1 L01 L receptor–negative carcinoma who received neoadjuvant Khare et al. 35 chemotherapy (Breast cancer) Percentage of patients who received systemic- 431 2016 Canada PMe1 L01 L02 L relapse post-adjuvant therapy within 5 years of diagnosis Khare et al. 35 (Breast cancer) Percentage of patients receiving 432 35 2016 Canada OMe8 L01 L Khare et al. chemotherapy with grade 4 (Breast cancer) Wait time for systemic adjuvant therapy from 433 35 2016 Canada PMe5 L01 L02 L Khare et al. the final pathology report (Breast cancer) Wait time for first-line chemotherapy for 434 2016 Canada metastatic disease, from medical visit that decides PMe5 L01 L Khare et al. 35 on chemotherapy (Prostate cancer) Percentage of patients with metastatic 435 35 2016 Canada PMe1 L01 L02 L Khare et al. disease treated with first-line systemic therapy (Prostate cancer) Percentage of patients with bone 436 2016 Canada metastases receiving bone-targeted therapy (for example, PMe1 M05 M Khare et al. 35 bisphosphonates or RANK inhibitor) Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Prostate cancer) Time between positive biopsy showing high- risk disease (clinical stage T3-4, or Gleason score 8–10, or 437 2016 Canada PMe5 L01 L02 L PSA > 20 ng/mL at diagnosis) and initiation of one or more of these treatments: radiation therapy, systemic therapy, surgery Khare et al. 35 (Lung cancer) Percentage of patients undergoing curative 438 2016 Canada localized therapy (either surgery or chemoradiation) who PMe7 L01 L Khare et al. 35 receive positron-emission tomography before treatment (Lung cancer) Percentage of patients with metastatic lung 439 2016 Canada cancer treated with cytotoxic chemotherapy during the last 2 PMe1 L01 L Khare et al. 35 weeks of life (Lung cancer) Percentage of patients receiving systemic 440 35 2016 Canada OMe8 L01 L Khare et al. therapy experiencing grade 3 or 4 toxicity (Lung cancer) Wait time to systemic therapy for metastatic 441 35 2016 Canada PMe5 L01 L Khare et al. disease () Percentage of patients with stage III colon 442 2016 Canada cancer who commence adjuvant chemotherapy within 8 PMe1 L01 L Khare et al. 35 weeks of surgery (Colorectal cancer) Percentage of patients receiving 443 35 2016 Canada OMe8 L01 L Khare et al. chemotherapy who experience grade 3 or 4 toxicity (Colorectal cancer) Percentage of colon or rectal cancer 444 2016 Canada patients with systemic relapse within 5 years after adjuvant OMe9 L01 L Khare et al. 35 therapy, by initial stage (Colorectal cancer) Percentage of patients with colon or rectal cancer, not treated with preoperative chemotherapy or 445 2016 Canada OMe9 L01 L radiotherapy, admitted for surgery within 8 weeks from the Khare et al. 35 time of first surgical consultation (In-hospital use of ACEIs or ARBs) The percentage of inpatients with a documented history of HF or newly diagnosed HF resulting from poor left ventricular systolic 446 2016 Canada PMe1 C09 C function who are prescribed an ACEI or ARB during the hospital stay and at hospital discharge, unless a McKelvie et al. 36 contraindication or known drug intolerance exists (Treatment) Percentage of patients undergoing concurrent 447 2017 Canada chemoradiotherapy who have a complete transurethral PMe1 L01 L Khare et al. 37 resection of the bladder tumor before therapy (Treatment) Percentage of patients who initiated trimodality 448 2017 Canada therapy within 6 wk of last transurethral resection of the PMe1 L01 L Khare et al. 37 bladder tumor (Treatment) For patients indicated for radiation, percentage 449 37 2017 Canada PMe1 L01 L Khare et al. who received chemosensitizer with radiation (Treatment) Percentage of patients who started first cycle of 450 2017 Canada neoadjuvant chemotherapy within 4 wk of date of request to PMe1 L01 L Khare et al. 37 consult medical oncology (Treatment) Percentage of patients without neoadjuvant 451 2017 Canada chemotherapy who had radical cystectomywithin 6 wk of last PMe1 L01 L Khare et al. 37 transurethral resection of the bladder tumor (Treatment) Percentage of patients with neoadjuvant 452 2017 Canada chemotherapy who had radical cystectomywithin 16 wk of PMe1 L01 L Khare et al. 37 initiation of neoadjuvant chemotherapy (Treatment) For patients with muscle-invasive bladder 453 2017 Canada cancer, percent who received any definitive therapy (radical PMe1 L01 L Khare et al. 37 cystectomy or trimodality therapy) (Treatment) Percentage of patients with muscle-invasive who initiated curative intent therapy 454 2017 Canada PMe1 L01 L (neoadjuvant chemotherapy, trimodality therapy, or RC) within Khare et al. 37 6 wk of transurethral resection of the bladder tumor (Treatment) Percentage of eligible patients with muscle- invasive bladder cancer on transurethral resection of the 455 2017 Canada PMe1 L01 L bladder tumor being referred to medical oncology preoperatively for consideration of neoadjuvant chemotherapy Khare et al. 37 (Treatment) For patients with muscle-invasive bladder cancer and normal estimated glomerular filtration rate, Eastern 456 2017 Canada PMe1 L01 L Cooperative Oncology Group of 0–1, and <80 y of age, Khare et al. 37 percentage who received neoadjuvant chemotherapy (Treatment) For patients with muscle-invasive bladder cancer and receiving neoadjuvant chemotherapy, percentage who 457 2017 Canada PMe1 L01 L completed a minimum of 3 cycles of cisplatin-based Khare et al. 37 combination therapy (Treatment) Percentage of patients with high-risk non-muscle- 458 37 2017 Canada PMe1 J07 J Khare et al. invasive bladder cancer receiving BCG (Treatment) Percentage of patients with high-risk non-muscle- 459 2017 Canada invasive bladder cancer who initiated intravesical BCG within PMe1 J07 J 4 wk of transurethral resection of the bladder tumor Khare et al. 37 (Treatment) For patients with high-risk non-muscle-invasive 460 2017 Canada bladder cancer, percentage who had intravesical BCG PMe1 J07 J Khare et al. 37 induction course with at least 1-y maintenance (Treatment) Percentage of patients with metastatic or 461 2017 Canada unresectable bladder cancer receiving cisplatin-based PMe1 L01 L Khare et al. 37 systemic chemotherapy (Prophylactic measures (patients undergoing cystectomy)) 462 2017 Canada Percentage of patients who received intravenous antibiotics PMe15 J01 J Khare et al. 37 within 60 min before incision (Prophylactic measures (patients undergoing cystectomy)) 463 2017 Canada Percentage of patients who received pharmacologic PMe1 B01 B Khare et al. 37 thrombosis prophylaxis perioperatively (Prophylactic measures (patients undergoing cystectomy)) 464 2017 Canada Percentage of patients who received pharmacologic PMe1 B01 B thrombosis prophylaxis after discharge for a period of 4 wk Khare et al. 37 (Organizational process and outcomes) For patients undergoing trimodality therapy, percentage who had: (1) acute ≧ grade 3 Radiation Therapy Oncology Group 465 2017 Canada OMe9 L01 L toxicity (2) late (equal to or greater than 3 mo) ≧ grade 3 Radiation Khare et al. 37 Therapy Oncology Group toxicity Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Organizational process and outcomes) Transfusion rate during hospital admission for post-radical cystectomypatients 466 2017 Canada who: OMe9 L01 L (1) received neoadjuvant chemotherapy Khare et al. 37 (2) did not receive neoadjuvant chemotherapy (Organizational process and outcomes) Stage (at diagnosis)- 467 2017 Canada specific 5-y recurrence-free, disease-specific and overall OMe9 L01 L survival after radical cystectomy or trimodality therapy Khare et al. 37

468 37 2017 Canada (Case volume) Annual hospital volume of trimodality therapy P Me 1 L01 L Khare et al. Number of patients in the denominator who were (Hypertension) Number of primary healthcare patients with 469 2017 Canada prescribed/self-report taking at least one anti-hypertension PMe1 C02C03C07C08C09 C hypertension, 20 years of age and older Tu et al. 38 medication (Hypertension) Number of primary healthcare patients with Mean number of antihypertensive medications taken among 470 2017 Canada hypertension, 20 years of age and older taking at least one PMe1 C02C03C07C08C09 C patients in the denominator Tu et al. 38 antihypertensive medication (Diabetes) Number of primary healthcare patients with Number of patients in the denominator who are taking anti- 471 38 2017 Canada PMe1 A10 A Tu et al. diabetes (type I or type II), age 20 and older diabetic medications (oral agents or insulin) (Diabetes) Number of primary healthcare patients with Number of patients in the denominator who are taking ACE- 472 38 2017 Canada PMe1 C09 C Tu et al. diabetes (Type I or Type II), age 55 and older inhibitors or ARBs (Diabetes) Number of primary healthcare patients with Number of patients in the denominator who were prescribed 473 38 2017 Canada PMe1 C10 C Tu et al. diabetes (Type I or Type II), age 40 and older statins (Dyslipidemia) Number of high risk (defined by Framingham risk score ≥ 20%, patients with LDL >5.0 mmol/L, diabetic Number of patients in the denominator who were 474 2017 Canada PMe1 C10 C patients, or other definition of cardiovascular risk) primary prescribed/self-report taking statins healthcare patients age 20 and older Tu et al. 38 (Dyslipidemia) Number of primary healthcare patients age 20 Number of patients in the denominator with most recent blood 475 38 2017 Canada PMe7 C10 C Tu et al. and older taking statins test showing LDL-C ≤2 mmol/L (Atrial Fibrillation) Number of primary healthcare patients age Number of patients in the denominator prescribed Warfarin or 476 38 2017 Canada PMe1 B01 B Tu et al. 20 and older with atrial fibrillation direct oral anticoagulant (Atrial Fibrillation) Number of primary healthcare patients age Number of patients in the denominator whose average INR 477 2017 Canada 20 and older with atrial fibrillation on warfarin with at least one PMe7 B01 B test results was 2-3 Tu et al. 38 INR test result Percentage of patients with diabetes and albuminuria (moderately or severely increased albumin–creatinine ratio ≥ 3 478 2017 Canada PMe1 C09 C mg/mmol) who were prescribed an ACE inhibitor or ARB unless a contraindication or adverse effects are recorded. Tu et al. 39 Percentage of patients with chronic kidney disease who had a 479 2017 Canada serum potassium test 7–30 days after initial ACE inhibitor– PMe7 C09 C Tu et al. 39 ARB prescription. Percentage of patients with chronic kidney disease 480 2017 Canada PMe1 C09 C simultaneously receiving both an ACE inhibitor and an ARB. Tu et al. 39 Percentage of patients with stage 3–5 chronic kidney disease 481 2017 Canada and a prescription for a nonsteroidal anti-inflammatory drug PMe14 M01 M02 M Tu et al. 39 for more than 2 weeks. Percentage of patients ≥ 50 years and ≤ 80 years of age with 482 2017 Canada stage 3–5 chronic kidney disease and taking a statin unless PMe1 C10 C Tu et al. 39 contraindicated. Percentage of patients with chronic kidney disease who 483 2017 Canada received an influenza vaccine in the past year unless PMe1 J07 J Tu et al. 39 contraindicated. (All oral anticoagulant therapy) Documentation of 484 Chartrand et 2018 Canada PMe7 B01 B thromboembolic risk (CHADS2 or CHA2 DS2 VASc score) al. 40 (All oral anticoagulant therapy) Documentation of confirmation of the bi- or tri-therapy initiation (anticoagulant with 485 2018 Canada PMe1 B01 B Chartrand et antiplatelets) with the prescriber (except if prescribed by the same physician on the same prescription) al. 40 (All oral anticoagulant therapy) Documentation of patient 486 Chartrand et 2018 Canada anticoagulation therapy education done at the beginning and PMe5 B01 B al. 40 during treatment (Vitamin K antagonist) Documentation of bleeding risk (HAS- BLED (hypertension, abnormal renal/liver function, stroke, bleeding, labile INR, elderly and drugs/) score or other 487 2018 Canada (e.g., HEMORR2HAGES (hepatic or renal disease, PMe7 B01 B abuse, malignancy, older age, reduced count or Chartrand et function, rebleeding risk, hypertension, anemia, genetic factors, excessive fall risk and stroke), Landefeld index)) al. 40 Chartrand et (Vitamin K antagonist) Documentation of modification or no 488 2018 Canada PMe1 B01 B al. 40 modification in smoking status in the past 6 months Chartrand et (Vitamin K antagonist) Documentation of change or no 489 2018 Canada PMe1 B01 B al. 40 change in alcohol consumption in the past 6 months (Vitamin K antagonist) Documentation of reconfirmation of the 490 Chartrand et 2018 Canada target INR with prescriber when patient initiates one or more PMe7 B01 B al. 40 antiplatelets (Vitamin K antagonist) External quality control procedure of 491 Chartrand et 2018 Canada the portable coagulometer is done by pharmacist at least SMe5 B01 B twice a year if this device is used for anticoagulated patients al. 40 Chartrand et (Vitamin K antagonist) Availability of a validated nomogram for 492 2018 Canada SMe3 B01 B al. 40 dosage adjustment reported by pharmacist Chartrand et (Vitamin K antagonist) Documentation of patient’s natural 493 2018 Canada PMe1 B01 B al. 40 health products consumption Chartrand et (Vitamin K antagonist) Documentation of patient’s over-the- 494 2018 Canada PMe1 B01 B al. 40 counter drugs consumption Chartrand et (Vitamin K antagonist) Patient’s target range of INR is 495 2018 Canada PMe7 B01 B al. 40 appropriate according to patient’s indication Chartrand et (Vitamin K antagonist) Documentation that prescriber has 496 2018 Canada PMe9 B01 B al. 40 been notified at the latest 7 days following an INR < 1.8 Chartrand et (Vitamin K antagonist) Documentation that prescriber has 497 2018 Canada PMe9 B01 B al. 40 been notified at the latest 7 days following an INR > 5 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Vitamin K antagonist) Documentation of the pharmacist’s intervention at the latest 7 days following 3 consecutive 498 2018 Canada PMe7 B01 B Chartrand et nontherapeutic INRs for patients taking Vitamin K antagonist al. 40 for more than 6 months Chartrand et (Vitamin K antagonist) TTR ≥ 60% for patients taking Vitamin 499 2018 Canada OMe7 B01 B al. 40 K antagonist for more than 6 months Chartrand et (Vitamin K antagonist) A new INR is available at the latest 7 500 2018 Canada PMe7 B01 B al. 40 days after a patient’s nontherapeutic INR Chartrand et (Vitamin K antagonist) A new INR is available at the latest 14 501 2018 Canada PMe7 B01 B al. 40 days after a patient’s moderately nontherapeutic INR Chartrand et (Vitamin K antagonist) A new INR is available at the latest 28 502 2018 Canada PMe7 B01 B al. 40 days after a patient’s slightly nontherapeutic INR Chartrand et (Vitamin K antagonist) A new INR is available at the latest 6 503 2018 Canada PMe7 B01 B al. 40 weeks after a patient’s therapeutic INR (Vitamin K antagonist) Documentation that the prescriber has 504 Chartrand et 2018 Canada been notified when a patient is no longer a customer of the PMe9 B01 B al. 40 pharmacy or is lost to follow-up Chartrand et (Vitamin K antagonist) Documentation of pharmacist’s 505 2018 Canada PMe7 B01 B al. 40 intervention to find a probable cause when TTR is < 60% (Vitamin K antagonist) Documentation of pharmacist’s intervention to suggest/verify possibility of switching vitamin K 506 2018 Canada PMe1 B01 B Chartrand et antagonist to direct oral anticoagulant when TTR is < 60% al. 40 without reason (Vitamin K antagonist) Documentation of pharmacist’s 507 Chartrand et 2018 Canada intervention to add LMWH when INR is < 1.8 and thrombotic PMe1 B01 B risk is important (CHA2DS2 > 3, mechanical heart valve) al. 40 Chartrand et (Direct oral anticoagulant) Documentation of patient’s 508 2018 Canada PMe7 B01 B al. 40 estimated creatinine clearance minimally once a year (Direct oral anticoagulant) Documentation of pharmacist’s intervention with prescriber to suggest/verify possibility of 509 2018 Canada decreasing dabigatran dosage to 110 mg BID if one of these PMe3 B01 B Chartrand et factors is present: weight < 50 kg, age ≥ 80, or estimated al. 40 creatinine clearance between 30-49 mL/min (Direct oral anticoagulant) Documentation of pharmacist’s intervention with prescriber to suggest decreasing apixaban 510 2018 Canada PMe3 B01 B Chartrand et dosage to 2.5 mg BID when estimated creatinine clearance is between 30-49 mL/min and age ≥ 80 or weight ≤ 60 kg al. 40 (Direct oral anticoagulant) Documentation of pharmacist’s intervention with the prescriber to suggest decreasing 511 2018 Canada PMe3 B01 B Chartrand et rivaroxaban dosage to 15 mg DIE when estimated creatinine al. 40 clearance is between 30-49 mL/min Chartrand et (Direct oral anticoagulant) Documentation of patient’s 512 2018 Canada PMe9 B01 B al. 40 absence of mechanical heart valve (Direct oral anticoagulant) Documentation of pharmacist’s intervention with prescriber to suggest possibility of switching 513 2018 Canada PMe1 B01 B Chartrand et Direct oral anticoagulant to vitamin K antagonist when patient al. 40 has a mechanical heart valve (Direct oral anticoagulant) Documentation of pharmacist’s intervention: • With patient if adherence is suboptimal during 3 months (quantity of dispensed drug ≤ 90% or ≥ 110% of the required 514 2018 Canada PMe5 B01 B quantity according to prescription) • With prescriber if adherence is suboptimal during 3 months Chartrand et (quantity of dispensed drug ≤ 80% or ≥ 120% of the required al. 40 quantity according to prescription) Chartrand et 515 2018 Canada (Direct oral anticoagulant) Adherence ≥ 80% O Me 5 B01 B al. 40 (Direct oral anticoagulant) Documentation of pharmacist’s 516 Chartrand et 2018 Canada intervention to manage interactions between oral PMe1 B01 J02 BJ al. 40 anticoagulants and “” drugs (Direct oral anticoagulant) Documentation of pharmacist’s 517 Chartrand et 2018 Canada intervention to manage interactions between oral PMe1 B01 J05 BJ al. 40 anticoagulants and (Direct oral anticoagulant) Documentation of pharmacist’s 518 Chartrand et 2018 Canada intervention to manage interactions between oral PMe1 B01 J04 BJ al. 40 anticoagulants and rifampin (Direct oral anticoagulant) Documentation of pharmacist’s 519 Chartrand et 2018 Canada intervention to manage interaction when patient is taking St. PMe1 B01 B al. 40 John's wort Chartrand et (Direct oral anticoagulant) Documentation of presence or 520 2018 Canada PMe7 B01 B al. 40 absence of side effects (Direct oral anticoagulant) Documentation of pharmacist’s intervention to suggest possibility of switching Direct oral 521 2018 Canada PMe1 B01 B Chartrand et anticoagulant to vitamin K antagonist when estimated al. 40 creatinine clearance ≤ 30 mL/min (Effective) Percentage of patients with HbA1c >9.0% on 522 41 2018 Canada Patients with diabetes Number of patients with HbA1c >9% AND on insulin treatment PMe1 A10 A Mukerji et al. insulin treatment (Effective) Percentage of patients with diabetes and Number of patients with diabetes and proteinuria Number of patients with diabetes and proteinuria proteinuria prescribed angiotensin-converting enzyme (ACE) 523 2018 Canada (microalbuminuria or macroalbminuria) prescribed ACE- PMe1 C09 C (microalbuminuria or macroalbminuria) inhibitor (or angiotensin II receptor blockers [ARB]) within the inhibitor (or ARB) within three months unless contraindicated Mukerji et al. 41 audit year unless contraindicated (Effective) Percentage of non-incident Type 2 diabetes Number of non-incident Type 2 diabetes patients not receiving patients not receiving insulin prescribed a second oral insulin prescribed a second oral antihyperglycemic drug from 524 2018 Canada Patients with diabetes antihyperglycemic drug from a different class if with one oral PMe1 A10 A a different class if with one oral antihyperglycemic drug HbA1c antihyperglycemic drug HbA1c remained above their target remained >7% HbA1c (or personal HbA1c >7% if target HbA1c not available) Mukerji et al. 41 (Effective) Percentage of patients prescribed first line drug Patients with Type 2 diabetes in whom metformin is not Number of patients prescribed metformin unless 525 2018 Canada class (e.g. metformin) of all oral antidiabetic drugs if no PMe1 A10 A contraindicated contraindications Mukerji et al. 41 contraindication Number of patients with diabetes with high BP (≥140/ 90mm (Effective) Percentage of diabetes patients with high BP 526 41 2018 Canada Patients with diabetes PMe1 C02C03C07C08C09 C Mukerji et al. Hg) not receiving antihypertensive therapy (≥140/ 90mm Hg) not receiving antihypertensive therapy Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Number of patients with the diagnosis of diabetes and (Effective) Percentage of patients with the diagnosis of Number of patients 18–75 years of age with a diagnosis of ischemic vascular disease with documentation of taking daily diabetes and ischemic vascular disease with documentation 527 2018 Canada PMe1 B01 B diabetes and a diagnosis of ischemic vascular disease aspirin or have a documented contraindication in the of taking daily aspirin or have a documented contraindication Mukerji et al. 41 measurement year in the measurement year Number of patients who had poor diabetes control of: (Effective) Percentage of patients age 18–75 years with Type BP measurement in the last year and BP greater than 2 diabetes with suboptimal control: BP measurement in the Number of patients age 18–75 years old who have Type 2 150/90mm Hg 528 2018 Canada last year and BP greater than 150/90mm Hg; LDL tests in the PMe1 C10 C diabetes LDL tests in the last year and LDL greater than 3.5 mmol/L last year and LDL greater than 3.5 mmol/L and patient was and patient was not on a statin not on a statin; HbA1c greater than 9% Mukerji et al. 41 HbA1c greater than 9% Number of patients at risk for hypoglycemia (on insulin or oral (Safe) Percentage of patients at risk for hypoglycemia (on All patients at risk for hypoglycemia (on insulin or oral 529 2018 Canada secretogogues) who have hypoglycemia and driving insulin or oral secretogogues) who have hypoglycemia and PMe5 A10 A secretogogues) Mukerji et al. 41 counseling documented driving counseling documented Number of patients with documented instruction on how to inject, how to rotate sites, how to titrate insulin, signs and (Safe) Percentage of patients who are started on insulin and 530 2018 Canada All patients started on insulin with the measurement year PMe5 A10 A symptoms of hyper and hypoglycemia and how to treat receive the recommended training and education Mukerji et al. 41 hypoglycemia Number of patients being asked about current medications at (Safe) Percentage of patients asked about current 531 41 2018 Canada Patients with diabetes PGe7 N/A N/A Mukerji et al. every visit medications at every visit Patients with diabetes on insulin or antihyperglycemic agents Number of patients where hypoglycemia management (Safe) Percentage of patients where hypoglycemia 532 41 2018 Canada PMe5 A10 A Mukerji et al. that have the risk of hypoglycemia counseling was provided management counseling was provided The number of women in the denominator informed about (Safe) Percentage of women of childbearing age with diabetes preconception glycaemic control and of any risks including 533 2018 Canada The number of women of childbearing age with diabetes who are regularly informed of the risk of poorly controlled PMe5 A10 A medication that may harm an unborn child at their last diabetes and certain medications in Mukerji et al. 41 diabetes consultation (Safe) Percentage of patients with co-prescriptions to be Number of patients with co-prescriptions to be avoided, e.g. of Patients with Type 2 diabetes or cardiovascular risk avoided, e.g. of statins with , diuretic, ACE- 534 2018 Canada statins with macrolides, diuretic, ACE-inhibitor with potassium PMe1 A12 C03 C09 C10 J01 M01 M02 ACJM management inhibitor with potassium or nonsteroidal antiinflammatory drug or NSAID, metformin with glibenclamide, etc. Mukerji et al. 41 (NSAID), metformin with glibenclamide, etc. Number of patients with diabetes who’s medical record (Safe) Percentage of patients with diabetes where sick day 535 2018 Canada Number of patients with diabetes indicates counseling for sick day diabetes management has PMe5 A10 A management counseling has been documented Mukerji et al. 41 been provided. Number of patients with diabetes who’s medical record (Safe) Percentage of patients who had a documented 536 2018 Canada Number of patients with diabetes indicates counseling regarding the benefits, risks and side- discussion with their diabetes provider regarding the benefits, PMe5 A10 A Mukerji et al. 41 effects of statins has been provided risks and side-effects of statins (Safe) Percentage of patients who report being asked about Number of patients who report being asked about their other 537 2018 Canada All people with diabetes who complete the survey their other medical problems and medication changes at each PGe7 N/A N/A medical problems and medication changes at each visit Mukerji et al. 41 visit (Patient-centered) Percentage of people with diabetes who Number of people with diabetes who agree with their agree with their healthcare professional on a documented healthcare professional on a documented personalized personalized HbA1c target (usually between 6.5% and 7.5%), 538 2018 Canada The number of people with diabetes HbA1c target (usually between 6.5% and 7.5%), AND have a PMe7 A10 A have a documented HbA1c and who receive an ongoing documented HbA1c AND who receive an ongoing review of review of treatment to minimize hypoglycemia if on insulin treatment to minimize hypoglycemia Mukerji et al. 41 secretagogues or on insulin (Efficient) Percentage of people with diabetes who receive ongoing structured support to initiate and manage insulin The number of people in the denominator receiving ongoing 539 2018 Canada The number of people with diabetes starting insulin therapy therapy (trained healthcare professionals initiative and PMe5 A10 A support to initiate and manage insulin therapy manage therapy with insulin within a structured program that Mukerji et al. 41 includes dose by the person with diabetes) Confirmed AMI and ST-segment elevation or left bundle Patients with AMI who were eligible for fibrinolytic therapy and branch block on ECG and fibrinolytic therapy within 12 h after 540 2011 China arrived at hospital within 30 min after call for emergency PMe5 B01 B onset and age <75 and call made to emergency medical medical services Sun et al. 42 services (emergency call 120)

541 42 2011 China AMI patients without aspirin contraindications Patients with AMI received ASA within 3 h of hospital arrival P Me 15 B01 B Sun et al. Patients with AMI received beta-blockers within 12 h of 542 42 2011 China AMI patients PMe15 C07 C Sun et al. hospital arrival Patients with AMI received clopidogrel within 12 h of hospital 543 42 2011 China AMI patients PMe15 B01 B Sun et al. arrival AMI patients ST-segment elevation or left bundle branch Patients with AMI who received fibrinolytic therapy within 30 544 2011 China block on ECG and fibrinolytic therapy within 12 h after onset PMe5 B01 B min after hospital arrival Sun et al. 42 and age ,75

545 42 2011 China AMI patients alive at discharge AMI patients who are prescribed aspirin at hospital discharge P Me 1 B01 B Sun et al. Patients with AMI who are prescribed a beta-blocker at 546 42 2011 China AMI patients alive at discharge PMe1 C07 C Sun et al. hospital discharge Patients with AMI who are prescribed an ACEI at hospital 547 42 2011 China AMI patients alive at discharge PMe1 C09 C Sun et al. discharge Patients with AMI who are prescribed a statin at hospital 548 42 2011 China AMI patients alive at discharge PMe1 C10 C Sun et al. discharge AMI patients who are prescribed clopidogrel at hospital 549 42 2011 China AMI patients alive at discharge PMe1 B01 B Sun et al. discharge Breast cancer patients who received estrogen receptor and 550 2015 China Breast cancer patients who received systemic therapy receptor status assessment before systemic PMe7 L01 L02 L Bao et al. 43 therapy Patients aged 18 or over, with newly diagnosed invasive Patients with invasive breast cancer who received HER2 551 43 2015 China PMe7 L01 L02 L Bao et al. breast cancer who received systemic therapy testing before systemic treatment Premenopausal breast cancer patients with positive lymph Premenopausal breast cancer patients who were 552 43 2015 China PMe1 L01 L Bao et al. nodes administrated adjuvant chemotherapy Breast cancer patients diagnosed at age 50-70, with surgery Breast cancer patients who were administrated adjuvant 553 2015 China PMe1 L01 L confirmed positive lymph nodes or >=2cm tumor size chemotherapy Bao et al. 43 Patients who were administrated at least four cycles of 554 43 2015 China Breast cancer patients who received adjuvant chemotherapy PMe4 L01 L Bao et al. adjuvant chemotherapy Breast cancer patients who were treated by trastuzumab Breast cancer patients in whom heart function was monitored 555 43 2015 China PMe7 L01 L Bao et al. treatment every three months Breast cancer patients with positive estrogen receptor or Patients who were administrated tamoxifen or aromatase 556 2015 China progesterone receptor, tumor size >=1cm or positive axillary PMe1 L02 L inhibitor treatment lymph nodes, and was not taking tamoxifen prior to diagnosis Bao et al. 43 Breast cancer patients who were administrated neo-adjuvant 557 43 2015 China Breast cancer patients with clinical T2-T3 stage PMe1 L01 L Bao et al. chemotherapy Patients who received potent anti-emetic therapy before 558 43 2015 China Patients who ever received highly emetogenic chemotherapy PMe1 A04 L01 AL Bao et al. receiving highly emetogenic chemotherapy Postmenopausal breast cancer patients with vaginal bleeding Patients who received endometrial biopsy or pelvic trans 559 43 2015 China PMe7 L02 L Bao et al. occur after taking tamoxifen vaginal ultrasound Patients with stage I-III breast cancer who initiated tamoxifen Patients who were recommended for 5-year endocrine 560 2015 China or aromatase inhibitor treatment and there is no evidence of PMe4 L02 L treatment Bao et al. 43 disease progression Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Number of errors of medication administration within the 561 44 2016 China Number of administrations within the statistical period PGe 6 N/A N/A Chen et al. statistical period Number of pharmacological interventions in babies with pain 562 44 2016 China Number of all medical procedures within the statistical period PMe1 M02 N02 MN Chen et al. score >4 within the statistical period Number of times antibiotics are used on patients 60 min 563 45 2016 China Number of operations performed. PMe15 J01 J Wu et al. before incision at start of surgery Number of operations in which drugs on surgical table have 564 45 2016 China Total number of operations within a certain period. SGe 9 N/A N/A Wu et al. sterilisation markings. Nnumber of cases of transfusion reactions in patients when 565 45 2016 China Number of operations performed. OMe8 B05 B Wu et al. receiving transfusions during surgical period. (Drug selection for community-acquired pneumonia) 1.1 566 46 2017 China PMe1 J01 J Li et al. Proportion of antibiotic use (Drug selection for community-acquired pneumonia) 1.2 567 2017 China Proportion of broad-spectrum antibiotic use after pathogen PMe1 J01 J Li et al. 46 identification (Drug selection for community-acquired pneumonia) 1.3 568 46 2017 China PMe1 J01 J Li et al. Proportion of antibiotic use (Drug selection for community-acquired pneumonia) 1.4 569 46 2017 China PMe1 J01 J Li et al. Proportion of antibiotic combination therapy (Drug selection for community-acquired pneumonia) 1.5 570 2017 China Proportion of the combined use of macrolide and b-lactam PMe1 J01 J Li et al. 46 antibiotics (Drug selection for community-acquired pneumonia) 1.6 571 46 2017 China PMe1 J01 J Li et al. Proportion of third-generation cephalosporin antibiotic use (Drug selection for community-acquired pneumonia) 1.7 572 2017 China Microbiological examination rate of children with CAP who PMe7 J01 J Li et al. 46 were receiving antibiotics (Drug selection for community-acquired pneumonia) 1.8 573 46 2017 China PMe1 J05 J Li et al. Proportion of antiviral agent use (Drug selection for community-acquired pneumonia) 1.9 574 46 2017 China PMe1 J01 J05 J Li et al. Proportion of antibiotic use combined with antiviral agents (Drug selection for community-acquired pneumonia) 1.10 575 2017 China Proportion of acetaminophen or ibuprofen use among children PMe1 M01 M02 N02 MN Li et al. 46 who received antipyretics (Drug usage and dosage for community-acquired pneumonia) 576 46 2017 China PMe3 J01 J Li et al. 2.1 Antibacterial use density (AUD) (Drug usage and dosage for community-acquired pneumonia) 577 46 2017 China PMe3 J01 J Li et al. 2.2 Use density of macrolide antibiotics (Drug usage and dosage for community-acquired pneumonia) 578 2017 China PMe3 J01 J 2.3 Use density of third-generation cephalosporin antibiotics Li et al. 46 (Drug usage and dosage for community-acquired pneumonia) 579 2017 China PMe2 J01 J 2.4 Proportion of antibiotics administered intravenously Li et al. 46 (Drug usage and dosage for community-acquired pneumonia) 580 46 2017 China PMe1 J01 J Li et al. 2.5 Proportion of sequential therapy (Drug usage and dosage for community-acquired pneumonia) 581 2017 China PMe2 J05 J 2.6 Proportion of antiviral agents administered intravenously Li et al. 46 (Drug usage and dosage for community-acquired pneumonia) 582 2017 China 2.7 Proportion of traditional Chinese medicines administered PGe2N/A N/A Li et al. 46 intravenously (Drug usage and dosage for community-acquired pneumonia) 583 2017 China 2.8 Proportion of inhaled corticosteroid use among children PMe1 R03 R Li et al. 46 who received (Duration of drug therapy for community-acquired pneumonia) 584 2017 China PMe4 J01 J 3.1 Average number of days of antibiotic treatment Li et al. 46 (Duration of drug therapy for community-acquired pneumonia) 585 2017 China 3.2 Average time of antibiotic treatment for children with PMe4 J01 J Li et al. 46 pleural effusion or empyema (Duration of drug therapy for community-acquired pneumonia) 586 2017 China PMe4 J05 J 3.3 Average number of days of antiviral agent use Li et al. 46 (Duration of drug therapy for community-acquired pneumonia) 587 2017 China PMe4 H02 H 3.4 Average duration of systemic use Li et al. 46 Number of children who received antibiotics/ total number of 588 46 2017 China PMe1 J01 J Li et al. children x 100% Number of children who received broad-spectrum antibiotics 589 2017 China after the identification of pathogens/ number of children PMe1 J01 J Li et al. 46 identified the pathogens x 100% Number of children who received macrolide 590 2017 China PMe1 J01 J antibiotics/number of children who received antibiotics x 100% Li et al. 46 Number of children who received antibiotics combination 591 2017 China PMe1 J01 J therapy/number of children who received antibiotics x 100% Li et al. 46 Number of children who received macrolide antibiotics 592 2017 China combined with b-lactam antibiotics/number of children who PMe1 J01 J Li et al. 46 received antibiotics combination therapy x 100% Number of children who received third-generation 593 2017 China cephalosporin antibiotics/number of children who received PMe1 J01 J Li et al. 46 antibiotics x 100% Number of children who underwent a microbiological 594 2017 China examination before antibiotics therapy/number of children who PMe7 J01 J Li et al. 46 received antibiotics x 100% AUD was defined as DDDs per 100 patient days: total antibiotics consumption (cumulative DDD amount)/(average 595 2017 China PMe1 J01 J length of hospital stay x total number of patients (person-time) discharged from the hospital over the same time period) x 100 Li et al. 46 Total macrolide antibiotics consumption (cumulative DDD amount)/(average length of hospital stay x total number of 596 2017 China PMe1 J01 J patients (person-time) discharged from the hospital over the Li et al. 46 same time period) x 100% Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Total third-generation cephalosporin antibiotics consumption (cumulative DDD amount)/(average length of hospital stay x 597 2017 China PMe1 J01 J total number of patients (person-time) discharged from the hospital over the same time period) x 100% Li et al. 46 Number of children who received antibiotics administered 598 2017 China intravenously/number of children who received antibiotics x PMe2 J01 J Li et al. 46 100% Number of children who received sequential therapy/ number 599 46 2017 China PMe1 J01 J Li et al. of children who received antibiotics x 100% Total number of days of antibiotic treatment/number of 600 46 2017 China PMe4 J01 J Li et al. children who received antibiotics Total number of days of antibiotics treatment for children with 601 2017 China pleural effusion or empyema/number of children with pleural PMe4 J01 J Li et al. 46 effusion or empyema Number of children who received antiviral agents/total number 602 46 2017 China PMe1 J05 J Li et al. of children x 100% Number of children who received antibiotics combined with 603 46 2017 China PMe1 J01 J05 J Li et al. antiviral drugs/total number of children x 100% Number of children who received antiviral drugs administered 604 2017 China intravenously/number of children who received antiviral agents PMe2 J05 J Li et al. 46 x 100% Total number of days of antiviral drugs use/number of children 605 46 2017 China PMe4 J05 J Li et al. who received antiviral agents Number of children who received an injection of traditional 606 2017 China Chinese medicines/number of children who received PGe2N/A N/A Li et al. 46 traditional Chinese medicines x 100% Number of children with fever received acetaminophen or 607 2017 China ibuprofen/number of children who received antipyretics x PMe1 M01 M02 N02 MN Li et al. 46 100% Number of children who received inhaled 608 2017 China corticosteroids/number of children who received PMe1 R03 R Li et al. 46 glucocorticoids x 100% Total number of days of systemic glucocorticoid use/number 609 2017 China PMe4 H02 H of children who received systemic corticosteroid therapy Li et al. 46 Proportion of clinical stage III non-small cell lung cancer 610 2017 China patients for which a skeletal scintigraphy and a CT or MRI of PMe1 L01 L the brain is done before the initiation of combination therapy Wang et al. 47 Proportion of non-small cell lung cancer patients who receive 611 2017 China epidermal growth factor receptor test before combination PMe7 L01 L Wang et al. 47 therapy Proportion of non-small cell lung cancer patients staging IB to 612 2017 China II who receive lobectomy with adjuvant chemotherapy or PMe1 L01 L Wang et al. 47 lobectomy only Proportion of non-small cell lung cancer patients with stage 613 2017 China IIA, IIB or ΙΙΙA who receive adjuvant chemotherapy after PMe1 L01 L Wang et al. 47 curative resection Proportion of non-small cell lung cancer patients with stage IIA, IIB or ΙΙΙA who receive cisplatin-based adjuvant 614 2017 China PMe1 L01 L chemotherapy within 3 to 4 weeks after undergoing curative Wang et al. 47 resection Proportion of non-small cell lung cancer patients staging ΙΙΙB 615 2017 China with malignant effusion or Ις who receive first-line PMe1 L01 L Wang et al. 47 chemotherapy Proportion of non-small cell lung cancer patients staging ΙΙΙBor Ις who receive imaging study to assess response of 616 2017 China PMe7 L01 L chemotherapy at least once before the completion of four Wang et al. 47 cycles Proportion of locally advanced non-small cell lung cancer 617 47 2017 China PMe1 L01 L Wang et al. patients who receive neo-adjuvant chemotherapy Proportion of locally advanced non-small cell lung cancer 618 2017 China patients with performance status 0 or 1 who receive PMe1 L01 L Wang et al. 47 combination therapy Proportion of non-small cell lung cancer patients staging IA 619 2017 China who are recommend adjuvant chemotherapy after curative PMe5 L01 L Wang et al. 47 resection (lower score: better) Rate of prompt provision of painkillers to patients with severe 620 48 2018 China PMe1 N02 N Ju et al. pain 621 Ju et al. 48 2018 China Rate of drug delivery errors P Ge 6 N/A N/A Time compliance rate for beta-2 receptor agonist and 622 48 2018 China PMe5 R03 R Ju et al. bronchodilator treatment in acute severe asthma patients Percentage of patients with severe or infectious 623 2018 China shock who receive broad-spectrum antibiotics within 1 hour PMe15 B01 B Ju et al. 48 after a definite diagnosis 624 Ju et al. 48 2018 China First aid medication compliance rate P Ge 1 N/A N/A (Emergency plan in home environment) Being equipped with 625 2018 China medication and supplies for first aid according to specific S Ge 6 N/A N/A Tang et al. 49 situations (Patients with acute pharyngotonsillitis) Number of patients Number of patients with a positive Strep A test treated with 626 50 2017 Denmark PMe1J01 J Saust et al. with a positive Strep A test antibiotics (Patients with acute pharyngotonsillitis) Number of patients Number of patients fulfilling 0–1 modified Centor criterion 627 50 2017 Denmark PMe1J01 J Saust et al. fulfilling 0–1 modified Centor criterion treated with antibiotics (Patients with acute pharyngotonsillitis) Number of generally Number of generally affected patients fulfilling 4–5 modified 628 2017 Denmark PMe1J01 J affected patients fulfilling 4–5 modified Centor criteria Centor criteria treated with antibiotics Saust et al. 50 (Patients with acute otitis media) Number of patients <6 629 50 2017 Denmark Number of patients <6 months treated with antibiotics PMe1J01 J Saust et al. months (Patients with acute otitis media) Number of patients >6 Number of patients >6 months with no signs of fluid in the 630 50 2017 Denmark PMe1J01 J Saust et al. months with no signs of fluid in the middle ear middle ear treated with antibiotics (Patients with acute otitis media) Number of patients >6 Number of patients >6 months with ≦3 days of acute ear pain 631 2017 Denmark months with ≦3 days of acute ear pain and no signs of fluid in PMe1J01 J and no signs of fluid in the middle ear treated with antibiotics Saust et al. 50 the middle ear 632 Saust et al. 50 2017 Denmark (Patients with acute rhinosinusitis) Number of patients Number of patients treated with antibiotics PMe1J01 J (Patients with acute rhinosinusitis) Number of patients with a Number of patients with a CRP test <10 mg/l treated with 633 50 2017 Denmark PMe1J01 J Saust et al. CRP test <10 mg/l antibiotics Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Patients with acute rhinosinusitis) Number of patients fulfilling Number of patients fulfilling less than three diagnostic criteria 634 50 2017 Denmark PMe1J01 J Saust et al. less than three diagnostic criteria treated with antibiotics (Patients with acute rhinosinusitis) Number of patients fulfilling Number of patients fulfilling three or more diagnostic criteria 635 50 2017 Denmark PMe1J01 J Saust et al. three or more diagnostic criteria treated with antibiotics (Patients with acute rhinosinusitis) Number of patients with <5 Number of patients with <5 days symptom duration treated 636 50 2017 Denmark PMe1J01 J Saust et al. days symptom duration with antibiotics 637 Saust et al. 50 2017 Denmark (Patients with acute bronchitis) Number of patients Number of patients treated with antibiotics PMe1J01 J (Patients with acute bronchitis) Number of patients with Number of patients with purulent expectorate treated with 638 50 2017 Denmark PMe1J01 J Saust et al. purulent expectorate antibiotics 639 Saust et al. 50 2017 Denmark (Patients with pneumonia) Number of patients Number of patients treated with antibiotics PMe1J01 J (Patients with pneumonia) Number of patients <65 years Number of patients <65 years fulfilling less than diagnostic 640 50 2017 Denmark PMe1J01 J Saust et al. fulfilling less than two diagnostic criteria criteria treated with antibiotics (Patients with acute exacerbation of COPD) Number of Number of patients fulfilling 2 - 3 Anthonisen criteria treated 641 50 2017 Denmark PMe1J01 J Saust et al. patients fulfilling 2 - 3 Anthonisen criteria with antibiotics (Patients with acute exacerbation of severe (class C–D) 642 50 2017 Denmark Number of patients treated with antibiotics PMe1J01 J Saust et al. COPD) Number of patients (Patients with acute exacerbation of mild–moderate (class Number of patients with a CRP test <10 mg/l and/or absence A–B) COPD) Number of patients with a CRP test <10 mg/l 643 2017 Denmark of fever fulfilling less than two Anthonisen criteria treated with PMe1J01 J and/or absence of fever fulfilling less than two Anthonisen antibiotics Saust et al. 50 criteria (Patients with acute respiratory tract infection) Number of Number of patients prescribed antibiotics by telephone 644 50 2017 Denmark PMe1J01 J Saust et al. patients treated with antibiotics consultation For patients prescribed antihypertensive medication for 645 2008 Europe diagnosed hypertension there is a record of blood pressure at PMe7 C02C03C07C08C09 C Campbell et al. 51 least once in the last 15 months. All patients with a record of persistent blood pressure 646 2008 Europe elevation of >160/100mmHg are offered drug therapy to PMe1 C02C03C07C08C09 C Campbell et al. 51 reduce their blood pressure. All patients with CVD (CHD, stroke, TIA or PVD) are offered a 647 2008 Europe PMe1 C10 C Campbell et al. 51 statin. For patients with CVD (CHD, stroke, TIA or PVD) or after a cerebrovascular ischaemic event, there is a record that anti- 648 2008 Europe PMe13 B01 B platelet therapy (aspirin, clopidogrel or equivalent) at least Campbell et al. 51 75mg daily has been offered unless contraindicated. For patients who have heart failure there is a record that an 649 2008 Europe PMe1 C09 C Campbell et al. 51 angiotensin-converting enzyme-I has been offered. For patients who had a myocardial infarction there is a record 650 2008 Europe that a b-blocker has been offered (unless a contraindication or PMe1 C07 C Campbell et al. 51 side-effects is recorded). Drug therapies are offered in all patients with sustained (on more than three occasions) systolic blood pressure (BP) more than or equal to 160mmHg or sustained diastolic BP more 651 2008 Europe PMe1 C02C03C07C08C09 C than or equal to 100mmHg despite up to 6 months of non- pharmacological measures, unless contraindicated or Campbell et al. 51 intolerant. All patients at high risk (e.g. chronic respiratory disease, established CVD, chronic heart disease, chronic renal failure, diabetes, immunosuprression of any cause, residents of 652 2008 Europe PMe1 J07 J nursing homes etc, anyone aged above 65 years) are offered influenza vaccination in the preceding influenza season (e.g. 1 September– 31 March or 1 September–31 December). Campbell et al. 51 The medical record contains details of current actual 653 2008 Europe P Ge 9 N/A N/A Campbell et al. 51 prescribed medication. The medical record contains information about intolerances 654 2008 Europe P Ge 9 N/A N/A Campbell et al. 51 and contraindications to medication. The percentage of patients aged between 18 and 75 years Number of patients aged between 18 and 75 years diagnosed Number of patients aged between 18 and 75 years diagnosed 655 2011 Europe with acute bronchitis/bronchiolitis (ICPC-2-R: R78) prescribed PMe1 J01 J Adriaenssens et with R78 with R78 prescribed J01 x 100 antibacterials for systemic use (ATC: J01) [R78_J01_%] al. 52 The percentage of patients aged between 18 and 75 years with acute bronchitis/bronchiolitis (ICPC-2-R: R78) prescribed Number of patients aged between 18 and 75 years diagnosed Number of patients aged between 18 and 75 years diagnosed 656 2011 Europe antibacterials for systemic use (ATC: J01) receiving the PMe1 J01 J with R78 prescribed J01 with R78 prescribed J01CA or J01AA x 100 Adriaenssens et recommended antibacterials (ATC: J01CA or J01AA) al. 52 [R78_RECOM_%] The percentage of patients aged between 18 and 75 years with acute bronchitis/bronchiolitis (ICPC-2-R: R78) prescribed Number of patients aged between 18 and 75 years diagnosed Number of patients aged between 18 and 75 years diagnosed 657 2011 Europe antibacterials for systemic use (ATC: J01) receiving PMe1 J01 J with R78 prescribed J01 with R78 prescribed J01M x 100 Adriaenssens et quinolones (ATC: J01M) [R78_J01M_%] al. 52 The percentage of patients older than 1 year with acute upper Number of patients older than 1 year diagnosed with R74 658 Adriaenssens et 2011 Europe Number of patients older than 1 year diagnosed with R74 respiratory infection (ICPC-2-R: R74) prescribed antibacterials PMe1 J01 J prescribed J01 x 100 al. 52 for systemic use (ATC: J01) [R74_J01_%] The percentage of patients older than 1 year with acute upper Number of patients older than 1 year diagnosed with R74 Number of patients older than 1 year diagnosed with R74 respiratory infection (ICPC-2-R: R74) prescribed antibacterials 659 2011 Europe PMe1 J01 J Adriaenssens et prescribed J01 prescribed J01CE x 100 for systemic use (ATC: J01) receiving the recommended antibacterials (ATC: J01CE) [R74_RECOM_%] al. 52 The percentage of patients older than 1 year with acute upper Number of patients older than 1 year diagnosed with R74 Number of patients older than 1 year diagnosed with R74 respiratory infection (ICPC-2-R: R74) prescribed antibacterials 660 2011 Europe PMe1 J01 J Adriaenssens et prescribed J01 prescribed J01M x 100 for systemic use (ATC: J01) receiving quinolones (ATC: al. 52 J01M) [R74_J01M_%] The percentage of female patients older than 18 years with Number of female patients older than 18 years diagnosed with 661 Adriaenssens et 2011 Europe Number of female U71 patients older than 18 years cystitis/other urinary infection (ICPC-2-R: U71) prescribed PMe1 J01 J U71 prescribed J01 x 100 al. 52 antibacterials for systemic use (ATC: J01) The percentage of female patients older than 18 years with cystitis/other urinary infection (ICPC-2-R: U71) prescribed Number of female patients older than 18 years diagnosed with Number of female patients older than 18 years diagnosed with 662 2011 Europe antibacterials for systemic use (ATC: J01) receiving the PMe1 J01 J U71 prescribed J01 U71 prescribed J01XE or J01EA or J01XX x 100 Adriaenssens et recommended antibacterials (ATC: J01XE or J01EA or al. 52 J01XX) [U71_RECOM_%] The percentage of female patients older than 18 years with Number of female patients older than 18 years diagnosed with Number of female patients older than 18 years diagnosed with cystitis/other urinary infection (ICPC-2-R: U71) prescribed 663 2011 Europe PMe1 J01 J Adriaenssens et U71 prescribed J01 U71 prescribed J01M x 100 antibacterials for systemic use (ATC: J01) receiving al. 52 quinolones (ATC: J01M) [U71_J01M_%] The percentage of patients older than 1 year with acute Number of patients older than 1 year diagnosed with R76 664 Adriaenssens et 2011 Europe Number of patients older than 1 year diagnosed with R76 tonsillitis (ICPC-2-R: R76) prescribed antibacterials for PMe1 J01 J prescribed J01 x 100 al. 52 systemic use (ATC: J01) [R76_J01_%] Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka The percentage of patients older than 1 year with acute Number of patients older than 1 year diagnosed with R76 Number of patients older than 1 year diagnosed with R76 tonsillitis (ICPC-2-R: R76) prescribed antibacterials for 665 2011 Europe PMe1 J01 J Adriaenssens et prescribed J01 prescribed J01CE x 100 systemic use (ATC: J01) receiving the recommended al. 52 antibacterials (J01CE) [R76_RECOM_%] The percentage of patients older than 1 year with acute Number of patients older than 1 year diagnosed with R76 Number of patients older than 1 year diagnosed with R76 tonsillitis (ICPC-2-R: R76) prescribed antibacterials for 666 2011 Europe PMe1 J01 J Adriaenssens et prescribed J01 prescribed J01M x 100 systemic use (ATC: J01) receiving quinolones (ATC: J01M) al. 52 [R76_J01M_%] The percentage of patients older than 18 years with Number of patients older than 18 years diagnosed with R75 667 Adriaenssens et 2011 Europe Number of patients older than 18 years diagnosed with R75 acute/chronic sinusitis (ICPC-2-R: R75) prescribed PMe1 J01 J prescribed J01 x 100 al. 52 antibacterials for systemic use (ATC: J01) [R75_J01_%] The percentage of patients older than 18 years with acute/chronic sinusitis (ICPC-2-R: R75) prescribed Number of patients older than 18 years diagnosed with R75 Number of patients older than 18 years diagnosed with R75 668 2011 Europe antibacterials for systemic use (ATC: J01) receiving the PMe1 J01 J prescribed J01 prescribed J01CA or J01CE x 100 Adriaenssens et recommended antibacterials (ATC: J01CA or J01CE) al. 52 [R75_RECOM_%] The percentage of patients older than 18 years with Number of patients older than 18 years diagnosed with R75 Number of patients older than 18 years diagnosed with R75 acute/chronic sinusitis (ICPC-2-R: R75) prescribed 669 2011 Europe PMe1 J01 J Adriaenssens et prescribed J01 prescribed J01M x 100 antibacterials for systemic use (ATC: J01) receiving al. 52 quinolones (ATC: J01M) [R75_J01M_%] The percentage of patients older than 2 years with acute otitis Number of patients older than 2 years diagnosed with H71 670 Adriaenssens et 2011 Europe Number of patients older than 2 years diagnosed with H71 media/myringitis (ICPC-2-R: H71) prescribed antibacterials for PMe1 J01 J prescribed J01 x 100 al. 52 systemic use (ATC: J01) [H71_J01_%] The percentage of patients older than 2 years with acute otitis Number of patients older than 2 years diagnosed with H71 Number of patients older than 2 years diagnosed with H71 media/myringitis (ICPC-2-R: H71) prescribed antibacterials for 671 2011 Europe PMe1 J01 J Adriaenssens et prescribed J01 prescribed J01CA or J01CE x 100 systemic use (ATC: J01) receiving the recommended antibacterials (ATC: J01CA or J01CE) [H71_RECOM_%] al. 52 The percentage of patients older than 2 years with acute otitis Number of patients older than 2 years diagnosed with H71 Number of patients older than 2 years diagnosed with H71 media/myringitis (ICPC-2-R: H71) prescribed antibacterials for 672 2011 Europe PMe1 J01 J Adriaenssens et prescribed J01 prescribed J01M x 100 systemic use (ATC: J01) receiving quinolones (ATC: J01M) al. 52 [H71_J01M_%] The percentage of patients aged between 18 and 65 years Number of patients aged between 18 and 65 years diagnosed Number of patients aged between 18 and 65 years diagnosed 673 Adriaenssens et 2011 Europe with pneumonia (ICPC-2-R: R81) prescribed antibacterials for PMe1 J01 J with R81 with R81 prescribed J01 x 100 al. 52 systemic use (ATC: J01) [R81_J01_%] The percentage of patients aged between 18 and 65 years Number of patients aged between 18 and 65 years diagnosed Number of patients aged between 18 and 65 years diagnosed with pneumonia (ICPC-2-R: R81) prescribed antibacterials for 674 2011 Europe PMe1 J01 J Adriaenssens et with R81 prescribed J01 with R81 prescribed J01CA or J01AA x 100 systemic use (ATC: J01) receiving the recommended al. 52 antibacterials (ATC: J01CA or J01AA) [R81_RECOM_%] The percentage of patients aged between 18 and 65 years Number of patients aged between 18 and 65 years diagnosed Number of patients aged between 18 and 65 years diagnosed with pneumonia (ICPC-2-R: R81) prescribed antibacterials for 675 2011 Europe PMe1 J01 J Adriaenssens et with R81 prescribed J01 with R81 prescribed J01M x 100 systemic use (ATC: J01) receiving quinolones (ATC: J01M) al. 52 [R81_J01M_%] Number of patients with RA and a tuberculosis screening If a patient is diagnosed with RA and therapy with a biologic All patients with RA who has started with biologic DMARD 676 2014 Europe performed and results interpreted before starting therapy with DMARD is prescribed then a tuberculosis screening should be PMe7 L04 L Petersson et therapy over the past 12 months. a biologic DMARD over the past 12 months. performed and results interpreted before therapy start. al. 53 677 2013 France Total number of women who delivered vaginally Number of women with epidural analgesia use P Me 1 N02 N Boulkedid et al. 54 Number of women given blood transfusions during and/or 678 2013 France Total number of women delivered PMe1 B05 B Boulkedid et al. 54 after delivery (delivery related blood loss .1500 mL) 679 2014 Germany Patients with stage I-III malignant melanoma Patients with adjuvant systemic chemotherapy / P Me 1 L01 L Follmann et al. 55 680 2014 Germany Patients with stage I-IIIB malignant melanoma Patients with adjuvant extremity perfusion P Me 1 L01 L Follmann et al. 55 Patients with stage IV malignant melanoma with a BRAF 681 2014 Germany Patients in whom BRAF-inhibitor therapy has been initiated P Me 1 L01 L Follmann et al. 55 inhibitor- sensitive mutation (Conservative and surgical treatments) Usage of systemic 682 2017 Germany PMe1 J01 J antibiotics in dental treatments without indication for antibiotics Hussein et al. 56 (Conservative and surgical treatments) Usage of systemic 683 56 2017 Germany PMe1 J01 J Hussein et al. antibiotics in teeth extractions (Conservative and surgical treatments) Usage of systemic 684 56 2017 Germany PMe1 J01 J Hussein et al. antibiotics in root canal treatments (Conservative and surgical treatments) Usage of systemic 685 56 2017 Germany PMe1 J01 J Hussein et al. antibiotics in sharp tooth edges (Conservative and surgical treatments) Usage of systemic 686 56 2017 Germany PMe1 J01 J Hussein et al. antibiotics in measures to preserve tooth vitality (Conservative and surgical treatments) Usage of systemic 687 56 2017 Germany PMe1 J01 J Hussein et al. antibiotics in minor surgical interventions (Conservative and surgical treatments) Usage of systemic 688 56 2017 Germany PMe1 J01 J Hussein et al. antibiotics when measuring Periodontal Screening Index (Conservative and surgical treatments) Usage of systemic 689 56 2017 Germany PMe1 J01 J Hussein et al. antibiotics in Local medical treatment (Conservative and surgical treatments) Usage of systemic 690 56 2017 Germany PMe1 J01 J Hussein et al. antibiotics in filling (Conservative and surgical treatments) Usage of systemic 691 56 2017 Germany PMe1 J01 J Hussein et al. antibiotics in removal of calculus (Use of antibiotics in dental treatments) Percentage of 692 56 2017 Germany PMe1 J01 J Hussein et al. prescriptions in dental treatments (Use of antibiotics in dental treatments) Percentage of 693 56 2017 Germany PMe1 J01 J Hussein et al. prescriptions in dental treatments % of persons with a new diagnosis of major depression who 694 2006 International receive at least three medication visits or at least eight PMe4 N06 N Hermann et al. 57 psychotherapy visits in a 12-week period % of persons age 65+ years prescribed using 695 2006 International PMe1 N06 N Hermann et al. 57 an anticholinergic antidepressant drug % of persons age ≥18 years who are diagnosed with a new episode of depression and treated with antidepressant 696 2006 International PMe4 N06 N medication, with an 84-day (12-week acute treatment phase) treatment with antidepressant medication Hermann et al. 57 % of persons age ≥18 years who are diagnosed with a new episode of depression and treated with antidepressant 697 2006 International PMe4 N06 N medication, with a 180-day treatment of antidepressant Hermann et al. 57 medication Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a patient with RA is taking oral corticosteroids, THEN there 698 2015 International should be evidence of intent to taper the corticosteroids or PMe3 H02 H Barber et al. 58 reduce to the lowest possible dose. IF a patient has RA, AND has established CV disease OR is at intermediate or high CV risk AND is taking a nonsteroidal 699 2015 International antiinflammatory drug (or COX-2 inhibitor), THEN a PMe5 M01 M discussion about the potential CV risks should occur and be Barber et al. 58 documented. 700 Wakai et al. 59 2013 Ireland Number of drug errors S Ge 6 N/A N/A Time to antibiotics in children with suspected bacterial 701 59 2013 Ireland PMe5 J01 J Wakai et al. meningitis Time to antibiotics in sepsis of any cause (e.g. due to bacterial 702 59 2013 Ireland PMe5 J01 J Wakai et al. pneumonia, urosepsis, bacterial meningitis) Proportion of children hospitalised for general anaesthesia for 703 2013 Ireland minor procedures where ED-based procedural sedation would PMe8 N01 N Wakai et al. 59 prevent admission 704 Wakai et al. 59 2013 Ireland Time to analgesia in patients with fractured neck of femur P Me 5 N02 N Proportion of patients with moderate/severe abdominal pain 705 59 2013 Ireland PMe5 N02 N Wakai et al. given timely analgesia 706 Wakai et al. 59 2013 Ireland Time to first nebuliser in acute asthma P Me 5 R03 R Proportion of patients with an acute coronary syndrome given 707 59 2013 Ireland PMe1 B01 B Wakai et al. aspirin 708 Wakai et al. 59 2013 Ireland Time to analgesia in children with forearm fractures P Me 5 N02 N Time to first beta-agonist treatment in acute asthma in 709 59 2013 Ireland PMe5 R03 R Wakai et al. children Proportion of patients presenting with asthma exacerbation 710 59 2013 Ireland PMe1 R03 R Wakai et al. treated with beta-agonists Time to antipyretic in children with a temperature greater than 711 59 2013 Ireland PMe5 N02 N Wakai et al. 38.5C if not given in the preceding 6 hours Proportion of patients presenting with asthma exacerbation 712 59 2013 Ireland PMe1 H02 R03 HR Wakai et al. prescribed steroids prior to ED discharge Proportion of elderly patients who received analgesia in the 713 2013 Ireland ED in whom there is documentation of a formal assessment PMe7 N02 N Wakai et al. 59 for the presence of pain before discharge Proportion of ED patients with wounds who have their tetanus 714 2013 Ireland PMe1 J07 J status ascertained and anti-tetanus toxoid administered Wakai et al. 59 (Prehospital emergency care) In patients with ACS, rate of 715 60 2016 Ireland PMe1 B01 B Murphy et al. aspirin administration (Prehospital emergency care) In patients with ACS, rate of 716 60 2016 Ireland PMe1 C01 C Murphy et al. GTN administration (Prehospital emergency care) In patients with ACS, rate of 717 2016 Ireland appropriate administration of analgesia (morphine and/or PMe1 N01 N02 N Murphy et al. 60 ) (Prehospital emergency care) In patients with STEMI, rate of 718 2016 Ireland PMe1 B01 B administration of second-line antiplatelet agent as per CPG Murphy et al. 60 (Prehospital emergency care) Median time to thrombolysis in 719 2016 Ireland patients with STEMI, where time to PCI will exceed 90 PMe5 B01 B Murphy et al. 60 minutes (Prehospital emergency care) In patients suffering from acute 720 2016 Ireland stroke / TIA, rate of documentation of whether or not the PMe1 B01 B Murphy et al. 60 patient is on anticoagulant therapy (Prehospital emergency care) In patients with acute asthma 721 60 2016 Ireland PMe1 R03 R Murphy et al. exacerbations, rate of administration of β2-agonist (Prehospital emergency care) In patients actively seizing, rate 722 60 2016 Ireland PMe1 N03 N Murphy et al. of benzodiazepine administration (Prehospital emergency care) Proportion of patients with 723 2016 Ireland seizures in whom the seizure is terminated by pre-hospital PMe1 N03 N Murphy et al. 60 practitioner administered anticonvulsant therapy (Prehospital emergency care) Rate of pain score 724 60 2016 Ireland PMe7 N02 N Murphy et al. documentation pre- and post-analgesic intervention (Prehospital emergency care) Proportion of patients with 725 60 2016 Ireland PMe1 N02 N Murphy et al. severe pain in whom an opiate analgesic is administered (Prehospital emergency care) In children with seizures, rate of 726 2016 Ireland PMe1 N02 N paracetamol administration where fever is documented Murphy et al. 60 (Prehospital emergency care) In children with acute pain, rate 727 2016 Ireland PMe7 N02 N of pain score assessment pre- and post-analgesic intervention Murphy et al. 60 (Prehospital emergency care) Proportion of children with 728 60 2016 Ireland PMe1 N02 N Murphy et al. severe pain in whom an opiate analgesic is administered (Prehospital emergency care) In patients with ACS, recording 729 60 2016 Ireland PMe7 N02 N Murphy et al. of pain scores (before and after treatment) (Prehospital emergency care) In patients with acute asthma 730 2016 Ireland PMe1 V03 V exacerbations, rate of oxygen administration, as per CPG Murphy et al. 60 (Prehospital emergency care) Rate of appropriate oxygen 731 60 2016 Ireland PMe1 V03 V Murphy et al. use, as per CPG (Prehospital emergency care) Rate of oxygen saturation 732 60 2016 Ireland PMe7 V03 V Murphy et al. documentation pre- and post-oxygen administration (Prehospital emergency care) Rate of oxygen saturation 733 60 2016 Ireland OMe9 V03 V Murphy et al. improvement post oxygen administration (Respiratory system) Intranasal should not be 734 61 2016 Ireland and UK PMe1 R01 R Barry et al. prescribed to children under 6 years. (Respiratory system) Carbocisteine should not be prescribed 735 61 2016 Ireland and UK PMe1 R05 R Barry et al. to children (Respiratory system) An inhaled short-acting β-2 agonist 736 2016 Ireland and UK should be prescribed to all children who are prescribed two or PMe1 R03 R Barry et al. 61 more inhaled corticosteroids for presumed asthma (Respiratory system) An inhaled short-acting β-2 agonist 737 2016 Ireland and UK should be prescribed to children under 5 years who are also PMe1 R03 R taking a leukotriene for presumed asthma. Barry et al. 61 (Respiratory system) An inhaled corticosteroid should be 738 2016 Ireland and UK prescribed to children aged 5–15 years, who are taking a long PMe1 R03 R Barry et al. 61 acting β-2 agonist Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Respiratory system) Children under 12 years who are 739 2016 Ireland and UK prescribed a pressurised metered-dose inhaler should also be PMe5 R03 R prescribed a spacer device at least every 12 months Barry et al. 61 (Gastrointestinal System) Loperamide should not be 740 61 2016 Ireland and UK PMe1 A07 A Barry et al. prescribed to children under 4 years. (Gastrointestinal System) should not be 741 61 2016 Ireland and UK PMe1 A03 J01 AJ Barry et al. prescribed concomitantly with . (Dermatological system) An emollient should be prescribed to 742 2016 Ireland and UK children who are prescribed greater than one topical PMe1 D02 D07 D Barry et al. 61 corticosteroid in a year. (Dermatological system) should not be 743 61 2016 Ireland and UK PMe1 D06 D Barry et al. prescribed to children under 12 years. (Neurological system) / medications 744 2016 Ireland and UK PMe1 N02 N should not be prescribed to children under 12 years. Barry et al. 61 (Neurological system) Sedating should not be 745 61 2016 Ireland and UK PMe1 R06 R Barry et al. prescribed to children under 2 years. CKD patients with hypertension who satisfied criteria of A and (B or C) A: patients labeled with hypertension (ICD10) 746 2016 Japan Patients on RAS inhibitors P Me 1 C09 C B: CKD patients labeled with diabetes (ICD10) C: non-DM CKD patients with proteinuria Fukuma et al. 62 Patients labeled with hyperkalemia are excluded CKD patients on RAS inhibitor with eGFR <60 ml/min and age Measurement of serum creatinine (or cystatin) and potassium 747 62 2016 Japan PMe7 C09 C Fukuma et al. ≧65 years levels at least once during 3 months No routine use of NSAIDs CKD patients with eGFR<45 ml/min 748 2016 Japan Routine use are defined as NSAIDs prescription ≧14 days PMe1 M01 M Patients labeled with rheumatoid arthritis are excluded Fukuma et al. 62 during the latest 1 month 749 Fukuma et al. 62 2016 Japan Diabetic CKD patients with eGFR<45 ml/ min Patients without biguanide P Me 1 A10 A THEN: Investigate what is causing difficulty in oral dietary intake and explain to the patient the choice in implementing artificial hydration and nutrition, including the choice not to implement it; evaluate the situation from the perspective of the pros and cons for the life of the individual; make the goals clear and choose the best course of action. Do not neglect the (Decision Making for Treatment or Care: Involvement in family situation and living environment in determining the best Selecting or Reconsidering Artificial Hydration and Nutrition) 750 2017 Japan course of action for the individual. In addition, electing to PMe5 B05 B IF:The elderly person is having difficulty with oral dietary implement artificial hydration and nutrition or not should be intake, considered in light of the predictors that render artificial hydration and nutrition ineffective; they include advanced age, severe dementia, hypoalbuminemia, comorbid disease, cancer incidence, recent sepsis, hospitalization history, low nutrition due to difficulty swallowing, doctor predictions regarding poor prognosis, and DNR orders. Masaki et al. 63 THEN: Consider discontinuing or reducing the use of artificial hydration and nutrition. If this seems more beneficial for the (Decision Making for Treatment or Care: Involvement in individual than continuing the current treatment, or if the family Selecting or Reconsidering Artificial Hydration and Nutrition) requests discontinuation, create an opportunity or place to IF: The physical condition of the elderly person worsens, and make a decision based on the will, or assumed will, of the 751 2017 Japan PMe5 B05 B no longer possible to maintain a necessary QOL, and artificial individual, knowing what their most beneficial course of action. hydration and nutrition appears less beneficial for the Specifically, in consultation with family members, medical individual, staff, care providers, and welfare workers, go through a consensus‐building process by looking at the individual's life and deciding on the best course of action for them. Masaki et al. 63

THEN: Assessment of pain is necessary in understanding the experience of physical and emotional pain. When measuring pain, it is important to use current scales. However, it is also necessary to adopt a comprehensive approach, which should include the following: listening to the verbal expressions; noticing in facial expressions; observing changes in actions of daily activity; and keeping in close contact with and exchanging information among other people and (Symptom Management and Pain Relief: Pain Management) 752 2017 Japan professionals, such as caregivers and physical PMe7 M01 M02 N02 MN IF:The elderly patient has pain, therapists. It is also necessary to verify any current medication taken, how the medication works, and such factors as its duration, influence on other organs, and side effects. It is important to confirm that pain control is effective. Depending on the situation or individual needs, provide ways for the patient to keep warm, offer access to entertainment, and consider non‐drug‐related pain management, including massages. Masaki et al. 63 THEN: While checking for associated symptoms and pain, assess the condition of constipation through inspection of the faeces, the amount of food and water intake, medications taken, and visual examination and palpation of the abdomen and anus. Do not simply regard this condition with respect to bowel movement; give priority to alleviation of the patient's pain and discomfort; consider how best to assist in relieving (Symptom Management and Pain Relief: Care for constipation. Such steps as massages, hot fomentation, and 753 2017 Japan Constipation) IF: The elderly patient continually suffers from PMe17 A06 A adding more liquid to the diet may all be considered in this constipation, regard. Provide sufficient support so that they can go to the bathroom on their own; pain management; making physical adjustments to the bathroom; considering new postures that could assist them in going there. If medication is to be used, begin with intestinal regulators (antiflatulents); then try mechanical and finally laxatives for immediate effect. Masaki et al. 63 Infant administered vitamin K three times by one month after 754 64 2017 Japan PMe1 B02 B Ueda et al. birth Medication error made in non-recommended abbreviations, 755 2017 Japan PGe6 N/A N/A symbols or dose designations used in medical prescriptions Ueda et al. 64 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka The availability of intravenous fluids with physiological sodium Low-income 756 2010 concentrations (one or more of: Normal saline, Hartmann’s SMe6 A12 A countries Ntoburi et al. 65 solution, or Ringer’s Lactate) Low-income 757 65 2010 The availability of Epinephrine () for injection S Me 6 C01 C Ntoburi et al. countries Low-income The availability of the locally recommended first line oral 758 65 2010 SMe6 P01 P Ntoburi et al. countries antimalarial in settings where there is malaria Low-income 759 65 2010 The availability of S Me 6 J01 J Ntoburi et al. countries The availability of including Pentavalent vaccine or Low-income 760 2010 DTP or DTP-HepB, BCG polio and measles vaccine in the SMe6 J07 J countries Ntoburi et al. 65 hospital Low-income 761 65 2010 The availability of ORS S Me 6 A07 A Ntoburi et al. countries Availability of mix (containing Cu Zn Se & Mg) for Low-income 762 2010 malnourished children (where ready to use foods for severely SMe6 A12 A countries Ntoburi et al. 65 malnourished children is not available) Low-income 763 65 2010 The availability of a nebuliser for administration of Salbutamol S Me 6 R03 R Ntoburi et al. countries Low-income 764 65 2010 The availability of oral potassium for malnourished children S Me 6 A12 A Ntoburi et al. countries Low-income The availability of all anti-TB drugs needed according to the 765 65 2010 SMe6 J04 J Ntoburi et al. countries national TB control programme Low-income The availability of oral Amoxicillin (or alternative, locally 766 65 2010 SMe6 J01 J Ntoburi et al. countries recommended first line treatment for pneumonia) Low-income 767 65 2010 The availability of a first line anticonvulsant e.g. Diazepam S Me 6 N03 N Ntoburi et al. countries Low-income The availability of the locally recommended second line oral 768 65 2010 SMe6 P01 P Ntoburi et al. countries antimalarial in settings where there is malaria Low-income The availability of the nationally recommended treatment for 769 65 2010 SMe6 J01 J Ntoburi et al. countries dysentery (e.g. oral Ciprofloxacin or Nalidixic acid) Low-income 770 65 2010 The availability of oral Co-trimoxazole S Me 6 J01 J Ntoburi et al. countries The availability of injectable Phenobarbitone for first line Low-income 771 2010 treatment of newborn convulsions and second line treatment SMe6 N03 N countries Ntoburi et al. 65 for infants and children Low-income The availability of first line parenteral antimalarial therapy in 772 65 2010 SMe6 P01 P Ntoburi et al. countries settings where there is malaria Low-income 773 65 2010 The availability of oral Sulphate S Me 6 A12 A Ntoburi et al. countries Low-income The availability of Benzyl penicillin (or where this is 774 65 2010 SMe6 J01 J Ntoburi et al. countries preferred) for injection Low-income The availability of Vitamin K IM injection in a newborn 775 65 2010 SMe6 B02 B Ntoburi et al. countries preparation Low-income Proportion of children with documentation of all doses and 776 65 2010 P Ge 7 N/A N/A Ntoburi et al. countries times medication was given by a nurse Low-income The availability of an antistaphylococcal penicillin e.g. 777 65 2010 SMe6 J01 J Ntoburi et al. countries injectable Flucloxacillin The availability of spacers (either commercially manufactured Low-income or home-made) that are appropriate for locally available 778 2010 SMe6 R03 R countries metered doses (spray) of Salbutamol with masks for Ntoburi et al. 65 administration Low-income 779 65 2010 The availability of syrup/tablets S Me 6 B03 B Ntoburi et al. countries Low-income The availability of a 3rd generation cephalosporin e.g. 780 65 2010 SMe6 J01 J Ntoburi et al. countries Ceftriaxone Low-income 781 65 2010 The availability of vitamin A S Me 6 A11 A Ntoburi et al. countries Proportion of children prescribed IV fluids who have Low-income 782 2010 documentation of volume and time IV fluids were given by a PMe5 V06 V countries Ntoburi et al. 65 nurse Low-income 783 65 2010 The availability of IV Chloramphenical S Me 6 J01 J Ntoburi et al. countries A composite indicator of correct documentation , correct classification and correct treatment (dose, frequency and Low-income 784 2010 route) appropriate to the severity classification for children PMe23 J01 J countries with pneumonia, severe pneumonia and very severe Ntoburi et al. 65 pneumonia The proportion of children with severe or very severe asthma Low-income 785 2010 correctly prescribed an inhaled bronchodilator (including route PMe23 R03 R countries Ntoburi et al. 65 of administration dose and frequency) The proportion of children with severe or very severe asthma Low-income 786 2010 correctly prescribed a steroid (including route of administration PMe23 R03 R countries Ntoburi et al. 65 dose and frequency) The proportion of children requiring oxygen (i.e. children with Low-income cyanosis or other signs of very severe pneumonia/asthma 787 2010 PMe1 V03 V countries including grunting / head nodding / inability to drink or breastfeed / AVPU

IF a vulnerable elder is diagnosed with dementia with recent onset symptoms (2-3 years), THEN the general practitioner should refer the patient to a specialist if: - The diagnosis of dementia cannot be made with certainty; 881 2008 Netherlands - The diagnosis of dementia is clear, but it has a) a PMe9 N06 N conspicuous course; b) conspicuous symptoms; c) indications of deviations which can be treated with specialist treatment. - Medical treatment for Alzheimers disease is wished for. - There is a need for the specialists advice. Ploeg et al. 72 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a vulnerable elder with dementia has a caregiver, THEN the general practitioner should give the patient and/or caregiver information on the following: - Dementia diagnosis, prognosis, and associated behavioral symptoms; - Home occupational safety; 882 2008 Netherlands PMe5 A03N04R03S01 ANRS - Suitability to drive a vehicle; - Community resources; - Possibility of medication with cholinesterase inhibitors or other agents that might affect dementia symptoms or course without affording cure; Ploeg et al. 72 - Care/ help for the informal caregiver. IF a vulnerable elder with dementia is treated for psychotic affective disorder and/or behavioral problems, THEN the general practitioners record should contain documentation 883 2008 Netherlands PMe7 N06 N that a psycho-social intervention was tried first/concurrently, OR if treated first with a pharmacologic intervention that the Ploeg et al. 72 problem was severe IF a vulnerable elder with dementia and psychotic affective disorder and/or behavioral problems is newly treated with an 884 2008 Netherlands PMe5 N05 N antipsychotic, THEN there should be a documented risk- Ploeg et al. 72 benefit discussion IF a vulnerable elder is diagnosed with depression, THEN psychotherapy, or antidepressant treatment, should be offered within 2 weeks after diagnosis unless there is documentation 885 2008 Netherlands (e.g. “watchful waiting”) within that period that the patient has PMe1 N06 N improved, or unless the patient has substance abuse or dependence, in which case treatment may wait until six weeks after the patient is in a drug or alcohol free state Ploeg et al. 72 IF a diabetic vulnerable elder does not have established renal 886 2008 Netherlands disease and is not receiving an ACEI or ARB, THEN a test for PMe7 C09 C Ploeg et al. 72 creatinine clearance should be done annually IF a diabetic vulnerable elder has a persistent (on 2 consecutive visits) elevation of systolic BP >140 mm Hg, THEN the general practitioner should initiate an intervention 887 2008 Netherlands PMe1 C02C03C07C08C09 C (pharmacologic, lifestyle, compliance, etc.) or there should be documentation of a reversible cause/other justification for the elevation or a reason why an intervention was not done Ploeg et al. 72 IF a vulnerable elder dies with a progressive incurable disease (for example metastatic cancer, or dementia) THEN there should be evidence within 6 months prior to death that they received a comprehensive assessment including: - Pain; - Anxiety, depression; 888 2008 Netherlands - Vomiting and dyspnea; P Ge 7 N/A N/A - Spiritual and existential concerns; - Caregiver burdens/need for practical assistance; - Wishes concerning medical treatment and care at the end of life; - A discussion about and if possible the determination of a surrogate decision maker. Ploeg et al. 72 IF a vulnerable elder with metastatic cancer or oxygen dependent pulmonary disease has dyspnea refractory to non- 889 2008 Netherlands PMe1 N02 N opiate medications, THEN opiate medications should be Ploeg et al. 72 offered IF a vulnerable elder reports a history of ≧ 2 falls (or 1 fall for which the elder visits the general practitioner) in the past year, THEN the general practitioner should document a basic fall history (including type and circumstances of the falls, and 890 2008 Netherlands P Ge 7 N/A N/A possible contributing factors like medication, chronic conditions, alcohol intake) within 3 months of the reported history (or within 4 weeks, if the most recent fall occurred in Ploeg et al. 72 the past 4 weeks) IF a vulnerable elder reports a history of ≧ 2 falls (or 1 fall for which the elder visits the general practitioner) in the past year 891 2008 Netherlands and is taking a benzodiazepine, THEN the general practitioner PMe5 N05 N should document a discussion of related risks and assistance offered to reduce/discontinue benzodiazepine use Ploeg et al. 72 IF a vulnerable elder is prescribed a drug, THEN the 892 72 2008 Netherlands P Ge 1 N/A N/A Ploeg et al. prescribed drug should have a clearly defined indication IF a vulnerable elder is prescribed a drug, THEN the 893 2008 Netherlands vulnerable elder (or a caregiver) should receive appropriate P Ge 5 N/A N/A Ploeg et al. 72 education about its use ALL vulnerable elders should have an up-to-date medication list readily available in the general practitioners record, 894 2008 Netherlands P Ge 9 N/A N/A accessible by all healthcare providers, and including, if known, over-the-counter medications Ploeg et al. 72 IF a vulnerable elder is prescribed an ongoing medication for 895 2008 Netherlands a chronic medical condition, THEN there should be a P Ge 7 N/A N/A Ploeg et al. 72 documentation of response to therapy ALL vulnerable elders should have an annual drug regimen 896 72 2008 Netherlands P Ge 7 N/A N/A Ploeg et al. review IF a vulnerable elder is prescribed an oral anticoagulant by 897 2008 Netherlands the Dutch Thrombosis Service or otherwise, THEN this should PMe7 B01 B be clearly marked in the general practitioners record Ploeg et al. 72 IF a vulnerable elder is prescribed an ACEI, THEN s/he 898 2008 Netherlands should have serum creatinine and potassium monitored within PMe7 C09 C 2 weeks after initiation of therapy and at least yearly thereafter Ploeg et al. 72 IF a vulnerable elder is prescribed a loop diuretic, THEN s/he 899 2008 Netherlands should have electrolytes checked within 2 weeks after PMe7 C03 C Ploeg et al. 72 initiation and at least yearly thereafter Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a vulnerable elder is taking a benzodiazepine (>2 weeks), THEN the general practitioner should stop or taper this 900 2008 Netherlands PMe4 N05 N treatment, unless documented discussion with the patient Ploeg et al. 72 provides counterarguments ALL vulnerable elders should not be prescribed any 901 2008 Netherlands medication with strong anticholinergic effects if alternatives PMe1 A03 A04 G04 M03 N02 N04 N05 N06 R06 S01 A G M N R S Ploeg et al. 72 are available IF a vulnerable elder is started on an antipsychotic drug, 902 2008 Netherlands THEN the general practitioner should document a first PMe7 N05 N Ploeg et al. 72 assessment of response within 1 week IF a vulnerable elder is prescribed a NSAID (non- selective or 903 2008 Netherlands selective), THEN the general practitioner should document a PMe5 M01 M02 M discussion or consideration of gastrointestinal bleeding risks Ploeg et al. 72 IF a vulnerable elder is prescribed low-dose (＜ 325 mg/day) aspirin, THEN the general practitioner should consider the 904 2008 Netherlands PMe5 N02 N associated gastrointestinal bleeding risks and advise the Ploeg et al. 72 vulnerable elder accordingly IF a vulnerable elder is prescribed chronic high-dose acetaminophen (≥ 3 grams/day) OR a vulnerable elder with 905 2008 Netherlands PMe5 N02 N liver disease is prescribed chronic acetaminophen THEN s/he Ploeg et al. 72 should be advised of the risk of liver toxicity IF a vulnerable elder is prescribed an NSAID, THEN the GP record should indicate whether or not s/he has a history of 1) 906 2008 Netherlands gastrointestinal bleeding or ulcers and 2) renal insufficiency or PMe7 M01 M02 M 3) heart failure AND, if a history is present, the general practitioner should document justification of NSAID use Ploeg et al. 72 IF a vulnerable elder is treated with a NSAID, THEN s/he 907 2008 Netherlands should be treated concomitantly with either misoprostol or a PMe1 A02 M01 M02 AM Ploeg et al. 72 proton pump inhibitor IF a vulnerable elder is treated with daily NSAIDs (selective or nonselective) AND the vulnerable elder has risk factors for 908 2008 Netherlands developing renal insufficiency, THEN serum creatinine should PMe7 M01 M02 M be assessed at baseline and at least once in the first year Ploeg et al. 72 following the initiation of therapy ALL vulnerable elders in stable health states should take 800 909 72 2008 Netherlands PMe1 A11 A Ploeg et al. IU (or equivalent) of vitamin D supplementation daily IF a vulnerable elders has involuntary weight loss of ≥10% in ≦1 year or hypoalbuminemia (< 3.5 g/dl), THEN s/he should be evaluated for potentially relevant comorbid conditions, including assessment of: - Medications associated with decreased appetite (e.g., digoxin, SSRIs, amphetamines); 910 2008 Netherlands PMe7 C01 N06 CN - Depression; - Cognitive impairment; - Thyroid function; - Cancer, diabetes, malabsorption (e.g., exam of lymph nodes, breast, abdomen, prostate; CBC, erythrocyte sedimentation Ploeg et al. 72 rate, and comprehensive metabolic panel). IF a patient meets one of the following criteria, THEN the general practitioner should refer the patient to a multidisciplinary memory clinic. 1. Uncertainty about the diagnosis 2. Dementia diagnosis was made, and patients showed the following characteristics. a. The course of the dementia was stepwise or rapidly progressive. b. Characteristics that suggest rare types of dementia, like 911 2010 Netherlands PMe9 N06 N focal of frontal features or visual hallucinations in early stages of the dementia c. Symptoms or results that suggest disorders that can only be treated by a specialist d. Patient younger than 65 3. Patients or caregivers wish to start pharmacological treatment to ease dementia symptoms (cholinesterase inhibitors) Perry et al. 73 4. Patient’s or caregiver’s request to confirm the diagnosis IF a dementia diagnosis has been made, THEN the general practitioner should formally bring the cognitive evaluation to a close, reviewing the following items. 1. Explicit disclosure of the diagnosis 2. Information about the prognosis 912 2010 Netherlands PMe7 N06 N 3. Offering leaflets, written information on dementia 4. Suggestions on home care 5. Information on possibilities of treatment in dementia Perry et al. 73 6. Driving abilities Percentage of patients (children aged 1 year or older) with 913 2011 Netherlands constipation that received or as PMe1 A06 A Stienen et al. 74 initial or maintenance treatment Percentage of patients (children younger than 1 year) with 914 2011 Netherlands constipation that received lactulose as initial or maintenance PMe1 A06 A Stienen et al. 74 treatment treatment Percentage of patients that received laxatives for at least 2 915 74 2011 Netherlands PMe4 A06 A Stienen et al. months ALL diabetic elders with elevated blood pressure (SBP>140 mmHg) should be offered one of the following drugs (in order 916 2011 Netherlands PMe1 C03C07C08C09 C of choice) as an antihypertensive treatment: diuretic, calcium inhibitor, ACEI, AT2 receptor blocker or beta receptor blocker Wierenga et al. 75 IF an elder is diagnosed with delirium and a pharmacologic intervention is needed, THEN haloperidol (0.25 - 2.5 mg once 917 2011 Netherlands or twice daily) should be the first-line treatment option PMe13 N05 N UNLESS there is a known contraindication such as Parkinson’s disease or Lewy-bodies dementia Wierenga et al. 75 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a hospitalized elder needs or already uses a NSAID and has one or more solitary risk factors such as age > 70 years or untreated H. pylori or previous ulcer, THEN the patient 918 2011 Netherlands PMe1 A02 M01 M02 AM should receive prophylaxis with either a proton-pump inhibitor in combination with a NSAID or misoprostol in combination Wierenga et al. 75 with a NSAID IF an elder is presented with heart failure with AF without a sufficiently controlled ventricular response OR an elder is presented (or diagnosed in hospital) with heart failure without 919 2011 Netherlands AF but with remaining complaints of heart failure despite PMe1 C01C03C07C09 C treatment with ACEIs, diuretics and beta blockers and/or spironolactone, THEN digoxin treatment should be initiated or Wierenga et al. 75 given ALL elders WITH a TIA and/or a cerebrovascular infarction in their history AND a plasma cholesterol > 5.0 mmol/l OR a LDL 920 2011 Netherlands PMe1 C10 C concentration > 2.5 mmol/l, THEN prophylaxis with cholesterol Wierenga et al. 75 lowering medication should be considered If there are two or more cumulative risk factors present in an elder (age 65-70 years, use of acetylsalicylic acid/anticoagulants, serious rheumatoid arthritis, high dose NSAIDs (> DDD), use of corticosteroids, use of SSRIs, 921 2011 Netherlands PMe1 A02 B01 H02 M01 M02 N06 ABHMN diabetes or heart failure), THEN the physician should consider giving the patient prophylaxis with either a proton-pump inhibitor in combination with a NSAID or misoprostol in Wierenga et al. 75 combination with a NSAID IF an elder had a recent TIA or a non-invalidating stroke due to AF, THEN a prophylaxis should be offered. The first-choice 922 2011 Netherlands treatment is oral anticoagulation aiming at the INR range of PMe13 B01 B 2.5-3.5. If there is a contraindication for oral anticoagulation, Wierenga et al. 75 then aspirin 30-300 mg a day IF an elder has unstable angina or an acute MI, THEN he or 923 2011 Netherlands she should be offered therapy within 12 hours of PMe15 C07 C Wierenga et al. 75 presentation IF an elder admitted to a hospital has dementia complicated by a problematic behavior, THEN a pharmacologic treatment 924 2011 Netherlands PMe1 N06 N should be offered according to ‘flowchart problem behaviour’ if other non-pharmacologic interventions fail Wierenga et al. 75 If an elder has established IHD AND his or her LDL 925 2011 Netherlands cholesterol level > 2.5 mmol/l, THEN he or she should be PMe1 C10 C Wierenga et al. 75 offered cholesterol-lowering medication (statins) IF an elder has heart failure and atrial fibrillation, THEN oral 926 2011 Netherlands anticoagulation should be offered to achieve an INR of 2.5 to PMe1 B01 B Wierenga et al. 75 3.5 ALL diabetic elders with proven cardiovascular disease should 927 2011 Netherlands be offered daily aspirin therapy (80-100 mg per day) OR ELSE PMe13 B01 B an increased risk for cardiovascular complications will exist Wierenga et al. 75 IF a diabetic elder has an LDL level > 2.5 mmol/l, or a total cholesterol level > 4.5 mmol/l, THEN an intervention to lower 928 2011 Netherlands PMe1 C10 C cholesterol (statin) should be considered. This should be Wierenga et al. 75 mentioned in the patient’s record IF an elder is started on or is already treated with an antidepressant medication, and an additional sleeping disorder or fear episodes are present and additional short treatment is started with , THEN short t1/2 benzodiazepines should be used. Benzodiazepines with a 929 2011 Netherlands PMe1 N05 N06 N long t1/2 (diazepam, flurazepam, flunitrazepam, or chlordiazepoxide) should NOT be used OR ELSE there will be an increased risk of falls and fractures, respiratory depression, polyuria and incontinence (due to long half-life Wierenga et al. 75 benzodiazepines) If an elder has established IHD and is not receiving a 930 2011 Netherlands coumarin, THEN he or she should be offered antiplatelet PMe1 B01 B Wierenga et al. 75 therapy consisting of aspirin and/or clopidogrel IF an elder has a newly reported chronic painful condition 931 2011 Netherlands THEN treatment should be offered according to the pain PMe1 M01 M02 N02 MN Wierenga et al. 75 scheme of the WHO pain ladder IF an elder has hypertension and has renal parenchymal disease with a lowered glomerular filtration rate (creatinine > 932 2011 Netherlands PMe1 C09 C 150 µmol/l) or microalbuminuria, THEN therapy with an ACEI Wierenga et al. 75 or AT2 receptor blocker should be offered IF a hospitalized elder is at a very high risk for VTE (one of the following risk factors are present: heart failure, immobility, severe respiratory disease, severe acute , active malignancy, history of VTE, acute neurological diseases or 933 2011 Netherlands PMe1 B01 B inflammatory bowel diseases), THEN the patient should be offered venous thromboembolism prophylaxis with LMWH UNLESS the patient is already taking coumarins or UNLESS it is contraindicated Wierenga et al. 75 IF an elder with chronic pain is treated with opioids, THEN he or she should be offered a laxative OR the medical record 934 2011 Netherlands PMe1 A06 N02 AN should document the potential for constipation or give an Wierenga et al. 75 explanation why bowel treatment is not needed IF a diabetic elder has proteinuria, THEN he or she should be 935 2011 Netherlands PMe1 C09 C offered therapy with an ACEI or an AT2 receptor blocker Wierenga et al. 75 ALL elders diagnosed with delirium and presumed vitamin B 936 2011 Netherlands (B1 and/or B12) deficiency should be offered an adequate PMe1 A11 A Wierenga et al. 75 supplementation IF an elder has had a MI, THEN he or she should be offered a 937 2011 Netherlands PMe1 C07 C Wierenga et al. 75 beta blocker IF an elder is admitted to the hospital with pneumonia, THEN 938 2011 Netherlands the correct antibiotics should be administered within eight PMe15 J01 J Wierenga et al. 75 hours of hospital arrival. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF an elder is taking corticosteroids (≥ 7.5 mg prednisolone or 939 2011 Netherlands equivalent) for more than one month, THEN the patient should PMe1 A11 A12 H02 M05 AHM be offered calcium and vitamin D AND a bisphosphonate Wierenga et al. 75 ALL elders with repeating incidence of blood pressure > 185/95 mmHg in the chronic phase after stroke should be 940 2011 Netherlands PMe1 C03 C07 C offered blood-pressure-lowering treatment consisting of beta blocker and thiazide diuretics as a secondary prevention Wierenga et al. 75 IF an elder has heart failure AND left ventricular ejection fraction of 40% or less (or unknown), THEN he or she should 941 2011 Netherlands PMe1 C03 C09 C be offered an ACEI or an AT2 receptor blocker in combination Wierenga et al. 75 with a diuretic IF an elder had a TIA or non-invalidating stroke and no history of AF, THEN a prophylaxis should be offered. The first choice for treatment is aspirin 38-100 mg a day in combination with 942 2011 Netherlands PMe13 B01 B dipyridamole 200 mg twice daily (slow release). Both are to be given life-long. IF there is a contra-indication for aspirin, THEN Wierenga et al. 75 clopidogrel should be given IF an elder has a new diagnosis of osteoporosis, THEN the use of calcium (when daily diet is insufficient) and vitamin D 943 2011 Netherlands PMe1 A11 A12 A supplements (when exposure to sunlight is scarce) should be Wierenga et al. 75 recommended IF an elder has a new diagnosis of osteoporosis, THEN the 944 2011 Netherlands PMe1 M05 M patient should be offered treatment with bisphosphonates Wierenga et al. 75 IF an elder has heart failure and AF AND he or she has 945 2011 Netherlands documented contra-indications to oral anticoagulation, THEN PMe1 B01 B Wierenga et al. 75 he or she should be offered aspirin IF a diabetic elder has proven cardiovascular disease AND a total cholesterol > 4.5 mmol/l or an LDL cholesterol > 2.5 946 2011 Netherlands mmol/l, THEN medical treatment (statins, aspirin, beta PMe1 B01 C07 C09 C10 BC receptor blocker and ACEIs) should be given unless contra- Wierenga et al. 75 indicated IF an elder has an acute MI or unstable angina, THEN he or she should be given aspirin therapy within one hour of 947 2011 Netherlands PMe135B01 B presentation (300 mg loading dose, 100 mg per day Wierenga et al. 75 continuously) IF an elder is started on a new pharmacological antidepressant treatment during his or her hospital stay, THEN the first-line treatment should be a TCA (preferred are 948 2011 Netherlands PMe1 N06 N or and NOT amitriptyline) or an SSRI (regular sodium concentration check) or venlafaxine or Wierenga et al. 75 IF an elder is diagnosed with delirium and a pharmacological intervention is needed but haloperidol is contra-indicated by Parkinson’s disease or Lewy-bodies dementia or causes too many side-effects, THEN as a second-line treatment, an 949 2011 Netherlands PMe1 N05 N06 N (order of preference: 1) or , 2) risperidone, 3) or the cholinesterase inhibitor rivastigmine) can be considered UNLESS there is a known contra-indication such as cardiovascular disease Wierenga et al. 75 IF an elder has stable heart failure AND a left ventricular ejection fraction of 40% or less, THEN a beta blocker should be offered (recommended beta blockers are carvedilol, 950 2011 Netherlands PMe1 C07 C bisoprolol and metoprolol) UNLESS the patient has a documented contra-indication (for example, uncompensated Wierenga et al. 75 heart failure) IF an elder has valvular or congenital heart disease or an intracardiac valvular prosthesis or hypertrophic cardiomyopathy or mitral valve prolapse with regurgitation or a 951 2011 Netherlands PMe1 J01 J previous episode of endocarditis AND a high-risk procedure is planned, THEN endocarditis prophylaxis should be given Wierenga et al. 75 according to current local guidelines IF an elder receives a diagnosis of acute ischaemic stroke during his or her hospital stay or at admission, THEN 952 2011 Netherlands antiplatelet treatment with aspirin (loading dose of at least 160 PMe134B01 B mg aspirin) within 48 hours after the stroke should be offered Wierenga et al. 75 and continued for at least 14 days IF an elder receives a diagnosis of acute ischaemic stroke during hospital stay or at admission AND has blood pressure 953 2011 Netherlands > 220-230/125-135 mmHg, THEN an intravenous treatment PMe1 B01 C02 C03 C07 C08 C09 BC with blood-pressure-lowering drugs that can be titrated should Wierenga et al. 75 be offered IF oral pharmacological therapy is initiated to treat osteoarthritis in an elder, THEN paracetamol (acetaminophen) 954 2011 Netherlands PMe1 N02 N should be the first drug used, UNLESS there is a documented Wierenga et al. 75 contra-indication IF An elder requires analgesia, THEN meperidine (pethidine) 955 2011 Netherlands should not be used OR ELSE there is risk for severe PMe1 N02 N Wierenga et al. 75 confusion IF an elder has hypertension and pharmacological antihypertensive treatment is initiated, THEN alpha-blocking 956 2011 Netherlands PMe1 C02 C agents such as doxazosin, and terazosin should not Wierenga et al. 75 be used IF an elder is treated for a chronic painful condition, THEN he or she should not be treated with OR ELSE there 957 2011 Netherlands PMe1 M01 M02 M is a risk for gastropathy, neurological side effects and salt and Wierenga et al. 75 water retention IF an elder has cardiac arrhythmias AND therapy with an anti- arrhythmic is started, THEN disopyramide should not be used 958 2011 Netherlands PMe1 C01 C OR ELSE there could be a worsening of heart failure and fluid Wierenga et al. 75 retention and strong anticholinergic effects IF an elder has hypertension and asthma or COPD, THEN 959 2011 Netherlands beta blocker therapy for hypertension should not be used PMe1 C07 C Wierenga et al. 75 UNLESS no other option remains Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF an elder has dementia, THEN a long half-life benzodiazepine such as diazepam, flurazepam, 960 2011 Netherlands PMe1 N05 N flunitrazepam, clorazepate or chlordiazepoxide should not be Wierenga et al. 75 used IF an elder has a history of gout or an acute episode of gout, 961 2011 Netherlands THEN a thiazide diuretic should not be prescribed to treat PMe1 C03 C Wierenga et al. 75 hypertension OR ELSE gout attacks could happen IF an elder has a history of postural hypotension or heart block or glaucoma or urinary retention, THEN a tricyclic 962 2011 Netherlands PMe1 N06 N antidepressant should NOT be used because of the Wierenga et al. 75 anticholinergic effects of TCAs. IF an elder has Parkinson’s disease, THEN a classical 963 2011 Netherlands antipsychotic or metoclopramide should not be used UNLESS PMe1 A03 N05 AN the patient is delirious, THEN clozapine is indicated. Wierenga et al. 75 An elder should not be prescribed a medication with strong anticholinergic effects IF alternatives are available OR ELSE 964 2011 Netherlands PMe1 A03 A04 G04 M03 N02 N04 N05 N06 R06 S01 A G M N R S there is a risk for acute glaucoma, urine retention, constipation Wierenga et al. 75 and delirium. IF an elder has a cardiac, cardiovascular or cerebrovascular disease and a chronic painful condition, THEN he or she 965 2011 Netherlands PMe1 M01 M should NOT be treated with COX-2 selective NSAIDs because of an increased cardiovascular risk long-term. Wierenga et al. 75 IF an elder is treated for a sleeping disorder or for anxiety during his or her hospital stay or at admission, THEN long half- life benzodiazepines (diazepam, flurazepam, flunitrazepam, 966 2011 Netherlands PMe1 N05 N clorazepate or chlordiazepoxide) should NOT be used OR ELSE there is an increased risk of falls and fractures, respiratory depression, polyuria and incontinence. Wierenga et al. 75 IF an elder has heart failure AND left ventricular ejection fraction of 40% or less AND AF, THEN he or she should NOT be treated with a type I anti-arrhythmic agent (disopyramide, kinidine, procainamide, phenytoin, [lignocaine], 967 2011 Netherlands PMe1 C01 C or ) UNLESS an implantable cardioverter-defibrillator is in place. Only (class III) is allowed for treatment of the patient with heart failure and Wierenga et al. 75 AF. IF an elder has heart failure AND left ventricular ejection 968 2011 Netherlands fraction of 40% or less AND no AF, THEN calcium-channel- PMe1 C08 C Wierenga et al. 75 blocking medication should NOT be used. IF an elder is admitted to a hospital for any acute or chronic illness OR for any surgical procedure, THEN the evaluation 969 2011 Netherlands P Ge 7 N/A N/A should include within one day: 1) diagnoses, 2) pre-hospital Wierenga et al. 75 medications and 3) a current therapy plan. IF a new drug is prescribed to an elder on an ongoing basis for a chronic medical condition, THEN the prescribed drug 970 2011 Netherlands P Ge 9 N/A N/A should have a clearly defined indication documented in the Wierenga et al. 75 patient’s record. IF an elder who has been prescribed an ocular therapeutic regimen becomes hospitalized, THEN the regimen should be 971 2011 Netherlands PMe6 S01 S administered in the hospital unless discontinued by an Wierenga et al. 75 ophthalmological consultant. IF an elder is hospitalized with heart failure or develops heart failure during hospital stay, THEN the following parameters 972 2011 Netherlands should be measured within one day of hospitalization or P Ge 7 N/A N/A diagnosis: serum electrolytes (sodium and potassium), creatinine, blood urea, Hb, Hct, TSH and glucose. Wierenga et al. 75 IF an elder is discharged from a hospital to his or her home or to a nursing home, THEN a discharge summary including 973 2011 Netherlands information on medication at admission and discharge should P Ge 6 N/A N/A be sent to the outpatient physician or nursing home within 14 Wierenga et al. 75 days. IF an elder is discharged from a hospital to his or her home or to a nursing home AND he or she received a new drug (excluding temporary treatment during admission) OR a change in pre-hospital medication before discharge, THEN 974 2011 Netherlands P Ge 6 N/A N/A the GP or nursing home physician should be informed (including reasons for changes in medication and route of administration and information on dosing) by a discharge Wierenga et al. 75 letter. IF an elder presents him- or herself with symptoms of cognitive dysfunction THEN the patient's medication possibly 975 2011 Netherlands associated with these symptoms should be evaluated. Risky P Ge 7 N/A N/A interactions should also be considered. This evaluation should Wierenga et al. 75 be noted in the patient's record. IF an elder is admitted to a hospital for any acute or chronic illness or any surgical procedure THEN he or she should 976 2011 Netherlands P Ge 7 N/A N/A receive diagnostic screening for delirium (CAM score). This should be documented in the patient’s record. Wierenga et al. 75 IF an elder presents him- or herself with symptoms of delirium at admission or during his or her hospital stay, THEN the patient's medication possibly associated with these symptoms 977 2011 Netherlands P Ge 7 N/A N/A should be evaluated and risky interactions that could enhance the anticholinergic effects should also be considered. This evaluation should be noted in the patient's record. Wierenga et al. 75 IF an elder is admitted to a hospital for any acute or chronic illness or any surgical procedure, THEN he or she should 978 2011 Netherlands P Ge 7 N/A N/A receive a cognitive function evaluation (MMSE score). This should be documented in the patient’s record. Wierenga et al. 75 IF a new drug is prescribed to an elder on an ongoing basis for a chronic medical condition, THEN the advice to evaluate 979 2011 Netherlands P Ge 7 N/A N/A the response to therapy within three months should be Wierenga et al. 75 mentioned in the discharge letter. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF an elder is admitted to a hospital for any acute or chronic illness or any surgical procedure, THEN he or she should be 980 2011 Netherlands P Ge 7 N/A N/A examined for dementia AND this evaluation should be noted Wierenga et al. 75 in the patient’s record. IF an elder is admitted to a hospital for any acute or chronic illness or any surgical procedure, THEN he or she should be 981 2011 Netherlands P Ge 7 N/A N/A examined for depression (GDS score) AND this evaluation Wierenga et al. 75 should be noted in the patient’s record. ALL diabetic elders with proven cardiovascular disease should be examined for lipid disorders (TC, LDL, HDL 982 2011 Netherlands P Ge 7 N/A N/A and TG) and lab value evaluations should be noted in these Wierenga et al. 75 patients’ records. IF pain treatment is altered or newly begun in an elder, THEN he or she should be assessed for a response within six 983 2011 Netherlands PMe67 M01 M02 N02 MN months AND this advice should be mentioned in his or her Wierenga et al. 75 discharge letter. IF an elder is admitted to a hospital after a fall incident or has a fall incident during his or her hospital stay, THEN the patient's medication should be screened for drugs that are 984 2011 Netherlands associated with increased incidence of falling (hypnotics, PMe7 N05 N06 N tranquillizers, long acting benzodiazepines, antidepressants, sedatives and antipsychotics) AND this evaluation should be Wierenga et al. 75 noted in the patient’s record. IF the attending physician suspects that an elder is depressed or has a depressive episode, THEN a geriatrician or 985 2011 Netherlands psychiatrist should be consulted AND the medical record PMe7 N06 N should document the symptoms and grade of severity and whether medication is started or not, and why. Wierenga et al. 75 IF an elder admitted to a hospital receives a diagnosis of dementia OR has dementia diagnosed previously, THEN the patient's medication that possibly caused or worsened 986 2011 Netherlands PMe7 A03 A04 G04 M03 N02 N04 N05 N06 R06 S01 A G M N R S dementia-like symptoms should be evaluated (drugs with anticholinergic effects) AND this evaluation should be noted in Wierenga et al. 75 the patient's record. IF an elder has a new diagnosis of osteoporosis, THEN during the initial evaluation period, an underlying cause of 987 2011 Netherlands osteoporosis should be sought by checking medication use P Ge 7 N/A N/A and current alcohol use AND this should be noted in the Wierenga et al. 75 patient’s record. IF an elder is started in-hospital on chronic coumarin treatment, THEN there should be an evaluation of the risk 988 2011 Netherlands factors for bleeding during therapy before the patient is PMe67 B01 B discharged AND the evaluation should be reported in the Wierenga et al. 75 patient's record and at discharge to the GP. IF an elder is admitted to a hospital and after evaluation it is stated that there is no meaningful symptom response after four to six weeks of pharmacological antidepressant treatment begun in the outpatient setting, THEN one of the following should be initiated: the diagnosis should be reconsidered OR 989 2011 Netherlands PMe7 N06 N precipitating factors evaluated OR concordance should be evaluated OR the medication dosage should be optimized OR TDM should be performed (if applicable) OR the patient should be referred to a psychiatrist or psychotherapy should Wierenga et al. 75 be offered. IF an elder with a history of cardiac disease is started on a TCA, THEN baseline electrocardiography should be 990 2011 Netherlands PMe7 N06 N performed before initiation of or within three months before Wierenga et al. 75 treatment. IF an elder has a presumed stroke during his or her hospital stay or at admission, THEN a CT or an MRI of the head 991 2011 Netherlands should be obtained before the initiation or continuation of PMe7 B01 B thrombolytic treatment (r-TPA), oral anticoagulation, or antiplatelet therapy (aspirin, dipyridamole, clopidogrel). Wierenga et al. 75 IF oral pharmacological therapy for osteoarthritis in an elder is changed from paracetamol (acetaminophen) to a different oral 992 2011 Netherlands agent, THEN there should be evidence that the patient has PMe3 N02 N had a trial of maximum dose of paracetamol suitable for age Wierenga et al. 75 and co-morbid conditions. IF an elder is newly started on a diuretic for chronic use, THEN during hospital admission, serum potassium and creatinine levels should be checked .Within one month after 993 2011 Netherlands PMe67 C03 C discharge and yearly thereafter these parameters (potassium and creatinine) should be checked again. This advice should Wierenga et al. 75 be mentioned in the discharge letter. IF an elder begins receiving an ACEI, THEN serum potassium and creatinine levels should be checked within one month of 994 2011 Netherlands PMe67 C09 C initiation of therapy and thereafter yearly AND this advice should be mentioned in the discharge letter. Wierenga et al. 75 IF an elder uses a maintenance dose digoxin, THEN the maximal dosage per day is 0.125 mg UNLESS a lower 995 2011 Netherlands dosage has previously been insufficiently effective for the PMe37 C01 C patient AND TDM has shown therapeutic blood levels at this Wierenga et al. 75 high dosage. IF an elder has an INR higher than the advised range (depending on the indication), THEN the possible causes of 996 2011 Netherlands this elevation including interacting medications should be PMe37 B01 B evaluated AND the coumarin dosage adjusted until the INR Wierenga et al. 75 returns to within the therapeutic range. IF an elder is newly prescribed a coumarin, THEN an INR should be determined by at least five to seven days after 997 2011 Netherlands initiation, in-hospital or by the thrombosis service. The patient PMe7 B01 B should be enrolled in the program of the thrombosis service AND this should be mentioned in the patient’s records. Wierenga et al. 75 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF an elder is started on a new SSRI antidepressant treatment during his or her hospital stay, THEN evaluation of sodium levels should be performed by the prescribing physician 998 2011 Netherlands PMe67 N06 N (minimum once during hospital stay) OR should be continued after discharge by a GP (yearly) OR ELSE hyponatraemia Wierenga et al. 75 could occur. IF an elder is started on a new pharmacological antidepressant treatment during hospital stay, THEN a frequent evaluation of effectiveness and side effects should 999 2011 Netherlands be performed during the first four weeks of treatment (every PMe67 N06 N week) by the prescribing physician OR IF the patient leaves hospital before this term, THEN this advice should be stated Wierenga et al. 75 in the discharge letter. IF an elder uses an oral anticoagulation (acenocoumarol or fenprocoumon) AND also cotrimoxazole OR cefomandole OR metronidazole OR miconazole OR OR 1000 2011 Netherlands OR OR , THEN INR PMe7 B01 G01 BG should be monitored at least every week during concomitant use OR ELSE INR could rise and haemorrhagic events could Wierenga et al. 75 result. Systolic blood pressure ≧170 mmHg and/or diastolic blood pressure ≧110 mmHg in a patient with gestational 1001 2013 Netherlands PMe1 C02 C07 C hypertension or preeclampsia needs to be treated Luitjes et al. 76 medicamentaly Patients with severe preeclampsia need to be adequately stabilized before intervention (transport to tertiary care centers 1002 2013 Netherlands and/ or delivery). Treatment exists of PMe1 B05 C02 C07 BC and/or antihypertensive drugs depending on the blood Luitjes et al. 76 pressure. The physician needs to start magnesium sulfate when a 1003 76 2013 Netherlands PMe1 B05 B Luitjes et al. patient has symptoms of severe preeclampsia. First treatment to prevent eclampsia needs to exist of 1004 76 2013 Netherlands PMe1 B05 B Luitjes et al. magnesium sulfate. Methyldopa or a β-blocker should be first choice when a 1005 2013 Netherlands patient needs to start antihypertensive drug therapy in the first PMe1 C02 C07 C Luitjes et al. 76 trimester of the pregnancy. Total number of patients who started with empirical systemic antimicrobial therapy. ※All patients are: hospitalized adult Number of patients who started with empirical systemic 1006 2014 Netherlands PMe2 J01 J patients with sepsis, severe sepsis or septic shock, where antimicrobial therapy intravenously. systemic antimicrobial therapy must be started Bosch et al. 77 Total number of patients with severe sepsis or septic shock, who started with empirical systemic antimicrobial therapy. Number of patients with severe sepsis or septic shock who 1007 2014 Netherlands ※All patients are: hospitalized adult patients with sepsis, started with empirical systemic antimicrobial therapy within the PMe5 J01 J severe sepsis or septic shock, where systemic antimicrobial first hour after the clinical diagnosis. Bosch et al. 77 therapy must be started Total number of patients who started with empirical systemic Number of patients from whom at least 2 blood cultures and antimicrobial therapy. ※All patients are: hospitalized adult specimens for culture from suspected sites of infection were 1008 2014 Netherlands PMe7 J01 J patients with sepsis, severe sepsis or septic shock, where taken before empirical systemic antimicrobial therapy was systemic antimicrobial therapy must be started started. Bosch et al. 77 Total number of patients with empirical systemic antimicrobial Number of patients with a positive culture and empirical therapy whose culture became positive. ※All patients are: 1009 2014 Netherlands systemic antimicrobial therapy, which was changed to PMe1 J01 J hospitalized adult patients with sepsis, severe sepsis or septic pathogen- directed therapy after the results became available. shock, where systemic antimicrobial therapy must be started Bosch et al. 77 Total number of patients who started with empirical systemic antimicrobial therapy (only choice of antimicrobial agent). ※All Number of patients who started with empirical systemic 1010 2014 Netherlands patients are: hospitalized adult patients with sepsis, severe PMe1 J01 J antimicrobial therapy according to the national guideline. sepsis or septic shock, where systemic antimicrobial therapy Bosch et al. 77 must be started Total number of patients who started with empirical systemic antibiotic therapy. ※All Patients Are Adults, Admitted to a Non- Number of patients who started with empirical systemic 1011 2015 Netherlands PMe1 J01 J ICU Department With >24 h of Systemic Antibiotics Because antibiotic therapy according to the local guideline of a Suspected Bacterial Infection. Bosch et al. 78 Total number of patients who started with systemic antibiotic therapy. ※All Patients Are Adults, Admitted to a Non-ICU Number of patients in whom at least 2 blood cultures were 1012 2015 Netherlands PMe7 J01 J Department With >24 h of Systemic Antibiotics Because of a taken before systemic antibiotic therapy was started Bosch et al. 78 Suspected Bacterial Infection. Total number of patients who started with systemic antibiotic Number of patients who started with systemic antibiotic therapy. ※All Patients Are Adults, Admitted to a Non-ICU therapy and in whom cultures from suspected sites of 1013 2015 Netherlands PMe57 J01 J Department With >24 h of Systemic Antibiotics Because of a infection were taken within 24 h after the systemic antibiotics Bosch et al. 78 Suspected Bacterial Infection. were started Total number of patients with empirical systemic antibiotics Number of patients with empirical systemic antibiotics whose whose culture became positive. ※All Patients Are Adults, 1014 2015 Netherlands culture became positive and changing to pathogen-directed PMe1 J01 J Admitted to a Non-ICU Department With >24 h of Systemic therapy was done correctly Antibiotics Because of a Suspected Bacterial Infection. Bosch et al. 78 Total number of patients who started with systemic antibiotic therapy and who had a compromised renal function (defined Number of patients with a compromised renal function with a 1015 2015 Netherlands as eGFR <50 mL/min/ 1.73m2). ※All Patients Are Adults, dosing regimen adjusted to renal function (defined as eGFR PMe3 J01 J Admitted to a Non-ICU Department With >24 h of Systemic <50 mL/ min/1.73m2) Antibiotics Because of a Suspected Bacterial Infection. Bosch et al. 78 Total number of patients with intravenous antibiotics for 48–72 h, in whom changing to oral antibiotic therapy on the basis of Number of patients with intravenous antibiotics for 48–72 h, in 1016 2015 Netherlands the clinical condition was indicated. ※All Patients Are Adults, whom changing to oral antibiotic therapy on the basis of PMe2 J01 J Admitted to a Non-ICU Department With >24 h of Systemic clinical condition was done Antibiotics Because of a Suspected Bacterial Infection. Bosch et al. 78 Total number of patients who started with systemic antibiotic Number of patients who started with systemic antibiotic therapy. ※All Patients Are Adults, Admitted to a Non-ICU 1017 2015 Netherlands therapy for whom an antibiotic plan was documented in the PMe7 J01 J Department With >24 h of Systemic Antibiotics Because of a case notes Bosch et al. 78 Suspected Bacterial Infection. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Total number of patients who received for >3 d and/or for >5 d. ※All Patients Are Adults, Number of these patients with at least 1 serum drug level 1018 2015 Netherlands PMe7 J01 J Admitted to a Non-ICU Department With >24 h of Systemic measurement Antibiotics Because of a Suspected Bacterial Infection. Bosch et al. 78 Total number of patients who started empirical systemic antibiotic therapy, but lacked clinical and/or microbiological Number of patients whose empirical antibiotic therapy was 1019 2015 Netherlands evidence of infection. ※All Patients Are Adults, Admitted to a discontinued within 7 d, because of lack of clinical and/or PMe1 J01 J Non-ICU Department With >24 h of Systemic Antibiotics microbiological evidence of infection Because of a Suspected Bacterial Infection. Bosch et al. 78 A current local antibiotic guideline should be present in the hospital and an evaluation whether an update should be considered should be done every 3 y. ※All Patients Are 1020 2015 Netherlands SMe9 J01 J Adults, Admitted to a Non-ICU Department With >24 h of Systemic Antibiotics Because of a Suspected Bacterial Bosch et al. 78 Infection. Local antibiotic guidelines should correspond to the national antibiotic guidelines, but should deviate based on local 1021 2015 Netherlands resistance patterns. ※All Patients Are Adults, Admitted to a SMe9 J01 J Non-ICU Department With >24 h of Systemic Antibiotics Because of a Suspected Bacterial Infection. Bosch et al. 78 In case of a patient with PPH the clinician should monitor additional vital functions appropriately, give oxygen and replace fluid: i. Give 10–15 liters/min oxygen by face mask regardless of patient’s oxygen saturation. 1022 2015 Netherlands PMe17 B05 V03 BV ii. Monitor urine production. iii. Provide a second intravenous access (18-gauge), and replace volume by using pressure bags and warmed fluid (in case of large volumes). Woiski et al. 79 ※PPH>1000mL In case of a patient with PPH the clinician should urgently 1023 2015 Netherlands order units of blood and fresh frozen plasma, check and PMe17 B05 B Woiski et al. 79 correct clotting status. ※PPH>1000mL In case of a patient with PPH the clinician should follow 1024 79 2015 Netherlands PMe1 B05 B Woiski et al. hospital-wide mass transfusion protocol. ※PPH>2000mL In case of a patient with PPH the clinician should transfuse uncrossed matched O Rh-negative blood if hemorrhage is life- 1025 2015 Netherlands PMe1 B05 B threatening, correct clotting status. (Including platelets >50 x 10g or when surgery is planned >80 x 10g) ※PPH>2000mL Woiski et al. 79 In case of a patient with PPH the clinician should continuous uterine massage, bladder catheterization and 1026 2015 Netherlands PMe1 G02 G medication in steps according to local protocol. Woiski et al. 79 ※PPH>2000mL In case of a patient with PPH the clinician should treat PPH as 1027 2015 Netherlands an atony till proven otherwise, use i.v. as a last PMe1 G02 G resort if other uterotonic treatment fails. ※PPH>1000mL Woiski et al. 79 In every hospital system, the following local protocols and agreement should be available: i. Protocol PPH according to the national guideline. ii. Local mass transfusion protocol. 1028 2015 Netherlands SMe9 B05 B iii. Protocol for women refusing blood products. iv. A written agreement between the related disciplines (anesthesia, hematology, radiology) for a multidisciplinary Woiski et al. 79 approach in the treatment of PPH. The surgeon/consulted internist should discontinue oral 1029 2016 Netherlands hypoglycemic agents on the morning of surgery in patients PMe1 A10 A Hommel et al. 80 with diabetes who undergo major surgery The surgeon/consulted internist should order intravenous 1030 2016 Netherlands glucose-insulin-potassium infusion on the morning of surgery PMe1 A10 A for patients with diabetes who undergo major surgery Hommel et al. 80 The surgeon/consulted internist/anaesthesiologist should order administration of intravenous glucose in case of 1031 2016 Netherlands PMe1 A10 A hypoglycemia during fasting in patients with diabetes who Hommel et al. 80 undergo major surgery The surgeon/consulted internist should cover basal insulin 1032 2016 Netherlands requirements of patients with type 1 diabetes at all times when PMe1 A10 A Hommel et al. 80 they undergo major surgery The intensive care specialist should treat hyperglycemia in 1033 2016 Netherlands critically ill patients who undergo major surgery with PMe1 A10 A Hommel et al. 80 intravenous insulin The surgeon/consulted internist should revise the amounts of 1034 2016 Netherlands scheduled insulin at least daily on the basis of patient PMe3 A10 A response in patients with diabetes who undergo major surgery Hommel et al. 80 The hospital should have an algorithm to guide administration of intravenous insulin This algorithm should consider: − The different maintenance insulin requirements of different patients − Potential change in maintenance insulin requirements over 1035 2016 Netherlands SMe9 A10 A the course of treatment − Both current and previous glucose levels − The rate of change of plasma glucose − Current insulin infusion rate − Nutrition, glucose infusions, and variations in them (bolus or Hommel et al. 80 continuous) (Treatment of hypertension) The percentage of patients between the ages of 18 and 80 years with CKD Stages 4–5 1036 2016 Netherlands PMe1 C02C03C07C08C09 C and hypertension who are prescribed antihypertensives unless undesirable because of low diastolic blood pressure Smits et al. 81 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Treatment of hypertension) The percentage of patients between theages18 and 80 years with CKD Stages 3–5 and 1037 2016 Netherlands PMe1 C03 C09 C macro-albuminuria treated with multiple antihypertensives who are prescribed a combination of anACEI or ARB and a diuretic Smits et al. 81 (Treatment of hypertension) The percentage of patients between the ages 18 and 80 years with CKD Stages 3–5, 1038 2016 Netherlands microalbuminuria and diabetes treated with multiple PMe1 C03 C09 C antihypertensives who are prescribed a combination of an Smits et al. 81 ACEI or ARB and a diuretic (Treatment of albuminuria) The percentage of patients 1039 2016 Netherlands between the ages 18 and 80 years with CKD Stages 3–5 and PMe1 C09 C macroalbuminuria who are prescribed an ACEI or an ARB Smits et al. 81 (Treatment of albuminuria) The percentage of patients between the ages 18 and 80 years with CKD Stages 3–5, 1040 2016 Netherlands PMe1 C09 C microalbuminuria and diabetes who are prescribed an ACEI or Smits et al. 81 an ARB (Prescription of statins) The percentage of patients between 1041 2016 Netherlands the ages of 50 and 65 years with CKD Stages 3–5 who are PMe1 C10 C Smits et al. 81 prescribed a statin (Treatment of MBD) The percentage of patients between the 1042 2016 Netherlands ages 18 and 80 years with CKD Stages 3–5 and an elevated PMe1 V03 V phosphate level who are prescribed a phosphate binder Smits et al. 81 (Treatment of MBD) The percentage of patients between the ages 18 and 80 years with CKD Stages 3–5 treated with 1043 2016 Netherlands PMe1 V03 V phosphate binders and with an elevated calcium level who are prescribed a non-calcium-containing phosphate binder Smits et al. 81 (Treatment of MBD) The percentage of patients between the ages 18 and 80 years with CKD Stages 3–5 treated with 1044 2016 Netherlands PMe1 V03 V phosphate binders and with a low calcium level who are Smits et al. 81 prescribed a calcium- containing phosphate binder (Medication safety) The percentage of patients ≥18 years with 1045 2016 Netherlands CKD Stages 3–5 and a prescription of RAS blockers who are PMe1 C09 C prescribed at least two RAS blockers simultaneously Smits et al. 81 (Medication safety) The percentage of patients ≥18 years with 1046 2016 Netherlands CKD Stages 3–5 and elevated calcium levels who are PMe1 A11 A Smits et al. 81 prescribed active vitamin D (Medication safety) The percentage of patients ≥18 years with 1047 2016 Netherlands CKD Stages 3–5 and Hb ≥7.5 who are prescribed an PMe1 B03 B Smits et al. 81 erythropoiesis-stimulating agent (Medication safety) The percentage of patients ≥18 years with 1048 2016 Netherlands PMe1 M01 M02 M eGFR <30 mL/min/ 1.73 m2 who are prescribed an NSAID Smits et al. 81 (Medication safety) The percentage of patients ≥18 years with 1049 2016 Netherlands eGFR <30 mL/min/ 1.73 m2 and diabetes who are prescribed PMe1 A10 A Smits et al. 81 metformin (Medication safety) The percentage of patients ≥18 years with 1050 2016 Netherlands eGFR <50 mL/min/ 1.73 m2 who are prescribed digoxin PMe3 C01 C Smits et al. 81 >0.125 mg/day (Medication safety) The percentage of patients ≥18 years with 1051 2016 Netherlands CKD Stages 3–5 and who are prescribed with a combination PMe1 C03 C09 M01 M02 CM Smits et al. 81 of NSAID, RAS blocker and diuretic (1. Quality management) Presence of a valid quality 1052 82 2016 Netherlands S Ge 9 N/A N/A Teichert et al. management certificate (1. Quality management) Evaluating patients’ experiences 1053 82 2016 Netherlands P Ge 7 N/A N/A Teichert et al. within the past 3 years (1. Quality management) Availability of a procedure for registration of errors (e.g. wrong dosage, wrong substance, 1054 2016 Netherlands wrong compounding) that occurred during the work process in S Ge 6 N/A N/A the pharmacy and that were realized before the drug reached Teichert et al. 82 the patient (1. Quality management) Number of registered errors which occurred during the dispensing of medication and that 1055 2016 Netherlands P Ge 6 N/A N/A occurred during the work process in the pharmacy and that Teichert et al. 82 were realized after the drug reached the patient (1. Quality management) Presence of a registration system for 1056 2016 Netherlands errors that occurred during the work process within the S Ge 6 N/A N/A Teichert et al. 82 pharmacy and that did reach the patient (1. Quality management) Number of registered errors that did 1057 82 2016 Netherlands P Ge 6 N/A N/A Teichert et al. reach the patient (1. Quality management) Number of registered complaints 1058 82 2016 Netherlands O Ge 9 N/A N/A Teichert et al. made by patients (1. Quality management) Number of registered errors reported 1059 82 2016 Netherlands P Ge 6 N/A N/A Teichert et al. to a national registration of errors (2. Continuity of care) Attitude of the pharmacist to obtain 1060 2016 Netherlands information on patients’ actual drug use before dispensing S Ge 7 N/A N/A Teichert et al. 82 and to register this information in the patients’ record (2. Continuity of care) Participation in pharmacotherapy audit 1061 82 2016 Netherlands S Ge 7 N/A N/A Teichert et al. meetings with GPs (2. Continuity of care) Participation in pharmacotherapy audit 1062 2016 Netherlands S Ge 7 N/A N/A meetings on a regular basis and with specific agreements Teichert et al. 82 (2. Continuity of care) Percentage of patients older than 70 years with at least 5 different drug classes in chronic 1063 2016 Netherlands concomitant use, for whom the pharmacist contributed to the P Ge 6 N/A N/A exchange of actual drug use information between the general Teichert et al. 82 practitioner and the hospital (2. Continuity of care) The pharmacy staff always informs the 1064 2016 Netherlands anticoagulation directly in case of dispensing co-trimoxazole PMe5 B01 J01 BJ Teichert et al. 82 to a coumarin user (3. Communication with the patient) Percentage of patients 1065 2016 Netherlands with a first dispensing of inhalation medication who had been PMe5 R03 R Teichert et al. 82 offered information about its use Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (3. Communication with the patient) Percentage of users of 1066 2016 Netherlands inhalation medication with subsequent use of oropharyngeal OMe5 A01 R03 AR Teichert et al. 82 antimycotics (3. Communication with the patient) Presence of individual 1067 2016 Netherlands education programs and plans for every pharmaceutical staff S Ge 9 N/A N/A Teichert et al. 82 member (4. Clinical risk management) Parameters for clinical risk 1068 2016 Netherlands management in the pharmacy information system are S Ge 9 N/A N/A Teichert et al. 82 implemented according to prevailing guidelines (4. Clinical risk management) In case of an interaction actions 1069 82 2016 Netherlands S Ge 9 N/A N/A Teichert et al. taken are electronically registered (4. Clinical risk management) Availability of protocols for 1070 2016 Netherlands informing on contra indications for all patients, especially for S Ge 9 N/A N/A Teichert et al. 82 new patients (4. Clinical risk management) Availability of protocols for 1071 2016 Netherlands informing on allergic reactions for all patients, especially for S Ge 9 N/A N/A Teichert et al. 82 new patients (4. Clinical risk management) Availability of protocols to check 1072 2016 Netherlands on the dosage of active components for compounded S Ge 9 N/A N/A Teichert et al. 82 medication for children up to 6 years (4. Clinical risk management) Dosage in compounded mediation for children up to 6 years is checked by the 1073 2016 Netherlands P Ge 3 N/A N/A pharmacist in at least 80 % of all compounding for children Teichert et al. 82 younger than 6 years (4. Clinical risk management) Absolute number of coumarin 1074 82 2016 Netherlands PMe1 B01 J01 BJ Teichert et al. users with concomitant use of co-trimoxazole (5. Compounding) Availability of written agreements on responsibilities for external compounding on checking the 1075 2016 Netherlands S Ge 9 N/A N/A weight of capsules, analytical tests of samples and a final Teichert et al. 82 control by a pharmacist (5. Compounding) Availability of a standard operation 1076 2016 Netherlands procedure for the release of compounded medication before S Ge 9 N/A N/A Teichert et al. 82 dispensing to the patient (5. Compounding) Percentage of medication compounded for 1077 2016 Netherlands individual patients for which a standardized procedure was P Ge 6 N/A N/A Teichert et al. 82 followed (5. Compounding) Percentage of compounding of batches 1078 2016 Netherlands P Ge 6 N/A N/A with a validated procedure followed of all batch compounding Teichert et al. 82 (6. Dispensing) Availability of automated dose dispensing for 1079 82 2016 Netherlands S Ge 9 N/A N/A Teichert et al. eligible patients (6. Dispensing) If automated dose dispensing was used the 1080 2016 Netherlands actual guideline was followed by as well the pharmacist as the P Ge 9 N/A N/A Teichert et al. 82 supplier (6. Dispensing) For weekly dosed trays a system was 1081 82 2016 Netherlands S Ge 9 N/A N/A Teichert et al. available to control on drug use as prescribed (7. Follow up of pharmacotherapy guidelines) Percentage 1082 2016 Netherlands PMe1 A02 M01 M02 AM NSAID users >70 years with concomitant gastroprotection Teichert et al. 82 (7. Follow up of pharmacotherapy guidelines) Action was taken by the pharmacist in at least 80 % of the cases to add 1083 2016 Netherlands PMe1 A02 M01 M02 AM gastroprotection to NSAID users <70 years for whom this co- Teichert et al. 82 medication was lacking (7. Follow up of pharmacotherapy guidelines) Percentage of 1084 2016 Netherlands patients using nitrates with concomitant antithrombotic PMe1 B01 C01 BC Teichert et al. 82 medication (7. Follow up of pharmacotherapy guidelines) Action was taken by the pharmacist in at least 80 % of the cases to add 1085 2016 Netherlands PMe1 B01 C01 BC antithrombotic medication to nitrate users for whom this co- Teichert et al. 82 medication was lacking (7. Follow up of pharmacotherapy guidelines) Percentage of 1086 82 2016 Netherlands PMe1 A06 N02 AN Teichert et al. patients using opioids with concomitant laxatives (7. Follow up of pharmacotherapy guidelines) Action was taken by the pharmacist in at least 80 % of the cases to add 1087 2016 Netherlands PMe1 A06 N02 AN laxatives to opioid users in whom this co-medication was Teichert et al. 82 lacking (7. Follow up of pharmacotherapy guidelines) Percentage of patients under 6 or above 70 years of age with asthma 1088 2016 Netherlands P Me 5 R03 R inhalers and an additional inhalation device dispensed during Teichert et al. 82 the previous 24 months (7. Follow up of pharmacotherapy guidelines) Percentage of 1089 82 2016 Netherlands P Me 1 C10 C Teichert et al. simvastatin as the first statin dispensed (7. Follow up of pharmacotherapy guidelines) Percentage of 1090 82 2016 Netherlands P Me 1 C10 C Teichert et al. cardiovascular patients with concomitant statin use (7. Follow up of pharmacotherapy guidelines) Percentage of 1091 82 2016 Netherlands P Me 5 N02 N Teichert et al. triptan users without overuse within all triptan users (7. Follow up of pharmacotherapy guidelines) Percentage of 1092 2016 Netherlands first dispensings of hypnotics with an amount for less than 15 P Me 4 N05 N Teichert et al. 82 days within all first hypnotic dispensings (7. Follow up of pharmacotherapy guidelines) Percentage of 1093 2016 Netherlands PPI users with preferred PPIs according to national guidelines P Me 1 A02 A Teichert et al. 82 within all PPI users (7. Follow up of pharmacotherapy guidelines) Percentage of 1094 2016 Netherlands first dispensings of generic diclofenac, ibuprofen or naproxen PMe1 M01 M02 M Teichert et al. 82 within all first NSAID dispensings (7. Follow up of pharmacotherapy guidelines) Percentage of COX-2 inhibitor users without co-medication related to 1095 2016 Netherlands P Me 1 M01 M ischemic cardiovascular diseases within all COX-2 inhibitor Teichert et al. 82 users (7. Follow up of pharmacotherapy guidelines) The pharmacist 1096 2016 Netherlands followed additional courses for the performance of Medication P Ge 7 N/A N/A Teichert et al. 82 Reviews (7. Follow up of pharmacotherapy guidelines) Medication 1097 2016 Netherlands Reviews are performed according to the professional P Ge 7 N/A N/A Teichert et al. 82 guideline in cooperation with GPs and patients (7. Follow up of pharmacotherapy guidelines) Performance of 1098 2016 Netherlands at least 20 Medication Reviews according to the professional P Ge 7 N/A N/A guideline in cooperation with GPs and patients Teichert et al. 82 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (8. OTC counseling) Medication surveillance is conducted 1099 82 2016 Netherlands P Ge 7 N/A N/A Teichert et al. according to professional protocols (8. OTC counseling) Percentage of filled protocols for patient 1100 82 2016 Netherlands PMe7 A08 A Teichert et al. counseling within first dispensing of orlistat (8. OTC counseling) Percentage of filled protocols for patient 1101 2016 Netherlands PMe7 R05 R counseling within first dispensing of Teichert et al. 82 (8. OTC counseling) Percentage of filled protocols for patient 1102 82 2016 Netherlands PMe7 N06 N Teichert et al. counseling within first dispensing of hypericum (8. OTC counseling) Percentage of filled protocols for patient 1103 82 2016 Netherlands PMe7 A03 A Teichert et al. counseling within first dispensing of domperidon (8. OTC counseling) Percentage of filled protocols for patient 1104 82 2016 Netherlands PMe7 D11 D Teichert et al. counseling within first dispensing of hydrokinin (9. Logistics) Suppliers of compounding material were 1105 82 2016 Netherlands P Ge 6 N/A N/A Teichert et al. assessed according to the professional guideline (9. Logistics) Percentage of suppliers for compounding or 1106 2016 Netherlands package material that were assessed for their reliability as P Ge 6 N/A N/A Teichert et al. 82 stated by the guideline for reliable suppliers (9. Logistics) Availability of a valid system to check on expired 1107 82 2016 Netherlands S Ge 6 N/A N/A Teichert et al. drugs 1108 Teichert et al. 82 2016 Netherlands (9. Logistics) Official drug recalls were performed P Ge 6 N/A N/A (9. Logistics) Number of relevant recalls received in calendar 1109 82 2016 Netherlands P Ge 6 N/A N/A Teichert et al. in question 1110 Teichert et al. 82 2016 Netherlands (9. Logistics) Number of not completely finished recalls P Ge 6 N/A N/A (9. Logistics) Not completed drug recalls were due to a too 1111 82 2016 Netherlands P Ge 6 N/A N/A Teichert et al. high effort to address patients (9. Logistics) Number of internally reported expired medication 1112 82 2016 Netherlands P Ge 6 N/A N/A Teichert et al. before the drug was dispensed (9. Logistics) Number of dispensed expired medication that 1113 2016 Netherlands was reported by the patient and thus was noticed after P Ge 6 N/A N/A Teichert et al. 82 dispensing (10. Training of pharmaceutical staff) Percentage of 1114 82 2016 Netherlands S Ge 9 N/A N/A Teichert et al. pharmaceutical staff with a personal development plan (10. Training of pharmaceutical staff) Percentage of pharmacy 1115 2016 Netherlands technicians who were registered in a central quality S Ge 9 N/A N/A Teichert et al. 82 registration system for education (10. Training of pharmaceutical staff) Participation in a 1116 2016 Netherlands national program for patient reported side effects drugs of the S Ge 9 N/A N/A Teichert et al. 82 national pharmacovigilance center (10. Training of pharmaceutical staff) Number of patient 1117 2016 Netherlands reported side effects announced to the national O Ge 9 N/A N/A Teichert et al. 82 pharmacovigilance center (10. Training of pharmaceutical staff) Percentage of 1118 2016 Netherlands employees involved in pharmaceutical care that followed an S Ge 9 N/A N/A Teichert et al. 82 education in communication skills (Glucose lowering drugs) The percentage of patients with type 2 diabetes younger than 70 years with elevated HbA1C level 1119 2017 Netherlands (>53 mmol/mol) in the previous year that started with glucose P Me 1 A10 A lowering drugs or that reached the HbA1C target level (≤53 Smits et al. 83 mmol/ mol) (Glucose lowering drugs) The percentage of patients with type 2 diabetes younger than 70 years on monotherapy metformin 1120 2017 Netherlands and an elevated HbA1C level (>53 mmol/mol) in the previous P Me 1 7 A10 A year, whose treatment was intensified or that reached the Smits et al. 83 HbA1C target level (≤53 mmol/mol) (Glucose lowering drugs) he percentage of patients with type 2 diabetes younger than 70 years with two or more non- 1121 2017 Netherlands insulin glucose lowering drugs and an elevated HbA1C level P Me 1 7 A10 A (>53 mmol/ mol) in the previous year that started with insulin or that reached the HbA1C target level (≤53 mmol/mol) Smits et al. 83 (Glucose lowering drugs) The percentage of patients with type 1122 2017 Netherlands 2 diabetes that started with metformin among all starters of P Me 1 A10 A Smits et al. 83 oral glucose lowering drugs (Glucose lowering drugs) The percentage of patients with type 1123 2017 Netherlands 2 diabetes treated with metformin among all patients treated P Me 1 A10 A Smits et al. 83 with glucose lowering drugs (Glucose lowering drugs) The percentage of patients with type 2 diabetes treated with metformin and an SU- derivative 1124 2017 Netherlands P Me 1 A10 A among all patients treated with two non- insulin glucose Smits et al. 83 lowering drugs (Glucose lowering drugs) The percentage of patients with 1125 2017 Netherlands type 2 diabetes that started with gliclazide among all starters P Me 1 A10 A Smits et al. 83 of an SU- derivative (Lipid lowering drugs) The percentage of patients with type 2 1126 83 2017 Netherlands P Me 1 C10 C Smits et al. diabetes between 55 and 80 years treated with statins (Lipid lowering drugs) The percentage of patients with type 2 diabetes younger than 80 years with an elevated LDL- C level 1127 2017 Netherlands P Me 1 C10 C (>2.5 mmol/l) in the previous year that started with a statin or that reached the LDL- C target level (≤2.5 mmol/L) Smits et al. 83 (Lipid lowering drugs) The percentage of patients with type 2 diabetes younger than 80 years treated with simvastatin and 1128 2017 Netherlands an elevated LDL- C level (>2.5 mmol/L) in the previous year P Me 1 7 C10 C that switched to or rosuvastatin or that reached Smits et al. 83 the LDL- C target level (≤2.5 mmol/L) (Blood pressure lowering drugs) The percentage of patients with type 2 diabetes younger than 70 years of age and an 1129 2017 Netherlands elevated systolic blood pressure (>140 mmHg) in the previous P Me 1 C02C03C07C08C09 C year that started with antihypertensives or that reached the systolic blood pressure target level (≤140 mm Hg) Smits et al. 83 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Blood pressure lowering drugs) The percentage of patients with type 2 diabetes younger than 70 years treated with monotherapy antihypertensives and an elevated systolic blood 1130 2017 Netherlands P Me 1 7 C02C03C07C08C09 C pressure (>140 mm Hg) in the previous year, whose treatment was intensified or that reached the systolic blood pressure target level (≤140 mm Hg) Smits et al. 83 (Albuminuria lowering drugs) The percentage of patients with 1131 2017 Netherlands type 2 diabetes and treated with two or more P Me 1 C09 C Smits et al. 83 antihypertensives that were treated with an ACE- i or ARB (Albuminuria lowering drugs) The percentage of patients with type 2 diabetes younger than 70 years and with micro- or 1132 2017 Netherlands P Me 1 7 C09 C macro- albuminuria in the previous year that started with an ACE- i or ARB or that returned to normo- albuminuria Smits et al. 83 (Albuminuria lowering drugs) The percentage of patients with 1133 2017 Netherlands type 2 diabetes treated with antihypertensives and micro- or P Me 1 C02C03C07C08C09 C macro- albuminuria that were treated with an ACE- i or ARB Smits et al. 83 (Albuminuria lowering drugs) The percentage of patients with type 2 diabetes that started with an ACE- i among all patients 1134 2017 Netherlands P Me 1 C09 C that started with renin- angiotensin- aldosterone system Smits et al. 83 treatment (Medication safety) The percentage of patients with type 2 1135 2017 Netherlands diabetes that were treated with glibenclamide among all P Me 1 A10 A Smits et al. 83 patients treated with SU- derivatives (Medication safety) The percentage of patients with T2DM 1136 2017 Netherlands and an eGFR <30 mL/minute/1.73 m2 that were treated with P Me 1 A10 A Smits et al. 83 metformin (Medication safety) The percentage of patients with T2DM 80 1137 2017 Netherlands years or older and an HbA1C level <53 mmol/mol that were P Me 1 A10 A Smits et al. 83 treated with two or more glucose lowering drugs (Medication safety) The percentage of patients with type 2 1138 2017 Netherlands diabetes that were treated with a combination of an ACE- i P Me 1 C09 C Smits et al. 83 and an ARB among all patients with RAAS treatment Idanpaan- 1139 2006 OECD countries Discharged patients with AMI without aspirin contraindications Those prescribed aspirin at discharge P Me 1 B01 B Heikkila et al. 84 Idanpaan- Discharged patients with left ventricular systolic dysfunction 1140 2006 OECD countries Those prescribed an ACEI at discharge P Me 1 C09 C Heikkila et al. 84 and without ACEI contraindications Idanpaan- Discharged patients with AMI without β-blocker 1141 2006 OECD countries Those prescribed a β-blocker at hospital discharge P Me 1 C07 C Heikkila et al. 84 contraindications Idanpaan- People who attend primary care and who have had a cardiac People who attend primary care who have had a cardiac 1142 2006 OECD countries PMe1 C10 C Heikkila et al. 84 event event and who have been prescribed a statin Patients with confirmed AMI receiving thrombolytics and Number of minutes from time of arrival at hospital to time of 1143 Idanpaan- 2006 OECD countries having adequate documentation of the time of arrival and the PMe5 B01 B administration of the thrombolytic Heikkila et al. 84 time of administration of the thrombolytic Idanpaan- Number who received aspirin within 24 hours before or after 1144 2006 OECD countries Hospitalized AMI patients without aspirin contraindications PMe5 B01 B Heikkila et al. 84 hospital arrival Number of individual patients with a principal diagnosis of Number of individual patients discharged with a principal 1145 Idanpaan- 2006 OECD countries CHF (ICD-9 428, ICD-10 I50) who are prescribed an ACEI at PMe1 C09 C diagnosis of CHF Heikkila et al. 84 discharge Number of individual patients discharged with a diagnosis of Number of individual patients with a diagnosis of CHF (ICD-9 1146 Idanpaan- 2006 OECD countries PMe1 C07 C CHF 428, ICD-10 I50) who are prescribed a β-blocker at discharge Heikkila et al. 84 For all patients prescribed antihypertensive medication for 1147 2012 Slovenia diagnosed hypertension there should be a record of blood PMe7 C02C03C07C08C09 C Petek et al. 85 pressure at least once in the last 15 months. 1148 Petek et al. 85 2012 Slovenia All patients at high risk should be offered a statin. P Me 1 C10 C All patients aged ≥ 40 with diabetes (type 1 or type 2) should 1149 2012 Slovenia PMe1 C10 C be offered a statin unless there are no other risk factors. Petek et al. 85 All patients with established CVD (CHD, stroke, TIA, or pvd) 1150 85 2012 Slovenia PMe1 C10 C Petek et al. should be offered a statin. For all patients with diabetes who have sustained proteinuria 1151 2012 Slovenia PMe1 C09 C there should be a record that an ACEI has been offered Petek et al. 85 For all patients with established CVD (CHD, stroke, TIA, or pvd) or after a cerebrovascular ischemic event, there should 1152 2012 Slovenia be a record that anti-platelet therapy (acetilsalicilna kislina, PMe13 B01 B clopidogrel or equivalent) at least 75 mg daily has been Petek et al. 85 offered, unless contraindicated. For all patients who have heart failure there should be a 1153 85 2012 Slovenia PMe1 C09 C Petek et al. record that an ACEI has been offered For all patients who have had a myocardial infarction or have had coronary artery bypass graſt or percutaneous transluminal 1154 2012 Slovenia PMe1 C09 C coronary angioplasty there should be a record that an ACEI Petek et al. 85 has been offered All patients with coronary heart disease should be offered a 1155 2012 Slovenia beta blocker (unless a contraindication or side-effect is PMe1 C07 C Petek et al. 85 recorded). For all patients who have had a myocardial infarction there 1156 2012 Slovenia should be a record that a beta blocker has been offered PMe1 C07 C Petek et al. 85 (unless a contraindication or side-effects is recorded). For all patients with sustained high blood pressure readings (> 150/90 on 3 or more occasions) who are already taking 1157 2012 Slovenia PMe1 C02C03C07C08C09 C antihypertensive medication there should be a record of being Petek et al. 85 offered a change in therapy. Drug therapies should be offered in all patients with sustained (on more than 3 occasions) systolic BP ≥ 160 mm Hg or 1158 2012 Slovenia sustained diastolic BP ≥ 100 mm Hg despite up to six months PMe1 C02C03C07C08C09 C of non-pharmacological measures, unless contraindicated or Petek et al. 85 intolerant. The medical record should contain details of current 1159 85 2012 Slovenia P Ge 9 N/A N/A Petek et al. prescribed medications. The medical record should contain information about 1160 85 2012 Slovenia P Ge 7 N/A N/A Petek et al. intolerances and contraindications to medications. Minaya-Munoz IF a patient is started on pharmacological therapy to treat 1161 2013 Spain PMe1 M01 M02 M et al. 86 lateral epicondylalgia, THEN NSAIDs should be tried first. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a patient with a risk factor for GI bleeding (age ≥75, peptic ulcer disease, history of GI bleeding) is treated with a NSAID, 1162 2013 Spain PMe1 A02 M01 M02 AM Minaya-Munoz THEN he or she should be treated concomitantly with inhibitors (e.g. proton pump inhibitor, misoprostol, etc.). et al. 86 (ICCUs) Before starting treatment with a biologic drug, IBD patients with any sign of tuberculosis (on chest X-rays, or on 1163 2014 Spain PMe1 J04 L04 JL tuberculin or immunologic tests) should receive adequate Calvet et al. 87 antituberculous therapy. (ICCUs) All HBsAg-positive IBD patients should receive 1164 87 2014 Spain PMe1 J05 L04 JL Calvet et al. antiviral drugs while being treated with an anti-TNF drug. (ICCUs) Attenuated virus vaccines must be avoided in 1165 87 2014 Spain PMe1 J05 L04 JL Calvet et al. patients receiving immunosuppressive or anti-TNF drugs. (ICCUs) IBD patients with suspected septic complications 1166 87 2014 Spain PMe1 J01 J Calvet et al. should receive early appropriate antibiotic treatment. (ICCUs) In all IBD patients who had required two or more 1167 2014 Spain courses of steroids in the last year, treatment with an PMe1 A07 L04 AL Calvet et al. 87 should have been considered. (ICCUs) In patients with severe flare of UC not responding to 1168 2014 Spain intravenous steroids, treatment with either cyclosporine or an PMe1 H02 L04 HL Calvet et al. 87 anti-TNF drug should be initiated within 7 days. (ICCUs) Patients with steroid-refractory CD should receive an 1169 87 2014 Spain PMe1 H02 L04 HL Calvet et al. anti-TNF agent. (ICCUs) No IBD patients should receive a steroid dose over 1170 87 2014 Spain PMe4 A07 A Calvet et al. 20 mg a day for more than 6 months. (ICCUs) Antithrombotic therapy should be indicated in all IBD 1171 87 2014 Spain PMe1 B01 B Calvet et al. patients while hospitalized. (ICCUs) IBD patients should maintain treatment 1172 2014 Spain during pregnancy. Refusal of treatment should be PMe1 L04 L Calvet et al. 87 documented. (ICCUs) It should be documented in the clinical records that 1173 2014 Spain patient received adequate information regarding benefits and PMe5 L04 L risks before being started on immunosuppressive therapy. Calvet et al. 87 (ICCUs) It should be documented in the clinical records that 1174 2014 Spain patients received adequate information regarding benefits and PMe5 L04 L Calvet et al. 87 risks before starting biologic therapy. (ICCUs) Patients receiving immunosuppressive drugs should 1175 2014 Spain PMe7 L04 L be monitored with a blood count at least every four months. Calvet et al. 87 (ICCUs) Patients receiving anti-TNF drugs should be 1176 87 2014 Spain PMe7 L04 L Calvet et al. monitored with a blood count at least every four months. Ruiz-Canela- Number of patients who have been prescribed a spacer 1177 2015 Spain Number of children with prescribed a MDI device PMe5 R03 R Caceres et al. 88 chamber Ruiz-Canela- Number of patients with an indication of adequate inhaler 1178 2015 Spain Number of children with a verification of the technical inhaler PMe5 R03 R Caceres et al. 88 technique in the past six months (Thromboembolic prophylaxis in colorectal cancer) Patients Patients treated for colorectal carcinoma with bowel and/or 1179 Soria-Aledo et 2016 Spain treated surgically for colorectal carcinoma with bowel and/or PMe1 B01 B rectal resection, with correct thromboembolic prophylaxis al. 89 rectal resection (Antibiotic prophylaxis in colorectal cancer) Patients treated Patients treated for colorectal carcinoma who undergo bowel 1180 Soria-Aledo et 2016 Spain surgically for colorectal carcinoma with bowel and/or rectal PMe1 J01 J and/or rectal resection with correct antibiotic prophylaxis al. 89 resection Number of patients with colon cancer and AJCC TNM stage II Proportion of patients with colon cancer and AJCC TNM stage (T3N0M0, T4N0M0) high-risk (presence of at least one of the II (T3N0M0, T4N0M0) high-risk (presence of at least one of Number of patients with colon cancer and AJCC TNM stage II 1181 2013 Switzerland following factors: LN<12, G3, lymph-vascular or perineural the following factors: LN<12, G3, lymph-vascular or perineural PMe1 L01 L high-risk or III, undergoing surgery invasion, tumour obstruction, tumour perforation, pT4) or III, invasion, tumour obstruction, tumour perforation, pT4) or III Bianchi et al. 90 who have undergone adjuvant ChT undergoing adjuvant ChT Number of patients with colon cancer and AJCC TNM stage II Proportion of patients with colon cancer AJCC TNM stage II Number of patients with colon cancer and AJCC TNM stage II 1182 2013 Switzerland high-risk or III, who have undergone adjuvant ChT within 8 high-risk or stage III undergoing adjuvant ChT within 8 weeks PMe5 L01 L high-risk or III undergoing surgery and adjuvant ChT Bianchi et al. 90 weeks from surgical resection from surgical resection Number of patients with colorectal cancer and histology of the Proportion of patients with colorectal cancer and histology of Number of patients with colorectal cancer undergoing primary 1183 2013 Switzerland primary tumour or metastases obtained before the beginning the primary tumour or metastases obtained before the PMe7 L01 L ChT Bianchi et al. 90 of ChT beginning of ChT Number of patients with colorectal cancer and unresectable Number of patients with colorectal cancer and unresectable Proportion of patients with colorectal cancer and unresectable 1184 2013 Switzerland PMe1 L01 L metastases metastases who have undergone a first-line ChT or bio-ChT metastases undergoing first-line ChT or bio-ChT Bianchi et al. 90 Number of patients with colorectal cancer and hepatic Proportion of patients with colorectal cancer and hepatic Number of patients with colorectal cancer and unresectable 1185 2013 Switzerland metastases primarily unresectable turned into resectable metastases primarily unresectable turned into resectable OMe9 L01 L hepatic metastases undergoing neo-adjuvant ChT Bianchi et al. 90 metastases after neo-adjuvant ChT metastases after neo-adjuvant ChT Proportion of patients with locally advanced rectal cancer (T3- Proportion of patients with locally advanced rectal cancer (T3- Number of patients with locally advanced rectal cancer 1186 2013 Switzerland 4 and/or any T, N+ and M0) who have undergone neo- 4 and/or any T, N+ and M0) undergoing neo-adjuvant PMe1 L01 L undergoing surgery Bianchi et al. 90 adjuvant RT±ChT RT±ChT Number of patients with rectal cancer who have undergone Proportion of patients with rectal cancer and undergoing neo- Number of patients with rectal cancer undergoing neo- 1187 2013 Switzerland neo-adjuvant RT±ChT and were operated within 6–8 weeks adjuvant RT±ChT operated within 6–8 weeks after the end of PMe5 L01 L adjuvant RT ±ChT followed by surgery Bianchi et al. 90 after the end of neo-adjuvant RT±ChT neo-adjuvant RT±ChT The number of breast cancer women aged less than and The number of cancer women aged less than and equal to 50 Proportion of breast cancer women aged less than and equal 1188 2008 Taiwan equal to 50 years (pre-menopausal) with positive lymph nodes years (pre-menopausal breast) with positive lymph nodes to 50 years (pre-menopausal) with positive lymph node PMe1 L01 L Chung et al. 91 (exclude: male patients and metastasis patients) receiving adjuvant chemotherapy receiving adjuvant chemotherapy The number of breast cancer women aged greater than 50 Proportion of breast cancer women aged greater than 50 The number of breast cancer women aged greater than 50 1189 2008 Taiwan years (post-menopausal) with positive lymph nodes receiving years (post-menopausal) with positive lymph node receiving PMe1 L01 L02 L years (post-menopausal) with positive lymph nodes Chung et al. 91 adjuvant or chemotherapy adjuvant hormone therapy or chemotherapy Number of stage III colon cancer patients who was offered Number of stage III colon cancer patients who was offered Proportion of stage III colon cancer patients who was offered 1190 92 2010 Taiwan PMe5 L01 L Chung et al. chemotherapy after surgery (in the same hospital) chemotherapy within 6 weeks after surgery chemotherapy within 6 weeks after surgery Number of patients who are diagnosed with Stage II or III Proportion of patients who are diagnosed with Stage II or III Number of patients who are diagnosed with Stage II or III 1191 2010 Taiwan rectal cancer, was offered treatment including surgery, rectal cancer, was offered treatment including surgery, PMe5 L01 L rectal cancer, was offered treatment in the same hospital radiotherapy, or CCRT treatment within 6 weeks of diagnosis radiotherapy, or CCRT treatment within 6 weeks of diagnosis Chung et al. 92 Number of patients who are diagnosed with rectal cancer that Number of patients who are diagnosed with rectal cancer that Proportion of patients who are diagnosed with rectal cancer 1192 2010 Taiwan appears clinically to be Stage II or III, and was offered CCRT appears clinically to be Stage II or III, and was offered surgical that appears clinically to be Stage II or III, and was offered PMe5 L01 L before surgery resections within 16 weeks after beginning of CCRT surgical resections within 16 weeks after beginning of CCRT Chung et al. 92

1193 93 1998 UK The indication for the drug is recorded and upheld in the BNF P Ge 1 N/A N/A Cantrill et al. The reason for prescribing a drug of limited value is recorded 1194 93 1998 UK P Ge 1 N/A N/A Cantrill et al. and valid Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Compared with alternative treatments in the same therapeutic class, which are just as safe and effective, the drug prescribed 1195 1998 UK P Ge 1 N/A N/A is either one of the cheapest or a valid reason is given for Cantrill et al. 93 using an alternative 1196 Cantrill et al. 93 1998 UK A generic product is prescribed if one is available P Ge 1 N/A N/A If a potentially hazardous drug-drug combination is 1197 93 1998 UK P Ge 5 N/A N/A Cantrill et al. prescribed, the prescriber shows knowledge of the hazard If the total daily dose is outside the range stated in the BNF, 1198 93 1998 UK P Ge 5 N/A N/A Cantrill et al. the prescriber gives a valid reason If the dosing frequency is outside the range stated in the BNF, 1199 93 1998 UK P Ge 5 N/A N/A Cantrill et al. the prescriber gives a valid reason If the duration of treatment is outside the ranges stated in the 1200 93 1998 UK P Ge 5 N/A N/A Cantrill et al. BNF, the prescriber gives a valid reason Prescribing for hypertension adheres to the evidence-based 1201 93 1998 UK PMe1 C02C03C07C08C09 C Cantrill et al. guidelines in the BNF Pattern of care: Addition of amiodarone to the treatment of a patient already prescribed digoxin without reducing the digoxin 1202 2003 UK PMe17 C01 C Morris and dosage by initially one third to one half and subsequent Cantrill94 monitoring of the digoxin level Pattern of care: Regular use of a strong opioid analgesic (or 1203 Morris and 2003 UK co-proxamol/co-codamol at a dose of 4 tablets/day) without PMe1 A06 N02 AN Cantrill94 concurrent administration of a stimulant laxative Pattern of care: Concurrent use of an ACEI and either (i) a 1204 Morris and 2003 UK potassium-sparing diuretic or (ii) a potassium supplement PMe7 A12 C03 C09 AC Cantrill94 without monitoring the potassium level at least annually Morris and Pattern of care: Use of metoclopramide in a patient with a 1205 2003 UK PMe1 A03 A Cantrill94 history of Parkinson’s disease Morris and Pattern of care: Use of an inhaled steroid by high-dose 1206 2003 UK PMe5 R03 R Cantrill94 metered dose inhaler without usage of a spacer device Pattern of care: Use of a statin without monitoring the liver 1207 Morris and 2003 UK function before starting therapy, within 3 months of PMe7 C10 C Cantrill94 commencement and then at 6-month intervals thereafter Morris and Pattern of care: Prescribing beta-blocker eye drops to a 1208 2003 UK PMe1 S01 S Cantrill94 patient with a history of asthma or COAD Pattern of care: Use of long term steroids at a dose equivalent 1209 Morris and 2003 UK to 7.5 mg of prednisolone per day without osteoporosis PMe1 G03 H02 H05 M05 GHM Cantrill94 prophylaxis Pattern of care: Addition of amiodarone to the treatment of a 1210 Morris and 2003 UK patient already prescribed warfarin without reducing the PMe17 B01 C01 BC Cantrill94 warfarin dose and closely monitoring the INR Pattern of care: Use of an ACEI without monitoring the 1211 Morris and 2003 UK potassium level before starting therapy, within 6 weeks of PMe7 C09 C Cantrill94 commencement and at least annually thereafter Pattern of care: Use of an ACEI without monitoring the 1212 Morris and 2003 UK creatinine level before starting therapy, within 6 weeks of PMe7 C09 C Cantrill94 commencement and at least annually thereafter Pattern of care: Use of a potassium-wasting diuretic without: (i) concurrent use of a potassium supplement or (ii) 1213 2003 UK PMe17 A12 C03 AC Morris and concurrent use of a potassium-sparing diuretic or (iii) Cantrill94 monitoring the potassium level at least annually Pattern of care: Use of an oral or topical NSAID for 1 week or 1214 Morris and 2003 UK PMe1 M01 M02 M more in a patient with a history of peptic ulcers or GI bleeding Cantrill94 Pattern of care: Dispensing and issuing a prescription, by a pharmacist, for beta-blocker eye drops to a patient with a 1215 2003 UK known history of asthma or COAD without advising them to PMe5 S01 S Morris and contact their GP in the event of any deterioration of their Cantrill94 respiratory symptoms Pattern of care: Dispensing and issuing a prescription, by a 1216 Morris and 2003 UK pharmacist, for an oral NSAID without advising the patient to PMe5 M01 M02 M consult their GP if they experience or Cantrill94 Pattern of care: Prescribing, for the first time, an oral or topical NSAID to a patient with a history of asthma or COAD without 1217 2003 UK PMe5 M01 M02 M Morris and advising them to return in the event of any deterioration of Cantrill94 their respiratory symptoms Pattern of care: Dispensing and issuing a prescription, by a pharmacist, for an oral or topical NSAID to a patient with a 1218 2003 UK known history of asthma or COAD without advising them to PMe5 M01 M02 M Morris and contact their GP in the event of any deterioration in their Cantrill94 respiratory symptoms Pattern of care: Continued use of a previously established dose of digoxin without assessing the digoxin level in a patient 1219 2003 UK PMe7 C01 C Morris and presenting with any of the following symptoms: anorexia, nausea and vomiting, diarrhoea, visual disturbances or fatigue Cantrill94 Pattern of care: Continued use of a previously established 1220 Morris and 2003 UK dose of phenytoin, without assessing the phenytoin level, in a PMe7 N03 N Cantrill94 patient experiencing an altered seizure pattern Pattern of care: Prescribing, for the first time, without advising the patient to return should they experience 1221 2003 UK PMe5 H03 H Morris and any of the following symptoms: sore throat, mouth ulcers, Cantrill94 bruising, fever or malaise Pattern of care: Dispensing and issuing a prescription, by a pharmacist, for carbimazole without advising the patient to 1222 2003 UK contact their GP if they experience any of the following PMe5 H03 H Morris and symptoms: sore throat, mouth ulcers, bruising, fever or Cantrill94 malaise Morris and Pattern of care: In the absence of any contraindication, failing 1223 2003 UK PMe1 B01 B Cantrill94 to prescribe aspirin in a patient with a history of MI Pattern of care: In the absence of any contraindication, failing 1224 Morris and 2003 UK PMe14 C07 C to prescribe a beta-blocker for 2 to 3 years following MI Cantrill94 Pattern of care: In the absence of any contraindication, failing 1225 Morris and 2003 UK to prescribe an ACEI to a patient with known congestive heart PMe1 C09 C Cantrill94 failure Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a person aged 65 or older has mild-to-moderate Alzheimer's disease, THEN the treating physician should 1226 2004 UK PMe5 N06 N discuss treatment with a cholinesterase inhibitor with the Steel et al. 95 patient and the primary caregiver (if available) IF a person aged 65 or older is diagnosed with clinical depression, THEN antidepressant treatment, talking treatment, or electroconvulsive therapy should be offered 1227 2004 UK within 2 weeks after diagnosis unless within that period the PMe1 N06 N patient has improved, or unless the patient has substance abuse or dependence, in which case treatment may wait until 8 weeks after the patient is in a drug- or alcohol-free state Steel et al. 95 IF a person aged 65 or older with depression has no meaningful symptom response after 6 weeks of treatment, THEN one of the following treatment options should be initiated by the 8th week of treatment: medication dose should 1228 2004 UK PMe13 N06 N be optimised (if initial treatment was medication), or medication should be initiated (if initial treatment was psychotherapy alone), or referral to a psychiatrist should be Steel et al. 95 offered IF a diabetic person aged 65 or older does not have established renal disease and is not receiving an ACEI or 1229 2004 UK PMe7 C09 C angiotensin II receptor blocker, THEN he or she should Steel et al. 95 receive an annual test for proteinuria IF a diabetic person aged 65 or older has proteinuria not 1230 2004 UK caused by a urinary tract infection, THEN he or she should be PMe1 C09 C offered therapy with an ACEI or angiotensin II receptor blocker Steel et al. 95 ALL diabetic persons aged 65 or older not receiving other 1231 2004 UK PMe1 B01 B anticoagulation therapy should be offered daily aspirin therapy Steel et al. 95 IF a diabetic person aged 65 or older has one additional cardiac risk factor (i.e., smoker, hypertension, 1232 2004 UK hypercholesterolemia, or renal PMe1 C09 C insufficiency/microalbuminuria), THEN he/she should be Steel et al. 95 offered an ACEI or angiotensin II receptor blocker IF a person aged 65 or older has insulin treated diabetes, is 1233 2004 UK self-medicating, and is admitted to hospital, THEN they should PMe5 A10 A be supported to continue self-medication in hospital Steel et al. 95 IF a person aged 65 or older remains hypertensive after non- 1234 2004 UK pharmacological intervention, THEN pharmacological PMe1 C02C03C07C08C09 C Steel et al. 95 antihypertensive treatment should be initiated IF a person aged 65 or older requires pharmacotherapy for treatment of hypertension in the outpatient setting, THEN a 1235 2004 UK PMe3 C02C03C07C08C09 C once- or twice-daily medication should be used unless there is a need for agents that require more frequent dosing Steel et al. 95 IF a person aged 65 or older requires pharmacotherapy for treatment of hypertension in the outpatient setting, THEN a 1236 2004 UK PMe3 C02C03C07C08C09 C once-daily medication should be used unless there is a need Steel et al. 95 for agents that require more frequent dosing IF a person aged 65 or older has established CHD and is not 1237 2004 UK on warfarin, THEN he or she should be offered antiplatelet PMe1 B01 B Steel et al. 95 therapy IF a person aged 65 or older has had a myocardial infarction, 1238 2004 UK PMe1 C07 C THEN he or she should be offered a beta-blocker Steel et al. 95 IF a person aged 65 or older is prescribed a new drug, THEN the patient (or, if the patient is incapable, a caregiver) should 1239 2004 UK P Ge 5 N/A N/A receive education about the purpose of the drug, how to take it, and expected side effects or important adverse reactions Steel et al. 95 ALL persons aged 65 or older and taking medication should 1240 95 2004 UK P Ge 7 N/A N/A Steel et al. have a drug regimen review at least annually IF a person aged 65 or older is prescribed warfarin, THEN an 1241 95 2004 UK PMe7 B01 B Steel et al. INR should be determined at least every 12 weeks IF a person aged 65 or older is prescribed an oral 1242 2004 UK hypoglycaemic drug, THEN chlorpropamide should not be PMe1 A10 A Steel et al. 95 used ALL persons aged 65 or older should not be prescribed a 1243 2004 UK medication with strong anticholinergic effects if alternatives PMe1 A03 A04 G04 M03 N02 N04 N05 N06 R06 S01 A G M N R S Steel et al. 95 are available IF a person aged 65 or older does not need control of 1244 95 2004 UK PMe1 N05 N Steel et al. seizures, THEN should not be used IF a person aged 65 or older is treated with a non-selective 1245 2004 UK NSAID, THEN the patient should be advised of the PMe5 M01 M02 M gastrointestinal and renal risks associated with this drug Steel et al. 95 IF a person aged 65 or older is treated with a COX-2 selective 1246 2004 UK NSAID, THEN the patient should be advised of the PMe5 M01 M gastrointestinal and renal risks associated with this drug Steel et al. 95 IF a person aged 65 or over is treated with an NSAID 1247 2004 UK (selective or non- selective), THEN they should have a blood PMe7 M01 M02 M Steel et al. 95 pressure check at least once IF a person aged 65 or over is treated with an NSAID 1248 2004 UK (selective or non-selective), THEN they should be asked PMe7 M01 M Steel et al. 95 about gastro-intestinal symptoms at least annually IF a person aged 65 or older is newly prescribed an oral 1249 2004 UK PMe1 A10 A hypoglycaemic drug, THEN glibenclamide should not be used. Steel et al. 95 ALL persons aged 65 or older and taking four or more 1250 2004 UK medicines should have a drug regimen review every 6 P Ge 7 N/A N/A Steel et al. 95 months. IF oral pharmacological therapy is initiated to treat osteoarthritis among people aged 65 or older, THEN 1251 2004 UK PMe1 N02 N paracetamol should be the first drug used, unless there is a Steel et al. 95 contraindication to use. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF oral pharmacological therapy for osteoarthritis is changed from paracetamol to a different oral agent among people aged 1252 2004 UK PMe3 N02 N 65 or older, THEN the patient should have had a trial of maximum dose paracetamol (suitable for age/co-morbidities). Steel et al. 95 IF a person aged 65 or older with severe symptomatic osteoarthritis of the knee or hip has failed to respond to non- pharmacological and pharmacological therapy, THEN the 1253 2004 UK PMe7 M01 M02 N02 MN patient should be offered referral to an orthopaedic surgeon to be evaluated for total replacement within 6 months unless Steel et al. 95 surgery is contraindicated. IF a person aged 65 or older has untreated osteoporosis, 1254 2004 UK THEN calcium and vitamin D supplements should be PMe1 A11 A12 A Steel et al. 95 recommended at least once. IF a person aged 65 or older is taking corticosteroids at a dose of 7.5mg per day or more for more than 1 month, THEN 1255 2004 UK PMe1 A11 A12 H02 M05 AHM the patient should be offered calcium and vitamin D and a Steel et al. 95 biphosphonate. IF a woman aged 65 or older is newly diagnosed with osteoporosis, THEN the patient should be offered treatment 1256 2004 UK with hormone replacement therapy, SERMs, PMe1 A11 A12 G03 H05 M05 AGHM bisphosphonates, calcitonin, or calcium and vitamin D within 3 Steel et al. 95 months of diagnosis. IF a person aged 65 or older with a high risk of osteoporosis has a BMD ‘T score’ below –2.5, THEN the patient should be offered treatment with one or more of the following: 1257 2004 UK PMe1 A11 A12 G03 H05 M05 AGHM alendronate, calcitonin, calcitriol, cyclic etidronate, hormone replacement therapy, raloxifene, residronate, or vitamin D and Steel et al. 95 calcium. IF a person aged 65 or older with chronic pain is treated with 1258 2004 UK opioids, THEN he or she should be offered treatment to PMe1 A06 N02 AN Steel et al. 95 prevent constipation. IF a person aged 65 or older uses tobacco regularly, THEN he 1259 2004 UK or she should be offered advice and/or pharmacological PMe1 N07 N therapy to stop tobacco use at least once. Steel et al. 95 IF a person aged 65 or older has no history of anaphylactic hypersensitivity to eggs or to other components of the 1260 2004 UK PMe1 J07 J influenza vaccine, THEN the patient should be offered an Steel et al. 95 annual influenza vaccination. IF a person aged 65 or older has atrial fibrillation > 48-hour duration and has any "high risk" condition: - impaired left ventricle function - female gender 1261 2004 UK - hypertension or systolic blood pressure > 160 mmHg PMe1 B01 B - prior ischaemic stroke, transient ischaemic attack, or systemic embolism, THEN he or she should be offered oral anticoagulation Steel et al. 95 therapy, or antiplatelet therapy. IF a person aged 65 or older has had a previous stroke, 1262 2004 UK THEN the patient should be offered appropriate stroke PMe1 B01 B Steel et al. 95 prophylaxis with antiplatelet agents or warfarin. IF a person aged 65 or older has had a previous stroke, 1263 2004 UK THEN the patient should be offered antihypertensive PMe1 C02C03C07C08C09 C Steel et al. 95 medication. IF a person aged 65 or older who has been prescribed an ocular therapeutic regimen is admitted to hospital, THEN the 1264 2004 UK PMe6 S01 S regimen should be administered in the hospital unless contra- Steel et al. 95 indicated. IF a person aged 65 or older has valvular or congenital heart disease, intracardiac valvular prosthesis, hypertrophic 1265 2004 UK cardiomyopathy, mitral valve prolapse with regurgitation or PMe1 J01 J previous episode of endocarditis and a high-risk procedure is planned, THEN endocarditis prophylaxis should be given. Steel et al. 95 The indication for the drug is recorded in the inpatient medical 1266 96 2005 UK P Ge 9 N/A N/A Tully et al. record The indication for the drug is recorded in the discharge 1267 96 2005 UK P Ge 6 N/A N/A Tully et al. summary The indication for the drug in the discharge summary is 1268 96 2005 UK P Ge 1 N/A N/A Tully et al. upheld in the BNF If the drug is part of a questionable high-risk therapeutic 1269 2005 UK combination, the prescriber gives a reason in the discharge P Ge 6 N/A N/A Tully et al. 96 summary If the duration of a drug is outside the range stated in the 1270 2005 UK P Ge 6 N/A N/A BNF, the prescriber gives a reason in the discharge summary Tully et al. 96 If a drug is listed in the BNF as ‘less suitable for prescribing’, 1271 2005 UK the prescriber gives a reason for prescribing it in the P Ge 6 N/A N/A Tully et al. 96 discharge summary The drug is considered to be efficacious for the condition, or 1272 2005 UK the prescriber gives a reason for prescribing it in the P Ge 6 N/A N/A Tully et al. 96 discharge summary The drug is in the hospital formulary or the prescriber gives a 1273 2005 UK P Ge 1 N/A N/A reason for prescribing it in the patient medical record Tully et al. 96 If the total daily dose is outside the range stated in the BNF, 1274 2005 UK the prescriber gives a reason for prescribing it in the P Ge 6 N/A N/A Tully et al. 96 discharge summary If the dosage frequency is outside the range stated in the 1275 2005 UK BNF, the prescriber gives a reason for prescribing it in the P Ge 6 N/A N/A Tully et al. 96 discharge summary If a type A drug reaction occurs, there are details given of the 1276 2005 UK reaction and recommended future monitoring in the patient P Ge 8 N/A N/A Tully et al. 96 medical record If a type B drug reaction occurs, the prescriber gives details of 1277 2005 UK the reaction and recommended action in both the inpatient P Ge 6 N/A N/A Tully et al. 96 record and the discharge summary Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka If a potentially hazardous drug-drug combination is prescribed, the prescriber gives details of the interaction and 1278 2005 UK P Ge 6 N/A N/A recommended action in both the inpatient record and the Tully et al. 96 discharge summary If a potentially hazardous drug-disease combination is 1279 2005 UK prescribed, the prescriber gives a reason in the discharge P Ge 6 N/A N/A Tully et al. 96 summary Antibiotic prescriptions in children should be accompanied by 1280 2014 UK PMe5 J01 J a clearly documented rationale for this decision Gill et al. 97 Infants with colic should not be prescribed 1281 97 2014 UK PMe1 A03 A Gill et al. (dicyclomine) 1282 Gill et al. 97 2014 UK Children with asthma should be prescribed a spacer P Me 5 R03 R Children with Type 1 diabetes aged ≥6 months should have 1283 2014 UK documented evidence of being offered annual influenza PMe1 J07 J Gill et al. 97 immunisation

1284 97 2014 UK Children with atopic eczema should be prescribed emollients P Me 1 D02 D Gill et al. Percentage of children who have a repeat prescription of 1285 97 2014 UK PMe4 D07 D Gill et al. moderate/very potent topical steroids Children eligible for targeted hepatitis B immunisation should 1286 2014 UK PMe1 J07 J have a complete and up-to-date immunisation record Gill et al. 97 Children on long-term prescriptions should have an annual 1287 97 2014 UK P Ge 7 N/A N/A Gill et al. review in primary care Children taking methylphenidate, atomoxetine, or 1288 2014 UK PMe7 N06 N dexamfetamine should have clearly documented monitoring Gill et al. 97 Antidepressant medications should not be initiated by GPs for 1289 97 2014 UK PMe1 N06 N Gill et al. children and young people with depression Aspirin or clopidogrel prescribed to people with previous 1290 2014 UK PMe1 A02 B01 AB peptic ulcer or gastrointestinal bleed without gastroprotection Spencer et al. 98 Prescription of aspirin at a dose >75mg daily for ≥1 month in a 1291 98 2014 UK PMe4 B01 B Spencer et al. patient aged >65 years Prescription of digoxin at a dose >125 mg daily in a patient 1292 2014 UK PMe3 C01 C with renal impairment (for example, CKD 3 or worse) Spencer et al. 98 Prescription of digoxin at a dose of greater than 125 mg daily 1293 98 2014 UK PMe3 C01 C Spencer et al. for a patient with heart failure who is in sinus rhythm Prescription of diltiazem or in a patient with heart 1294 98 2014 UK PMe1 C05 C08 C Spencer et al. failure Prescription of a beta-blocker to a patient with asthma 1295 2014 UK (excluding patients who also have a cardiac condition, where PMe1 C07 C the benefits of beta-blockers may outweigh the risks) Spencer et al. 98 Prescription of a long-acting beta-2 agonist inhaler to a patient 1296 2014 UK with asthma who is not also prescribed an inhaled PMe1 R03 R Spencer et al. 98 corticosteroid Prescription of a benzodiazepine or Z drug for ≥21 days, in a 1297 2014 UK patient aged >65 years, who is not receiving benzodiazepines PMe4 N05 N Spencer et al. 98 or Z drugs on a long-term basis Initiation of prescription of benzodiazepine or Z drugs for ≥21 1298 98 2014 UK PMe4 N05 N Spencer et al. days in a patient aged >65 years with depression Antipsychotics prescribed for >6 weeks in the over 65s with 1299 98 2014 UK PMe4 N05 N Spencer et al. dementia but not psychosis Amitriptyline at dose >75mg prescribed to a patient with heart 1300 2014 UK PMe3 N06 N failure, arrhythmia, heart block. or postural hypotension Spencer et al. 98 1301 Spencer et al. 98 2014 UK Prescription of aspirin to a child aged ≤16 years P Me 1 B01 B 1302 Spencer et al. 98 2014 UK prescribed to a patient with epilepsy P Me 1 N06 N Prescription of mefloquine to a patient with a history of 1303 98 2014 UK PMe1 P01 P Spencer et al. convulsions 1304 Spencer et al. 98 2014 UK Glitazone prescribed to patient with heart failure P Me 1 A10 A Metformin prescribed to a patient with renal impairment where 1305 98 2014 UK PMe1 A10 A Spencer et al. the eGFR is ≤30ml/min Oral prednisolone prescribed at a dose ≥7.5mg daily for more 1306 2014 UK than 3 months to the over 65s without co-prescription of PMe1 G03 H02 H05 M05 GHM Spencer et al. 98 osteoporosis-preventing treatments Modified-release potassium supplements prescribed to a 1307 98 2014 UK PMe1 A12 A Spencer et al. patient with a history of peptic ulcer disease Prescription of a combined hormonal contraceptive to a 1308 2014 UK PMe1 G03 G woman with a history of venous or arterial thromboembolism Spencer et al. 98 Prescription of oral or transdermal oestrogens to a woman 1309 98 2014 UK PMe1 G03 G Spencer et al. with a history of breast cancer Prescription of oral or transdermal oestrogen without a 1310 98 2014 UK PMe1 G03 G Spencer et al. in a woman with an intact uterus Prescription of a combined hormonal contraceptive to a 1311 98 2014 UK PMe1 G03 G Spencer et al. woman aged ≥35 years who is a current smoker Prescription of a combined hormonal contraceptive to a 1312 98 2014 UK PMe1 G03 G Spencer et al. woman with a body mass index of ≥40 1313 Spencer et al. 98 2014 UK Methotrexate prescriptions should state ‘weekly’ P Me 3 L04 L 1314 Spencer et al. 98 2014 UK Methotrexate 2.5/10mg co-prescription P Me 3 L04 L 1315 Spencer et al. 98 2014 UK Methotrexate prescribed without folic acid P Me 1 B03 L04 BL Concurrent use of two NSAIDs for more than 2 weeks (not 1316 98 2014 UK PMe1 M01 M02 M Spencer et al. including low-dose aspirin) Prescription of an NSAID, without co-prescription of an ulcer- 1317 2014 UK PMe1 A02 M01 M02 AM healing drug, to a patient with a history of peptic ulceration Spencer et al. 98 1318 Spencer et al. 98 2014 UK Prescription of an NSAID in a patient with heart failure P Me 1 M01 M02 M Prescription of an NSAID in a patient with chronic renal failure 1319 98 2014 UK PMe1 M01 M02 M Spencer et al. with an eGFR <45 Allopurinol prescribed at a dose of >200mg/day to patients 1320 98 2014 UK PMe3 M04 M Spencer et al. with renal impairment (eGFR <30 or CKDA) Prescription of warfarin and aspirin in combination (without co- 1321 98 2014 UK PMe1 A02 B01 AB Spencer et al. prescription of gastroprotection) Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Concurrent use of warfarin and any antibiotic without 1322 98 2014 UK PMe7 B01 J01 BJ Spencer et al. monitoring the INR within 5 days 1323 Spencer et al. 98 2014 UK Prescription of warfarin in combination with an oral NSAID P Me 1 B01 M01 M02 BM Prescription of a phosphodiesterase type-5 inhibitor, for 1324 2014 UK example sildenafil, to a patient who is also receiving a nitrate PMe1 C01 G04 CG Spencer et al. 98 or nicorandil 1325 Spencer et al. 98 2014 UK Co-prescription of lithium with thiazide diuretic P Me 1 C03 N05 CN Prescription of a potassium salt or potassium-sparing diuretic 1326 2014 UK (excluding aldosterone antagonists) to a patient who is also PMe1 A12 C03 C09 AC receiving an ACEI or angiotensin II receptor antagonist Spencer et al. 98 Prescription of verapamil to a patient who is also receiving a 1327 98 2014 UK PMe1 C07 C08 C Spencer et al. beta-blocker Co-prescription of itraconazole with simvastatin, or with 1328 98 2014 UK PMe3 C10 J02 CJ Spencer et al. atorvastatin at a dose ≥80mg

1329 98 2014 UK Co-prescription of trimethoprim with methotrexate for >7 days P Me 4 J01 L04 JL Spencer et al. Prescription of clarithromycin or erythromycin to a patient who is also receiving simvastatin, with no evidence that the patient 1330 2014 UK PMe5 C10 J01 CJ has been advised to stop the simvastatin while taking the Spencer et al. 98 antibiotic Prescription of a penicillin-containing preparation to a patient 1331 98 2014 UK PMe1 J01 J Spencer et al. with a history of allergy to penicillin Patients aged >75 years on loop diuretics who have not had a 1332 98 2014 UK PMe7 C03 C Spencer et al. U+E in the previous 15 months Prescription of amiodarone without a record of liver function 1333 98 2014 UK PMe7 C01 C Spencer et al. being measured in the previous 9 months Prescription of amiodarone without a record of thyroid function 1334 98 2014 UK PMe7 C01 C Spencer et al. being measured within the previous 9 months Prescription of an ACEI or angiotensin II receptor antagonist 1335 2014 UK without a record of renal function and electrolytes being PMe7 C09 C Spencer et al. 98 measured prior to starting therapy Patients on an ACEI or angiotensin II receptor antagonist who 1336 98 2014 UK PMe7 C09 C Spencer et al. have not had a U+E in the previous 15 months Prescription of warfarin to a patient without a record of INR 1337 2014 UK having been measured within the previous 12 weeks PMe7 B01 B Spencer et al. 98 (excluding patients who self-monitor) Prescription of a statin without an ALT taken prior to starting 1338 98 2014 UK PMe7 C10 C Spencer et al. treatment Prescription of a statin without an ALT taken prior to starting 1339 2014 UK PMe7 C10 C treatment and within 3 months of starting treatment Spencer et al. 98 Prescription of lithium without a record of a lithium level being 1340 98 2014 UK PMe7 N05 N Spencer et al. measured within the previous 6 months 1341 Spencer et al. 98 2014 UK Metformin without yearly serum creatinine P Me 7 A10 A Use of a hypothyroid agent without monitoring relevant thyroid 1342 2014 UK function tests within 2 – 4 months of initiation or dosage PMe7 H03 H Spencer et al. 98 change and at least every 15 months thereafter Prescription of methotrexate without a record of a full blood 1343 98 2014 UK PMe7 L04 L Spencer et al. count within the previous 3 months Prescription of methotrexate without a record of liver function 1344 2014 UK PMe7 L04 L having been measured within the previous 3 months Spencer et al. 98 without baseline urea, electrolytes, creatinine and 1345 98 2014 UK PMe7 M04 M Spencer et al. eGFR The percentage of patients with coronary heart disease who 1346 2016 UK have had influenza immunisation in the preceding 1 August to PMe1 J07 J NICE99 31 March The percentage of patients with coronary heart disease with a 1347 2016 UK record in the preceding 12 months that aspirin, an alternative PMe1 B01 B antiplatelet therapy, or an anticoagulant is being taken NICE99 The percentage of patients with coronary heart disease, stroke or transient ischemic attack, diabetes and/or chronic 1348 2016 UK PMe1 J07 J obstructive pulmonary disease who have influenza NICE99 immunisation in the preceding 1 August and 31 March In those patients with atrial fibrillation with a record of a CHA2DS2-VASc score of 2 or more, the percentage of 1349 2016 UK PMe1 B01 B patients who are currently treated with anticoagulation drug NICE99 therapy. The percentage of patients on lithium therapy with a record of 1350 2016 UK PMe7 N05 N serum creatinine and TSH in the preceding 9 months NICE99 The percentage of patients on lithium therapy with a record of 1351 2016 UK lithium levels in the therapeutic range within the previous 4 PMe7 N05 N NICE99 months The percentage of patients on the CKD register who have 1352 2016 UK hypertension and proteinuria and who are currently being PMe1 C09 C NICE99 treated with renin-angiotensin system antagonists The percentage of patients with COPD who have had 1353 2016 UK PMe1 J07 J influenza immunisation in the preceding 1 August to 31 March NICE99 The percentage of patients with coronary heart disease, stroke or transient ischemic attack, diabetes and/or chronic 1354 2016 UK PMe1 J07 J obstructive pulmonary disease who have influenza NICE99 immunisation in the preceding 1 August and 31 March The percentage of women, on the register, prescribed an oral or patch contraceptive method in the preceding 12 months 1355 2016 UK who have also received information from the contractor about PMe5 G03 G long acting reversible methods of contraception in the NICE99 preceding 12 months The percentage of women, on the register, prescribed emergency 1 or more times in the preceding 12 months by the contractor who have received 1356 2016 UK PMe5 G03 G information from the contractor about long acting reversible methods of contraception at the time of or within 1 month of NICE99 the prescription Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka The percentage of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or 1357 2016 UK PMe1 C09 C microalbuminuria who are currently treated with an ACEI (or NICE99 ARBs) The percentage of patients with diabetes, on the register, who 1358 2016 UK have had influenza immunisation in the preceding 1 August to PMe1 J07 J NICE99 31 March In those patients with a new diagnosis of hypertension or type 2 diabetes aged 25-84 years, recorded between the preceding 1 April to 31 March (excluding those with pre-existing CHD, stroke and/or TIA), who have a recorded CVD risk 1359 2016 UK PMe1 C10 C assessment score (using the QRISK2 assessment tool) of >20% in the preceding 12 months: the percentage who are currently treated with statins (unless there is a NICE99 contraindication) The percentage of patients with coronary heart disease, stroke or transient ischemic attack, diabetes and/or chronic 1360 2016 UK PMe1 J07 J obstructive pulmonary disease who have influenza NICE99 immunisation in the preceding 1 August and 31 March Of the patients with type 1 diabetes who meet the following criteria: aged over 40 years and who have either had diabetes 1361 2016 UK for more than 10 years, or who have established nephropathy PMe1 C10 C or other CVD risk factors; the percentage currently treated NICE99 with a statin. The percentage of women under the age of 55 years who are taking antiepileptic drugs who have a record of information 1362 2016 UK PMe5 N03 N and counselling about contraception, conception and NICE99 pregnancy in the preceding 15 months The percentage of women with epilepsy aged 18 or over and who have not attained the age of 45 who are taking antiepileptic drugs who have a record of being given 1363 2016 UK PMe5 N03 N information and advice about pregnancy or conception or contraception tailored to their pregnancy and contraceptive intentions recorded in the preceding 12 months NICE99 The percentage of patients aged 18 or over on drug treatment 1364 2016 UK for epilepsy who have been seizure free for the last 12 months OMe9 N03 N NICE99 recorded in the preceding 12 months In those patients with a current diagnosis of heart failure due 1365 2016 UK to left ventricular systolic dysfunction, the percentage of PMe1 C09 C NICE99 patients who are currently treated with an ACEI or ARB In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction who are currently treated 1366 2016 UK with an ACEI or ARB, the percentage of patients who are PMe1 C07 C09 C additionally currently treated with a beta-blocker licensed for NICE99 heart failure In those patients with a new diagnosis of hypertension or type 2 diabetes aged 25-84 years, recorded between the preceding 1 April to 31 March (excluding those with pre-existing CHD, stroke and/or TIA), who have a recorded CVD risk 1367 2016 UK PMe1 C10 C assessment score (using the QRISK2 assessment tool) of >20% in the preceding 12 months: the percentage who are currently treated with statins (unless there is a NICE99 contraindication) The contractor establishes and maintains a register of 1368 2016 UK patients with who are currently treated with PMe1 H03 H NICE99 levothyroxine The percentage of patients who had a myocardial infarction in the preceding 1 April to 31 March and who are currently being 1369 2016 UK PMe1 B01 C07 C09 C10 BC treated with ACEI (or ARB if ACEI intolerant), dual anti-platelet therapy, beta-blocker and a statin NICE99 The percentage of patients with a history of myocardial infarction (more than 12 months ago) who are currently being 1370 2016 UK treated with an ACEI (or ARB if ACEI intolerant), aspirin (or PMe1 B01 C07 C09 C10 BC anticoagulant drug therapy) and a statin and a beta-blocker for those patients with left ventricular systolic dysfunction NICE99 The percentage of patients aged 50 or over and who have not attained the age of 75, with a record of a fragility fracture on or 1371 2016 UK after 1 April 2012, in whom osteoporosis is confirmed on DXA PMe1 M05 M scan, who are currently treated with an appropriate bone- NICE99 sparing agent The percentage of patients aged 75 or over with a fragility 1372 2016 UK fracture on or after 1 April 2012, who are currently treated with PMe1 M05 M NICE99 an appropriate bone-sparing agent The percentage of patients with peripheral arterial disease 1373 2016 UK with a record in the preceding 12 months that aspirin or an PMe1 B01 B NICE99 alternative antiplatelet is being taken The percentage of patients with a stroke shown to be non- haemorrhagic, or a history of TIA, who have a record in the 1374 2016 UK PMe1 B01 B preceding 12 months that an anti-platelet agent, or an anti- NICE99 coagulant is being taken The percentage of patients with stroke or TIA who have had 1375 2016 UK PMe1 J07 J influenza immunisation in the preceding 1 August to 31 March NICE99 Proportion of patients with atrial fibrillation on anticoagulation 1376 99 2016 UK OMe1 B01 B NICE admitted to hospital for stroke Proportion of patients with atrial fibrillation not on 1377 99 2016 UK OMe1 B01 B NICE anticoagulation admitted to hospital for stroke Proportion of people with dementia prescribed antipsychotic 1378 99 2016 UK PMe1 N05 N NICE medication If clinical evaluation and/or chest radiography showed evidence of volume overload (that is, leg edema, ascites, 1379 1996 USA PMe1 C03 C rales, jugular venous distension, or pulmonary edema), the Hadorn et al. 100 patient should be receiving a diuretic. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka All patients with LVEF ≦35% should be receiving an ACEI unless: a. There is documented intolerance to ACEIs (that is, symptomatic hypotension, cough, angioedema other allergic reactions, or worsening renal function as evidenced by a rise in the creatinine of 0.5 or greater), or b. The serum potassium has been greater than 5.5 at a time when the patient was not taking potassium supplements or a 1380 1996 USA potassium-sparing agent (for example, spironolactone. PMe13 C09 C amiloride, triamterene). The dose af the ACEI should be at least: a. 10mg BID of enalapril b. 50mg TID of captopril c. 20mg QID of lisinopril d. 20mg BID of quinapril Reasons for using lower doses (for example, symptomatic hypotension, impaired renal function) should be documented Hadorn et al. 100 (Heart failure) If patients experience persistent or worsening symptoms and/or signs of volume overload a record should 1381 1996 USA appear that they were questioned concerning their compliance P Ge 5 N/A N/A with diet and medications. Such questioning need take place only periodically, for example, every six months. Hadorn et al. 100 (Heart failure) if patients experience persistent or worsening symptoms and/or signs of volume overload, despite compliance with medications and diet, one of the following should be documented: a. A diuretic was newly prescribed b. The dose of the diuretic was increased c. A loop diuretic was initiated in a patient previously taking a 1382 1996 USA PMe13 C03 C thiazide diuretic d. A second diuretic (for example, metoazone, spironolactone) was added to the regimen of a patient taking a loop diuretic e. The patient was admitted to the hospital for intravenous diuretic therapy f. lt is stated that the patient cannot tolerate a higher dose of diuretic because of hypotension or renal insufficiency. Hadorn et al. 100 Initial history and physical examination of patients with hypertension should document assessment of at least 2 items from each of the following groups: 3a. History: Family or personal history of premature CAD, CVD, diabetes, or hyperlipidemia 1383 2001 USA 3b. Medication or substance use: Personal history of tobacco P Ge 7 N/A N/A abuse, alcohol abuse, or taking of medications that may cause hypertension 3c. Physical examination: Examination of the fundi, heart sounds, abdomen for bruits, peripheral arterial pulses, and Asch et al. 101 neurologic system Stage 1 hypertensive women taking drugs that may cause hypertension should have the drug discontinued (at least temporarily) before pharmacotherapy is initiated: • Oral contraceptives 1384 2001 USA PMe1 G03 N06 R01 GNR • Nasal • Appetite suppressants • Monoamine oxidase inhibitors Asch et al. 101 • Tricyclic antidepressants Stage 1-2 hypertensive patients whose blood pressure 1385 2001 USA remains stage 1-2 after 6 mo of lifestyle modification should PMe1 C08 C09 C Asch et al. 101 receive pharmacotherapy. Stage 3 hypertensive patients should receive 1386 101 2001 USA PMe1 C08 C09 C Asch et al. pharmacotherapy. First-line pharmacotherapy for diabetic patients should include 1387 101 2001 USA PMe1 C08 C09 C Asch et al. an ACEI or a . Hypertensive patients with persistent elevations of SBP of >160 mm Hg or DBP of >90 mm Hg should have 1 of the 1388 2001 USA following interventions recorded in the medical record: PMe135C08 C09 C • Change in dose or regimen of antihypertensive agents Asch et al. 101 • Repeated education regarding lifestyle modifications IF a gout patient is receiving an initial prescription for allopurinol and has significant renal impairment (defined as a serum creatinine level ≥2 mg/dl or measured/estimated creatinine clearance ≤50 ml/minute), THEN the initial daily 1389 2004 USA PMe3 M04 M allopurinol dose should be <300 mg per day, BECAUSE the risk of allopurinol-related toxicity is increased in the presence of significant renal impairment in gout patients given a daily allopurinol dose equal to or exceeding 300 mg. Mikuls et al. 102 IF a gout patient is given a prescription for oxidase inhibitor in the setting of required therapy with either 1) azathioprine (Imuran) or 2) 6-MP, THEN the dose of azathioprine/6-MP should be reduced by a minimum of 50%, 1390 2004 USA PMe3 M04 L01 L04 ML BECAUSE concurrent use of a xanthine oxidase inhibitor to a substantial increase in serum levels of azathioprine (and 6-MP) and increases the risk for severe drug-related Mikuls et al. 102 myelosuppression. IF a patient with tophaceous gout is given an initial prescription for a urate-lowering medication (xanthine oxidase inhibitor, , or ) and lacks both 1) significant renal impairment (a serum creatinine level ≥2 mg/dl or measured/estimated creatinine clearance ≤50 ml/minute) 1391 2004 USA PMe1 M01 M04 M and 2) peptic ulcer disease, THEN a prophylactic antiinflammatory agent ( or NSAID) should be given concomitantly, BECAUSE prophylactic antiinflammatory therapy reduces the risk of rebound gout attacks, which frequently follow the initiation of urate-lowering therapy. Mikuls et al. 102 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a patient has asymptomatic characterized by 1) no prior history of gouty arthritis or tophaceous deposits and 2) no prior history of nephrolithiasis or 1392 2004 USA and 3) no ongoing treatment of malignancy, THEN urate- PMe1 M04 M lowering therapies should not be initiated, BECAUSE there is currently no widely accepted indication for the treatment of asymptomatic hyperuricemia. Mikuls et al. 102 IF a gout patient is started on urate-lowering therapy and has either 1) a history of nephrolithiasis or 2) significant renal insufficiency (serum creatinine level ≥2 mg/dl or measured/estimated creatinine clearance ≤50 ml/minute), THEN a xanthine oxidase inhibitor should be started as the 1393 2004 USA initial urate-lowering medication rather than a agent PMe1 M04 M (probenecid or sulfinpyrazone), BECAUSE in contrast to xanthine oxidase inhibitors, uricosuric agents increase the renal of urate, enhancing the risk of nephrolithiasis, and may have diminished efficacy in the context of significant renal insufficiency. Mikuls et al. 102 IF a patient has hyperuricemia and gouty arthritis characterized by any of the following clinical characteristics, 1) tophaceous deposits, 2) gouty erosive changes on radiographs, or 3) gout attack frequency of ≥2 attacks per 1394 2004 USA PMe1 M04 M year, THEN the patient should be offered treatment with a urate-lowering drug, BECAUSE urate-lowering drugs have been well-tolerated and effective in decreasing the attack frequency and disease severity for those with severe gout. Mikuls et al. 102 IF a gout patient is given a prescription for a xanthine oxidase inhibitor, THEN a serum urate level should be checked at least once during the first 6 months of continued use, 1395 2004 USA PMe7 M04 M BECAUSE periodic serum urate measurements are required for appropriate dose adjustments of xanthine oxidase inhibitors (escalations or reductions). Mikuls et al. 102 IF a patient has acute gouty arthritis and lacks both of the relative contraindications to gout treatment, 1) significant renal impairment (a serum creatinine level ≥2 mg/dl or measured/ estimated creatinine clearance ≤50 ml/minute) and 2) peptic ulcer disease, THEN the patient should be treated with an antiinflammatory agent to include one of the following: 1) 1396 2004 USA PMe1 H02 M01 M04 HM NSAID, 2) ACTH or glucocorticoid (either systemic or intraarticular administration), or 3) colchicine, BECAUSE antiinflammatory agents have been shown to be both effective and well-tolerated for the short-term treatment of acute gout. Patients with renal impairment and a history of peptic ulcer disease may be at a higher risk for gout medication toxicity. Mikuls et al. 102 IF a gout patient receives long-term prophylactic oral colchicine (defined as a minimum daily dose of 0.5 mg for a duration of 6 months or longer) and has significant renal insufficiency (a serum creatinine level ≥2 mg/dl or measured/estimated creatinine clearance ≤50 ml/minute), 1397 2004 USA PMe7 M04 M THEN a complete blood cell count and creatine kinase should be evaluated a minimum of one time for every 6 months of continued use, BECAUSE the risk of colchicine-related myopathy and myelosuppression appears to be substantially increased in the context of reduced renal function. Mikuls et al. 102 IF a NH resident has depression with psychotic features THEN he or she should be referred to a psychiatrist and/or 1398 2004 USA should receive treatment with a combination of an PMe1 N05 N06 N antidepressant and an antipsychotic medication or with Saliba et al. 103 electroconvulsive therapy IF a NH resident is diagnosed with depression THEN antidepressant treatment, psychotherapy, or electroconvulsive therapy should be offered within 2 weeks after diagnosis 1399 2004 USA unless there is documentation within that period that the PMe5 N05 N06 N resident has improved, or unless the resident has substance abuse or dependence, in which case treatment could wait until 8 weeks after the resident is in a drug- or alcohol-free state Saliba et al. 103 IF a NH resident is started on an antidepressant medication THEN the following medications should not be used as first- or second-line therapy; tertiary amine tricyclics (amitriptyline, 1400 2004 USA PMe1 N05 N06 N imipramine, , clomipramine, ); MAOIs (unless atypical depression is present); benzodiazepines; or (except methylphenidate) Saliba et al. 103 IF a NH resident is taking a SSRI THEN a MAOI should not be used for at least 2 weeks after termination of , 1401 2004 USA PMe1 N06 N sertraline, fluvoxamine, and citalopram, and for at least 5 Saliba et al. 103 weeks after termination of fluoxetine IF a NH resident is taking a MAOI THEN he or she should not 1402 2004 USA receive medications that interact with MAOIs (for example, PMe1 N06 N SSRIs) for at least 2 weeks after termination of the MAOI Saliba et al. 103 IF a NH resident has depression treatment initiated THEN all of the following should be documented at the first 2 follow-up visits: the degree of response to at least two of the nine DSM- 1403 2004 USA IV target symptoms for major depression; medication side PMe7 N06 N effects, if he or she is taking antidepressant medications; and suicidal risk, if he or she had suicidal ideation during a Saliba et al. 103 previous visit IF a NH resident has experienced three or more episodes of 1404 2004 USA depression THEN he or she should receive maintenance PMe4 N06 N antidepressant medication for at least 36 months Saliba et al. 103 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a NH resident is being treated for depression with antidepressants THEN the antidepressants should be prescribed at appropriate starting doses, and they should 1405 2004 USA PMe3 N06 N have an appropriate titration schedule to a therapeutic dose, therapeutic blood level, or remission of symptoms by 12 Saliba et al. 103 weeks IF a NH resident has no meaningful symptom response after 6 weeks of treatment THEN one of the following should be initiated by the eighth week of treatment: Optimization of 1406 2004 USA medication (ie, alter dose of initial medication; change to or PMe13 N06 N add a different medication); psychiatric referral (if initial treatment was medication); or medication trial (if initial treatment was psychotherapy alone) Saliba et al. 103 IF a NH resident responds only partially after 12 weeks of treatment THEN at least one of the following treatment options should be instituted by the 16th week of treatment: switch to a different medication class or add a second medication to the 1407 2004 USA first (if initial treatment includes medication); add PMe1 N06 N psychotherapy (if the initial treatment was medication); a trial of medication (if initial treatment was psychotherapy without medication), consider electroconvulsive therapy, or referral to Saliba et al. 103 a psychiatrist IF a NH resident has responded to antidepressant medication THEN he or she should be continued on the drug at the same 1408 2004 USA dosage for at least 6 months, and at least one physician PMe4 N06 N documentation about depression should occur during that Saliba et al. 103 time period IF a NH resident with a history of cardiac disease is started on a tricyclic antidepressant THEN a baseline 1409 2004 USA PMe7 N06 N electrocardiogram should be obtained before initiation of Saliba et al. 103 treatment or within the 3 months before treatment IF a NH resident with diabetes has proteinuria THEN he or 1410 2004 USA she should be offered therapy with an ACEI or ACE receptor PMe1 C09 C Saliba et al. 103 blocker ALL NH residents with diabetes, who are not on other 1411 2004 USA PMe1 B01 B anticoagulant therapy, should be offered daily aspirin therapy Saliba et al. 103 IF a NH resident with diabetes has elevated blood pressure with blood pressure is >160/100 mmHg THEN he or she 1412 2004 USA PMe1 C09 C should be offered a therapeutic intervention to lower blood Saliba et al. 103 pressure within 3 months IF a diabetic vulnerable elder has one additiional cardiac risk factor (ie. Smoker, hypertension, hypercholesterolemia, or 1413 2004 USA PMe1 C09 C renal insufficiency/microalbuminuria) THEN he or she should be offered an ACEI or receptor blocker Saliba et al. 103 IF diuretics are given to a NH resident THEN the indication for 1414 2004 USA PMe9 C03 C the diuretic should be stated in the medical record Saliba et al. 103 IF a NH resident has heart failure and left ventricular ejection 1415 2004 USA fraction of 40% or less THEN he or she should be offered an PMe1 C09 C Saliba et al. 103 ACEI or an angiotensin receptor antagonist IF a NH resident has heart failure, has left ventricular ejection fraction of 40% or less, and New York Heart Association class 1416 2004 USA Ⅰ to Ⅲ disease THEN he or she should be offered a beta PMe1 C07 C blocker unless a contraindication (for example, uncompensated heart failure) has been indicated Saliba et al. 103 IF a NH resident with heart failure is treated with digoxin THEN the digoxin level should be checked within 1 week if 1417 2004 USA additional medications are added that chould affect digoxin PMe7 C01 C level (, verapamil, amiodarone) or if signs of toxicity Saliba et al. 103 develop IF a vulnerable elder remains hypertensive THEN he or she should be offered a therapeutic intervention to lower blood 1418 2004 USA PMe1 C02C03C07C08C09 C pressure: within 3 months if systolic blood pressure 161-180 mmHg or with 1 month if systolic blood pressure >180 mmHg Saliba et al. 103 IF a NH resident remains hypertensive after 1419 2004 USA nonpharmacologic intervention THEN pharmacologic PMe1 C02C03C07C08C09 C Saliba et al. 103 antihypertensive treatment should be initiated IF a NH resident is treated with antihypertensive medication 1420 2004 USA THEN both supine and standing blood pressures should be PMe7 C02C03C07C08C09 C measured with each adjustment of blood pressure medication Saliba et al. 103 IF a NH resident is diagnosed with hypertensiion and pharmacologic intervention is initiated THEN follow-up blood 1421 2004 USA pressure checks should occur every 2 weeks until blood PMe7 C02C03C07C08C09 C pressure control (<150/90 mmHg) or targeted blood pressure Saliba et al. 103 goal has been achieved IF a NH resident with hypertension is treated with pharmacologic therapy and has achieved blood pressure 1422 2004 USA control (<150/90 mmHg) or targeted blood pressure goal PMe7 C02C03C07C08C09 C THEN follow-up blood pressure checks should occur at least Saliba et al. 103 every 3 months IF a NH resident is prescribed a diuretic THEN he or she should have serum electrolytes (including blood urea 1423 2004 USA PMe7 C03 C or creatinine) checked within 7 days after initiation of therapy, after dose adjustment, and at least yearly Saliba et al. 103 IF a NH resident develops a hypertensive emergency with a diastolic blood pressure >120 mmHg and with manifestation of critical target organ damage (and no DNH order exists) THEN 1424 2004 USA parenteral hypertensive therapy to reduce mean arterial blood PMe15 C01C02C04C07C08C09 C pressure by 25% acutely and diastolic blood pressure to 100 - 110 mmHg within the next several hours should be initiated while the patient is in a monitored setting in the hospital Saliba et al. 103 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a NH resident has hypertension and renal parenchymal disease with a serum creatinine concentration greater than 1425 2004 USA PMe1 C09 C 1.5 mg/dL or more then 1g or protein/24 hours of collected urine THEN therapy with an ACEI should be offered Saliba et al. 103 IF a NH resident has hypertension and asthma THEN beta- 1426 103 2004 USA PMe1 C07 C Saliba et al. blocker therapy for hypertension should not be used IF a NH resident has an AMI or unstable angina THEN he or 1427 2004 USA she should be given aspirin therapy within 1 hour of reporting PMe15 B01 B Saliba et al. 103 symptoms IF a NH resident has an AMI or unstable angina THEN he or 1428 2004 USA she should be offered beta-blocker therapy within 12 hours of PMe15 C07 C Saliba et al. 103 presentation IF a NH resident has had a myocardial infarction THEN he or 1429 103 2004 USA PMe1 C07 C Saliba et al. she should be offered a beta-blocker IF a NH resident has established coronary artery disease and LDL cholesterol greater than 130 mg/dL and a trial of 1430 2004 USA PMe1 C10 C stepⅡdiet therapy was not offered or was ineffective THEN he or she should be offered cholesterol-lowering medication Saliba et al. 103 IF a NH resident has established coronary heart disease and 1431 2004 USA is not receiving warfarin THEN he or she should be offered PMe1 B01 B Saliba et al. 103 anti-platelet therapy IF a non-OTC drug is newly prescribed to treat new joint pain 1432 2004 USA THEN evident that the affected joint was examined should be PMe7 M02 M Saliba et al. 103 documented within 4 weeks IF oral pharmacologic therapy is initiated to treat osteoarthritis 1433 2004 USA PMe1 N02 N THEN acetaminophen should be the first drug used Saliba et al. 103 IF oral pharmacologic therapy for symptomatic osteoarthritis is changed from acetaminophen to a different oral agent THEN 1434 2004 USA there should be evidence that the NH resident has had a trial PMe3 N02 N of maximum dose acetaminophen (suitable for age and Saliba et al. 103 comorbid conditions) On admission to the NH, ALL female residents should be 1435 2004 USA offered both calcium and vitamin D and weight-bearing PMe1 A11 A12 A Saliba et al. 103 exercises within 1 month IF a NH resident has osteoporosis THEN calcium and vitamin 1436 2004 USA D supplements should be prescribed within 1 month of PMe1 A11 A12 A Saliba et al. 103 admission or of a new diagnosis of osteoporosis IF a NH resident is newly diagnosed with osteoporosis THEN he or she should be offered pharmacologic treatment 1437 2004 USA PMe1 G03 H05 M05 GHM (raloxifene, bisphosphonates or calcitonin) within 3 months of Saliba et al. 103 diagnosis IF a NH resident is taking corticosteroids for more than 1 1438 2004 USA month THEN the resident should also be offered calcium and PMe1 A11 A12 H02 AH Saliba et al. 103 vitamin D IF a NH resident has a new diagnosis of osteoporosis THEN 1439 2004 USA during the initial evaluation period, medications should be PMe7 G03 H05 M05 GHM reviewed as possibly contributing to osteoporosis Saliba et al. 103 IF a NH resident is diagnosed with pneumonia THEN 1440 2004 USA PMe15 J01 J antibiotics should be administered within 8 hours of diagnosis Saliba et al. 103 IF a NH resident treated for a NH-acquired pneumonia has hypoxia THEN the resident should be transferred to a hospital 1441 2004 USA PMe1 V03 V or receive oxygen therapy in the NH or the record should Saliba et al. 103 document why that is not indicated IF a NH resident with no history of allergy to the pneumococcla vaccine is not known to have received a 1442 2004 USA pneumococcal vaccine or received the vaccine more than 5 PMe1 J07 J years ago (if before age 65) THEN a pneumococcal vaccine Saliba et al. 103 should be offered IF a NH resident has no history of anaphylactic hypersensitivity to eggs or to othercomponents of the 1443 2004 USA PMe1 J07 J influenza vaccine THEN the resident should be offered an Saliba et al. 103 annual influenza vaccination IF pneumococcal and/or influenza vaccination rates among residents of a NH are low (less than 90% of institutionalized 1444 2004 USA PMe9 J07 J elderly) THEN methods to increase the rate of vaccination Saliba et al. 103 should be used ALL NHs should have a formal plan to offer and encourage 1445 103 2004 USA SMe9 J07 J Saliba et al. influenza vaccination among their employees IF a NH resident with NH-acquired pneumonia is to be switched from parenteral to oral antimicrobial therapy THEN unless intravenous access cannot be maintained, the resident should meet the following criteria: a clinically improving 1446 2004 USA condition (ie, improved cough, resolved fever, decreased PMe2 J01 J leukocytosis); hemodynamic stability (ie, heart rate ≤100 beats/min; systolic BP ≥90 mmHg; respiratory rate ≥24 breaths/min; oxygen saturation ≥90% on room air); tolerance Saliba et al. 103 of oral medication or food and fluids IF a NH resident has atrial fibrillation for more than a 48-hour duration, and has any "high-risk" condition (impaired left ventricular function: female older than 75 years of age; hypertension or systolic blood pressure greater than 160 1447 2004 USA PMe1 B01 B mmHg; prior ischemic stroke, TIA, or systemic embolism) THEN he or she should be offered either oral anticoagulation therapy with warfarin or antiplatelet therapy if the medical record documents a reason not to give anticoagulant therapy Saliba et al. 103 IF a NH resident is diagnosed with acute atherothrombotic ischemic stroke or with a TIA THEN antiplatelet treatment 1448 2004 USA PMe15 B01 B should be offered within 48 hours after the stroke or TIA, unless the patient is already receiving anticoagulant treatment Saliba et al. 103 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a NH resident is taking warfarin for atrial fibrillation THEN an INR should be checked at all of the following times: within 1449 2004 USA 4 days of the first dose; at least every 6 weeks, and within 1 PMe7 B01 B week of starting a medicine known to affect the anticoagulant Saliba et al. 103 activity of warfarin IF a NH resident under age 70 who has a life expectancy of >6 months and does not have advanced dementia has sustained a thrombotic stroke or TIA, and if two lipid 1450 2004 USA PMe1 C10 C measurements at least 2 weeks apart confirm LDL >130 and/or total cholesterol to HDL ratio >4 THEN the resident Saliba et al. 103 should be offered treatment IF a vulnerable elder has cerebrovascular disease THEN the 1451 2004 USA patient should be offered appropriate stroke prophylaxis with PMe1 B01 B Saliba et al. 103 antiplatelet agents or warfarin AMI patients without aspirin contraindications. Included populations: Discharges with an ICD-9-CM Principal Diagnosis Code for AMI as defined in Table 2. Excluded populations: ● Patients less than 18 years of age ● Patients transferred to another acute care hospital or federal hospital on day of or day after arrival ● Patients received in transfer from another acute care hospital, including another emergency department ● Patients discharged on day of arrival AMI–STEMI and NSTEMI patients without aspirin ● Patients who expired on day of or day after arrival AMI patients who received aspirin within 24 hours before or 1452 2006 USA contraindications who received aspirin within 24 hours before PMe15 B01 B ● Patients who left against medical advice on day of or day after hospital arrival. or after hospital arrival. after arrival ● Patients with one or more of the following aspirin contraindications/reasons for not prescribing aspirin documented in the medical record: - Active bleeding on arrival or within 24 hours after arrival - Aspirin allergy - Coumadin/warfarin as pre-arrival medication - Other reasons documented by physician, nurse practitioner, Krumholz et or physician assistant for not giving aspirin within 24 hours al. 104 before or after hospital arrival AMI patients without aspirin contraindications. Included populations: Discharges with an ICD-9-CM Principal Diagnosis Code for AMI as defined in Table 2. Excluded populations: ● Patients less than 18 years of age ● Patients transferred to another acute care hospital or federal hospital ● Patients who expired AMI–STEMI and NSTEMI patients without aspirin ● Patients who left against medical advice 1453 2006 USA AMI patients who are prescribed aspirin at hospital discharge. contraindications who are prescribed aspirin at hospital PMe1 B01 B ● Patients discharged to hospice discharge ● Patients with one or more of the following aspirin contraindications/reasons for not prescribing aspirin documented in the medical record: - Aspirin allergy - Active bleeding on arrival or during hospital stay - Coumadin/warfarin prescribed at discharge Krumholz et - Other reasons documented by physician, nurse practitioner, or physician assistant for not prescribing aspirin at discharge al. 104

AMI patients without beta blocker contraindications. Included populations: Discharges with an ICD-9-CM Principal Diagnosis Code for AMI as defined in Table 2. Excluded populations: ● Patients less than 18 years of age ● Patients transferred to another acute care hospital or federal hospital on day of or day after arrival ● Patients received in transfer from another acute care hospital, including another emergency department. ● Patients discharged on day of arrival ● Patients who expired on day of or day after arrival ● Patients who left against medical advice on day of or day AMI–STEMI and NSTEMI patients without beta-blocker after arrival AMI patients who received a beta-blocker within 24 hours after 1454 2006 USA contraindications who received a beta-blocker within 24 hours PMe15 C07 C ● Patients with one or more of the following beta-blocker hospital arrival. after hospital arrival contraindications/reasons for not prescribing beta-blocker documented in the medical record: - Beta-blocker allergy - Bradycardia (heart rate less than 60 beats/min) on arrival or within 24 hours after arrival while not on a beta-blocker - Heart failure on arrival or within 24 hours after arrival - Second- or third-degree heart block on ECG on arrival or within 24 hours after arrival and does not have a pacemaker - Shock on arrival or within 24 hours after arrival - Other reasons documented by a physician, nurse practitioner, or physician assistant for not giving a beta- Krumholz et blocker within 24 hours after hospital arrival al. 104 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka AMI patients without beta-blocker contraindications. Included populations: Discharges with an ICD-9-CM Principal Diagnosis Code for AMI as defined in Table 2. Excluded populations: ● Patients less than 18 years of age ● Patients transferred to another acute care hospital or federal hospital ● Patients who expired ● Patients who left against medical advice ● Patients discharged to hospice AMI–STEMI and NSTEMI patients without beta-blocker ● Patients with one or more of the following beta-blocker AMI patients who are prescribed a beta-blocker at hospital 1455 2006 USA contraindications who are prescribed a beta-blocker at PMe1 C07 C contraindications/reasons for not prescribing a beta-blocker discharge. hospital discharge documented in the medical record: - Beta-blocker allergy - Bradycardia (heart rate less than 60 beats/min) on day of discharge or day prior to discharge while not on a beta- blocker - Second- or third-degree heart block on ECG on arrival or during hospital stay and does not have a pacemaker - Other reasons documented by a physician, nurse Krumholz et practitioner, or physician assistant for not prescribing a beta- al. 104 blocker at discharge AMI patients with elevated LDL-c. Included populations: Discharges with: ● An ICD-9-CM Principal Diagnosis Code for AMI as defined in Table 2 AND ● Patients with one or more of the following documented in the medical record: - LDL-c ≧100 mg/dl (or narrative equivalent) on test performed during hospital stay OR - If no in-hospital test result, LDL-c >100 mg/dl (or narrative AMI–STEMI and NSTEMI patients with elevated low-density equivalent) on test performed prior to arrival AMI patients who are prescribed lipid-lowering medication at lipoprotein-cholesterol (LDL-c ≧100 mg/dl or narrative 1456 2006 USA Excluded populations: PMe1 C10 C hospital discharge. equivalent) who are prescribed a lipid-lowering medication at ● Patients less than 18 years of age hospital discharge. ● Patients transferred to another acute care hospital or federal hospital ● Patients who expired ● Patients who left against medical advice ● Patients discharged to hospice ● Patients who did not receive lipid-lowering medication and had a reason documented by a physician, nurse practitioner, Krumholz et or physician assistant for not prescribing lipid-lowering al. 104 medication at discharge AMI patients with LVSD and without both ACEI and ARB contraindications. Included populations: Discharges with: ● An ICD-9-CM Principal Diagnosis Code for AMI as defined in Table 2 AND ● Chart documentation of a LVEF less than 40% or a narrative description of LVS function consistent with moderate or severe systolic dysfunction. Excluded populations: ● Patients less than 18 years of age ● Patients transferred to another acute care hospital or federal hospital ● Patients who expired AMI–STEMI and NSTEMI patients with LVSD and without ● Patients who left against medical advice both ACEI and ARB contraindications who are prescribed an ● Patients discharged to hospice ACEI or ARB at hospital discharge. AMI patients who are prescribed an ACEI or ARB at hospital 1457 2006 USA ● Patients with BOTH a potential contraindication/reason for (For purposes of this measure, LVSD is defined as chart PMe1 C09 C discharge. not prescribing an ACEI at discharge AND a potential documentation of a LVEF less than 40% or a narrative contraindication/reason for not prescribing an ARB at description of LVS function consistent with moderate or discharge, as evidenced by one or more of the following: severe systolic dysfunction.) - ACEI or ARB allergy - Moderate or severe aortic stenosis - Physician, nurse practitioner, or physician assistant documentation of BOTH a reason for not prescribing an ACEI at discharge AND a reason for not prescribing an ARB at discharge - Reason documented by physician, nurse practitioner, or physician assistant for not prescribing an ARB at discharge AND an ACEI allergy - Reason documented by physician, nurse practitioner, or Krumholz et physician assistant for not prescribing an ACEI at discharge al. 104 AND an ARB allergy.* AMI patients with ST-elevation or LBBB on ECG who received fibrinolytic therapy. Included populations: Discharges with: ● An ICD-9-CM Principal Diagnosis Code for AMI as defined in Table 2 AND Median time from arrival to administration of fibrinolytic agent ● ST-segment elevation or LBBB on the ECG performed in patients with ST-segment elevation or LBBB on the ECG closest to hospital arrival AND performed closest to hospital arrival time. ● Fibrinolytic therapy within 6 hours after hospital arrival AND AMI patients whose time from hospital arrival to fibrinolytic 1458 2006 USA Acute myocardial infarction (AMI–STEMI and LBBB only) PMe5 B01 B ● Fibrinolytic therapy is primary reperfusion therapy therapy is 30 min or less. patients receiving fibrinolytic therapy during the hospital stay Excluded populations: and having a time from hospital arrival to fibrinolysis of 30 min ● Patients less than 18 years of age or less. ● Patients received in transfer from another acute care hospital including another emergency department ● Other reasons documented by physician, nurse practitioner, Krumholz et or physician assistant for delay in fibrinolytic therapy (e.g., social, religious, initial concern or refusal) al. 104 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka AMI patients with ST-segment elevation on ECG who received fibrinolytic therapy or primary PCI. Included populations: Discharges with: ● An ICD-9-CM Principal Diagnosis Code for AMI as defined in Table 2 AND ● ST-segment elevation on the ECG performed closest to Acute myocardial infarction (AMI–STEMI only) patients with hospital arrival AND 1459 2006 USA AMI patients who receive fibrinolytic therapy or primary PCI. ST-segment elevation on the ECG performed closest to PMe1 B01 B ● Patients presenting within 12 hours of symptom onset. arrival, who receive fibrinolytic therapy or primary PCI Excluded populations: ● Patients less than 18 years of age ● Patient refusal of reperfusion therapy ● Other reasons documented by a physician, nurse Krumholz et practitioner, or physician assistant for not doing reperfusion al. 104 therapy IF a patient is undergoing colorectal cancer surgery, THEN a history of present illness should be documented before operation including: 1460 2006 USA (a) presenting symptoms PMe7 L01 L (b) diagnostic tests and results (c) receipt of neoadjuvant therapy (for rectal cancer), with date McGory et al. 105 of completion IF a patient is undergoing colorectal cancer surgery, THEN the following additional history should be documented before operation including the following: (a) past medical history (including presence or absence of cardiac disease, pulmonary disease, and diabetes) (b) past surgical history (c) medications/allergies (including most recent list of 1461 2006 USA P Ge 7 N/A N/A outpatient medications and dosages) (d) tobacco use (current or previous smoker) (e) alcohol use (g) any family history of cancer (h) if family history of cancer positive, then include details of cancer history, age of patients, and type of cancer McGory et al. 105 (i) evaluation for bleeding disorders IF a patient is undergoing colorectal cancer surgery without 1462 2006 USA neoadjuvant therapy, THEN a CEA level should be obtained PMe7 L01 L McGory et al. 105 preoperatively (between diagnosis and surgery) IF a patient is undergoing colorectal cancer surgery with neoadjuvant therapy, THEN a CEA level should be obtained 1463 2006 USA PMe7 L01 L preoperatively: McGory et al. 105 (a) before neoadjuvant therapy IF a patient is undergoing rectal cancer surgery, THEN the tumor location relative to the anal sphincters must be 1464 2006 USA determined and documented before surgery (or before PMe7 L01 L neoadjuvant therapy, if given) by the: McGory et al. 105 (a) operating surgeon IF a patient is undergoing rectal cancer surgery and receives neoadjuvant therapy, THEN the tumor location relative to the 1465 2006 USA anal sphincters must be determined and documented in the PMe7 L01 L period after neoadjuvant therapy and before surgery by the: (a) operating surgeon McGory et al. 105 IF a patient is undergoing rectal cancer surgery and receives neoadjuvant therapy, THEN imaging of the abdomen/pelvis 1466 2006 USA PMe7 L01 L with CT or MRI should be performed: McGory et al. 105 (a) before neoadjuvant therapy IF a patient is undergoing rectal cancer surgery, THEN the 1467 2006 USA depth of tumor invasion should be evaluated preoperatively or PMe7 L01 L preneoadjuvant therapy (if neoadjuvant given) McGory et al. 105 IF a patient is undergoing rectal cancer surgery and CT does not show obvious wall invasion, THEN the depth of tumor invasion should be performed preoperatively or preneoadjuvant therapy (if neoadjuvant given) by the 1468 2006 USA PMe7 L01 L following: (a) TRUS or EUS (b) MRI McGory et al. 105 (d) a or b (but not c) IF a patient is undergoing rectal cancer surgery, THEN the characterization of perirectal lymph nodes should be 1469 2006 USA PMe7 L01 L performed preoperatively or preneoadjuvant therapy (if McGory et al. 105 neoadjuvant given) IF a patient is undergoing rectal cancer surgery, THEN the characterization of perirectal lymph nodes should be performed preoperatively or preneoadjuvant therapy (if 1470 2006 USA neoadjuvant given) by the following: PMe7 L01 L (a) TRUS or EUS (b) MRI McGory et al. 105 (e) a or b

IF a patient is undergoing colorectal cancer surgery, THEN the following issues should be discussed and documented by the surgeon in the medical record: (a) treatment options with patient’s priorities and preferences (including operative and nonoperative alternatives) (b) operative risks, including complications and mortality 1471 2006 USA (c) functional outcome, including period of disability, time to PMe5 L01 L resume normal function, likelihood of better or worse function, and ostomy issues (if appropriate) (d) advance directive or living will (e) advance directive or durable power of attorney for health care indicating the patient’s surrogate decision maker (f) need for possible chemotherapy or radiation (if appropriate) McGory et al. 105 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a patient is undergoing rectal cancer surgery for a tumor that is a distal, T1, and well differentiated without 1472 2006 USA lymphovascular invasion, THEN a transanal local excision PMe5 L01 L should be discussed including possible role of adjuvant McGory et al. 105 therapy IF a patient is undergoing colorectal cancer surgery, THEN 1473 2006 USA intravenous antibiotic prophylaxis should be given within 1 h of PMe15 J01 J McGory et al. 105 surgical incision IF a patient undergoes colorectal cancer surgery, THEN 1474 2006 USA intravenous antibiotic prophylaxis should be discontinued PMe4 J01 J McGory et al. 105 within 24 h postoperatively IF a patient is undergoing colorectal cancer surgery and meets criteria for perioperative beta blockade, THEN unless 1475 2006 USA PMe1 C07 C contraindicated, beta blocker therapy should be initiated McGory et al. 105 before surgery IF a patient undergoes colorectal cancer surgery and meets criteria for perioperative beta blockade, THEN unless 1476 2006 USA PMe1 C07 C contraindicated, beta blocker therapy should be continued postoperatively at least until discharge from the hospital McGory et al. 105 IF a patient is undergoing colorectal cancer surgery and is taking one of the following classes of medications, THEN specific instructions regarding preoperative management of the following classes of medications should be given to the 1477 2006 USA PMe5 A10 B01 C01 C03 C07 C08 C09 C10 ABC patient: (a) antiplatelet medications (b) diabetes medications McGory et al. 105 (c) cardiovascular medications IF a patient taking warfarin is undergoing colorectal cancer surgery, THEN withdrawal of warfarin before surgery should 1478 2006 USA PMe1 B01 B be managed according to recommendations from the Seventh ACCP Conference on Antithrombotic Therapy McGory et al. 105 IF a patient undergoes colorectal cancer surgery, THEN postoperative deep venous thrombosis prophylaxis should be provided with low-dose unfractionated heparin or low – 1479 2006 USA molecular weight heparin, in addition to mechanical PMe1 B01 B prophylaxis (intermittent pneumatic compression and/or graduated compression stockings) according to the Seventh McGory et al. 105 ACCP Conference on Antithrombotic Therapy Total number of noncomatose patients for whom mechanical Documentation of opiates, benzodiazepines, or similar agents Total number of noncomatose patients for whom mechanical ventilation is withdrawn in anticipation of death who have an prescribed to manage distress or dyspnea for noncomatose 1480 2006 USA PMe1 N02 N05 N ventilation is withdrawn in anticipation of death. order written for opiates or benzodiazepines as scheduled or patients undergoing terminal withdrawal of mechanical Mularski et al. 106 as needed. ventilation. Mangione-Smith () If oral antibiotics are prescribed, papules and/or 1481 2007 USA PMe1 D06 D et al. 107 pustules must be present. Mangione-Smith (Acne) Tetracycline should not be prescribed for adolescents 1482 2007 USA PMe1 D06 D et al. 107 less than 12 years of age. Mangione-Smith (Acne) Before tetracycline is prescribed, the provider must 1483 2007 USA PMe1 D06 D et al. 107 determine that the patient is not pregnant. (Acne) If isotretinoin is prescribed, there must be evidence of 1484 Mangione-Smith 2007 USA severe acne (papules, pustules, cysts and nodules) and PMe1 D10 D et al. 107 failure of previous therapy. (Acne) If isotretinoin is prescribed to post-pubescent girls, a 1485 Mangione-Smith 2007 USA negative pregnancy test should be obtained within two weeks PMe7 D10 D et al. 107 of start of therapy. Mangione-Smith (Acne) If isotretinoin is prescribed, liver function tests should 1486 2007 USA PMe7 D10 D et al. 107 be performed at least every three months. Mangione-Smith (Acne) If isotretinoin is prescribed, triglyceride levels should 1487 2007 USA PMe7 D10 D et al. 107 be performed at least every three months. (ADHD) If the child has ADHD without a comorbidity, or with oppositional defiant disorder or conduct disorder, or with a 1488 2007 USA learning disorder, and is started on pharmacotherapy, the PMe1 N06 N Mangione-Smith initial medication choice should be methylphenidate, et al. 107 dextroamphetamine, or pemoline. (ADHD) Before a child is started on stimulant medication such 1489 Mangione-Smith 2007 USA as methylphenidate, dextroamphetamine, or pemoline, the PMe7 N06 N health care provider should assess the heart rate of the child. et al. 107 (ADHD) Before a child is started on stimulant medication such as methylphenidate, dextroamphetamine, or pemoline, the 1490 2007 USA PMe7 N06 N Mangione-Smith health care provider should assess the blood pressure of the et al. 107 child. (Allergic Rhinitis) Treatment for allergic rhinitis should include 1491 Mangione-Smith 2007 USA at least one of the following: recommendation for allergen PMe1 R01 R06 R avoidance, , nasal steroids, nasal cromolyn. et al. 107 (Allergic Rhinitis) If topical nasal decongestants are 1492 Mangione-Smith 2007 USA prescribed, duration of treatment should be for no longer than PMe4 R01 R et al. 107 4 days. (Asthma) All patients > 5 years of age with the diagnosis of 1493 Mangione-Smith 2007 USA asthma should have been prescribed a beta2-agonist inhaler PMe1 R03 R et al. 107 for symptomatic relief of exacerbations. Mangione-Smith (Asthma) Patients ≤ 5 years of age should be prescribed a 1494 2007 USA PMe1 R03 R et al. 107 nebulizer (for administering asthma medications). (Asthma) Patients who report using a beta2- agonist inhaler more than 3 times per day on a daily basis should be 1495 2007 USA PMe1 R03 R Mangione-Smith prescribed a longer acting bronchodilator (theophylline) and/or an anti-inflammatory agent (inhaled corticosteroids, cromolyn). et al. 107 (Asthma) In any patients requiring chronic treatment with oral 1496 Mangione-Smith 2007 USA corticosteroids a trial of inhaled corticosteroids should have PMe1 R03 R et al. 107 been attempted. (Asthma) Any child with asthma who takes high doses of 1497 Mangione-Smith 2007 USA inhaled corticosteroids should have growth patterns monitored PMe7 R03 R et al. 107 at least annually. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Asthma) Patients who require frequent bursts of prednisone (2-3 trials of 5-day therapy with oral corticosteroids after an 1498 2007 USA exacerbation of asthma within the past 6 months) who are not PMe1 H02 R03 HR Mangione-Smith already on inhaled corticosteroids or chromolyn sodium should be started on them. et al. 107 (Asthma) All patients presenting to the physician’s office or emergency department with FEV1 or PEFR <=70 percent of 1499 2007 USA baseline (or predicted) should be treated with beta2-agonists PMe1 R03 R Mangione-Smith before discharge. (Note: OP'ed eligibility is patients who et al. 107 present with an exacerbation) (Asthma) Patients who receive treatment with beta2-agonists for FEV1 or PEFR <70 percent in the physician’s office or ED 1500 2007 USA should have an FEV1 or PEFR repeated prior to discharge. PMe7 R03 R Mangione-Smith (Note: OP'ed eligibility is patients who who receive beta2- agonists for exacerbation) et al. 107 (Asthma) Patients with an FEV1 or PEFR <=70 percent of baseline (or predicted) after treatment for an asthma 1501 2007 USA exacerbation in the physician’s office should be placed on an PMe3 H02 H Mangione-Smith oral corticosteroid taper. (Note: OP'ed eligibility is patients et al. 107 who receive >1 beta2-agonists for exacerbation) (Asthma) Patients who have persistent symptoms, diffuse wheezes on chest auscultation, and a PEFR or FEV1<=40 1502 2007 USA PMe9 R03 R Mangione-Smith percent of baseline (or predicted) after treatment with beta2- agonist should be admitted to the hospital. et al. 107 (Asthma) Patients whose asthma medication is changed (new 1503 Mangione-Smith 2007 USA medication added, current dose decreased/increased) during PMe7 R03 R one visit should have a follow- up within 3 weeks. et al. 107 Mangione-Smith (Asthma) Patients on chronic oral corticosteroids should have 1504 2007 USA PMe7 H02 H et al. 107 follow-up visits at least 4 times in a calendar year. (Depression) Once diagnosis of major depression has been 1505 Mangione-Smith 2007 USA made, treatment with antidepressant medication and/or PMe1 N06 N et al. 107 psychotherapy should begin within 2 weeks. (Depression) Anti-anxiety agents should NOT be used (except 1506 Mangione-Smith 2007 USA ) as the sole agent for treatment of depression, PMe1 N05 N unless there is documentation of a comorbid anxiety disorder. et al. 107 (, Acute) If the child had mild-moderate dehydration 1507 Mangione-Smith 2007 USA and is able to take oral fluids, oral rehydration therapy should PMe1 A07 A et al. 107 be prescribed. Mangione-Smith (Diarrhea, Acute) Antimicrobial agents should be used in a 1508 2007 USA PMe1 J01 J et al. 107 child with suspected or culture-proven shigella. (Diarrhea, Acute) Antimicrobial agents should be used in a 1509 Mangione-Smith 2007 USA child with Giardia with symptoms of greater than 10-14 days PMe1 J01 J duration and with positive stool ova and parasite examination. et al. 107 Mangione-Smith (Diarrhea, Acute) Antidiarrheal or antimotility medications are 1510 2007 USA PMe1 A07 A et al. 107 not used in treatment of diarrhea in a child. Mangione-Smith (Immunizations (Childhood)) All children should have had two 1511 2007 USA PMe1 J07 J et al. 107 OPV/IPV between six weeks and the first birthday. (Immunizations (Childhood)) All children should have had 1512 Mangione-Smith 2007 USA PMe1 J07 J three OPV/IPV between six weeks and the second birthday. et al. 107 (Immunizations (Childhood)) Children with immunocompromise (hematologic and solid tumors, 1513 2007 USA congenital immunodeficiency, and long-term PMe1 J07 J Mangione-Smith immunosuppressive therapy) or HIV infection should receive et al. 107 IPV rather than OPV (at the same ages as OPV). (Immunizations (Childhood)) All children should have had three Diptheria, Tetanus and Pertussis/Diphtheria, Tetanus, 1514 2007 USA PMe1 J07 J Mangione-Smith and Pertussis Vaccines/Diphtheria, and Tetanus Vaccine (DTP/DTaP/DT) between six weeks and the first birthday. et al. 107 (Immunizations (Childhood)) All children should have had four DTP/DTaP/DT between six weeks and the second birthday, 1515 2007 USA PMe1 J07 J Mangione-Smith with at least six months between the third and fourth dose (the fourth may be DTaP if given after 15 months old). et al. 107 (Immunizations (Childhood)) All children should have had two 1516 Mangione-Smith 2007 USA PRP-OMP Hib or three Hib (any combination of formulations) PMe1 J07 J et al. 107 between six weeks and the first birthday. (Immunizations (Childhood)) Between the ages of six weeks and 2 years, all children should have had either four Hib 1517 2007 USA PMe1 J07 J Mangione-Smith vaccinations, or three Hib vaccinations if the first two were et al. 107 PRP-OMP Hib. Mangione-Smith (Immunizations (Childhood)) All children should have had one 1518 2007 USA PMe1 J07 J et al. 107 MMR between their first and second birthdays. (Immunizations (Childhood)) All children whose mothers are known to be HBsAg-Negative should have had at least two 1519 2007 USA PMe1 J07 J Mangione-Smith HBV by the first birthday with at least one month between the et al. 107 first two doses. (Immunizations (Childhood)) All children whose mothers are known to be HBsAg-Negative should have had three HBV by 1520 2007 USA PMe1 J07 J Mangione-Smith the second birthday with at least one month between the first et al. 107 two doses. (Immunizations (Childhood)) All children whose mothers are 1521 Mangione-Smith 2007 USA known to be HBsAg-Positive at birth should receive HBIG and PMe1 J07 J et al. 107 HBV by the beginning of the twelfth hour of life. (Immunizations (Childhood)) All children whose mothers are 1522 Mangione-Smith 2007 USA known to be HBsAg-Positive should have had three HBV by PMe1 J07 J et al. 107 the beginning of the ninth month of life. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Immunizations (Childhood)) Children with asthma and other chronic pulmonary diseases, hemodynamically significant 1523 2007 USA cardiac disease, hemoglobinopathies (e.g., sickle cell PMe1 J07 J Mangione-Smith disease) or undergoing immunosuppressive therapy should et al. 107 receive a yearly influenza vaccine. (Immunizations (Childhood)) Each immunization given at that 1524 Mangione-Smith 2007 USA PMe9 J07 J institution should be documented with the manufacturer. et al. 107 Mangione-Smith (Immunizations (Childhood)) Each immunization given at that 1525 2007 USA PMe9 J07 J et al. 107 institution should be documented with the lot number. (Otitis Media) All patients with the diagnosis of otitis media 1526 Mangione-Smith 2007 USA with effusion should receive either antibiotics or trial of PMe1 J01 J et al. 107 observation. (Prenatal Care) Pregnant women with positive urine cultures 1527 Mangione-Smith 2007 USA (> 100,000 bacteria/cc) should receive an appropriate PMe1 J01 J et al. 107 antibiotic. (Upper Respiratory Illness) Antibiotics should only be prescribed in a patient with nasal congestion and pharyngitis if 1528 2007 USA PMe1 J01 J Mangione-Smith a rapid strep test or throat culture is obtained, or if there is evidence of a diagnosis of other bacterial infections. et al. 107 Mangione-Smith (Upper Respiratory Illness) Aspirin should not be used in 1529 2007 USA PMe1 B01 B et al. 107 children and teenagers with pharyngitis. Mangione-Smith (Upper Respiratory Illness) Treatment for acute sinusitis 1530 2007 USA PMe4 J01 J et al. 107 should be with antibiotics for at least 10 days. (Upper Respiratory Illness) In the absence of symptoms of 1531 Mangione-Smith 2007 USA allergic rhinitis (thin, watery rhinorrhea, and sneezing), PMe1 R06 R antihistamines should not be prescribed for acute sinusitis. et al. 107 (Upper Respiratory Illness) In the absence of symptoms of 1532 Mangione-Smith 2007 USA allergic rhinitis (thin, watery rhinorrhea, and sneezing), PMe1 R06 R antihistamines should not be prescribed for chronic sinusitis. et al. 107 (Urinary Tract Infection) Children with UTI and systemic 1533 Mangione-Smith 2007 USA symptoms such as hypotension, poor perfusion, anorexia, or PMe1 J01 J emesis, should be treated initially with parenteral antibiotics. et al. 107 (Urinary Tract Infection) A child with four UTIs in a single year 1534 Mangione-Smith 2007 USA PMe4 J01 J should receive prophylactic antibiotics for at least six months. et al. 107 (Vaginitis and STDs) Treatment for bacterial vaginosis should 1535 Mangione-Smith 2007 USA be with metronidazole (orally or vaginally) or clindamycin PMe1 G01 G et al. 107 (orally or vaginally). (Vaginitis and STDs) Treatment for T. vaginalis should be with 1536 Mangione-Smith 2007 USA PMe1 G01 G oral metronidazole in the absence of allergy to metronidazole. et al. 107 (Vaginitis and STDs) Treatment for non-recurrent (three or fewer episodes in previous year) yeast vaginitis should be with 1537 2007 USA PMe1 G01 J02 GJ Mangione-Smith topical "azole" preparations (e.g., clotrimazole, , et al. 107 etc.) or fluconazole. (Vaginitis and STDs) Total antibiotic therapy for PID should be 1538 Mangione-Smith 2007 USA for no less than 10 days (inpatient, if applicable, plus PMe4 G01 G et al. 107 outpatient). IF a homebound patient has symptoms of constipation that correspond in time with the initiation of new medications, 1539 2007 USA P Ge 1 N/A N/A THEN the physician should discontinue or justify the necessity Smith et al. 108 of continuing these medications. IF a homebound patient has constipation that does not respond to fiber or fluid intake, THEN lactulose, polyethylene 1540 2007 USA PMe1 A06 A glycol, ora short trial of a stimulant (senna or bisacodyl) should be tried sequentially until improvement is documented. Smith et al. 108 IF a homebound patient is found to have impacted stool on digital rectal examination, THEN manual disimpaction should 1541 2007 USA PMe1 A06 A be performed, followed by or suppositories as Smith et al. 108 needed. IF a homebound patient is started on a new prescription medication and he or she has a follow-up visit with the prescribing physician, THEN the medical record at the follow- up visit should document one of the following: 1) that the 1542 2007 USA P Ge 7 N/A N/A medication is being taken, 2) that the physician asked about the medication (for example, side effects, adherence, or availability), or 3) that the medication was not started because Smith et al. 108 it was not needed or was changed. IF a homebound patient is under the outpatient care of 2 or more physicians, and 1 physician has prescribed a new prescription medication or a change in medication (medication 1543 2007 USA P Ge 9 N/A N/A termination or change in dosage), THEN subsequent medical record entries by the nonprescribing physician should Smith et al. 108 acknowledge the medication change. IF a homebound patient is discharged from a hospital to home and he or she received a new prescription medication or a change in medication (medication termination or change in 1544 2007 USA P Ge 6 N/A N/A dosage) before discharge, THEN the outpatient medical record should acknowledge the medication change within 4 Smith et al. 108 weeks of discharge. IF a homebound patient presents with symptoms of dementia, THEN the physician should review the patient’s medication list 1545 2007 USA P Ge 7 N/A N/A for initiation of medications that might correspond chronologically to the onset of dementia symptoms. Smith et al. 108 IF a homebound patient presents with symptoms of new-onset cognitive decline that correspond in time with the initiation of 1546 2007 USA P Ge 1 N/A N/A new medications, THEN the physician should discontinue or justify the necessity of continuing these medications. Smith et al. 108 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a homebound patient has depression with psychotic features, THEN the patient should be referred to a psychiatrist 1547 2007 USA and/or should receive treatment with a combination of an PMe1 N05 N06 N antidepressant and an antipsychotic medication or with Smith et al. 108 electroconvulsive therapy. IF a homebound patient is diagnosed with depression, THEN antidepressant treatment, psychotherapy, or electroconvulsive therapy should be offered within 2 weeks after diagnosis 1548 2007 USA unless there is documentation within that period that the PMe1 N06 N patient has improved or unless the patient has substance abuse or dependence, in which case treatment may wait until 8 weeks after the patient is in a drug- or alcohol-free state. Smith et al. 108 IF a homebound patient is started on an antidepressant medication, THEN the following medications should not be 1549 2007 USA used as first- or second-line therapy: tertiary amine tricyclics, PMe1 N05 N06 N MAOIs (unless atypical depression is present), Smith et al. 108 benzodiazepines, or stimulants (except methylphenidate). IF a homebound patient has depression with psychotic features (for example, auditory hallucinations, delusions) or has melancholic or vegetative depression with pervasive anhedonia, unreactive mood, psychomotor disturbances, 1550 2007 USA PMe1 N06 N severe terminal insomnia, and weight and appetite loss, THEN he or she should not be treated with psychotherapy alone, unless he or she is unable or unwilling to take Smith et al. 108 medication. IF a homebound patient with a history of cardiac disease is started on a tricyclic antidepressant, THEN a baseline 1551 2007 USA PMe7 N06 N electrocardiogram should be obtained before initiation of or Smith et al. 108 within 3 months after treatment. IF a homebound patient is being treated for depression with antidepressants, THEN the antidepressants should be prescribed at appropriate starting doses, and they should 1552 2007 USA PMe3 N06 N have an appropriate titration schedule to a therapeutic dose, therapeutic blood level, or remission of symptoms by 12 Smith et al. 108 weeks. IF a homebound patient has no meaningful symptom response after 6 weeks of treatment (for depression), THEN one of the following treatment options should be initiated by the 8th week of treatment: medication dose should be 1553 2007 USA PMe13 N06 N optimized or the patient should be referred to a psychiatrist (if initial treatment was medication), or medication should be initiated or referral to a psychiatrist should be offered (if initial treatment was psychotherapy alone). Smith et al. 108 IF a homebound patient responds only partially after 12 weeks of treatment (for depression), THEN one of the following treatment options should be instituted by the 16th week of treatment: maximize the dose of the selected medication, switch to a different medication class or add a second 1554 2007 USA PMe13 N06 N medication to the first (if initial treatment includes medication), add psychotherapy (if the initial treatment was medication), try medication (if initial treatment was psychotherapy without medication), consider electroconvulsive therapy, or refer to a psychiatrist. Smith et al. 108 IF a homebound patient has responded to antidepressant medication, THEN he or she should be continued on the drug 1555 2007 USA at the same dose for at least 6 months and should make at PMe4 N06 N least one clinician contact (home visit or telephone) during Smith et al. 108 that time period. If a homebound patient has experienced three or more episodes of depression, THEN the patient should receive 1556 2007 USA PMe4 N06 N maintenance antidepressant medication for at least 36 Smith et al. 108 months. IF a diabetic homebound patient does not have established renal disease and is not receiving an ACEI or ACE receptor 1557 2007 USA PMe7 C09 C blocker, THEN an annual test for proteinuria should be Smith et al. 108 offered. IF a diabetic homebound patient has proteinuria, THEN he or 1558 108 2007 USA PMe1 C09 C Smith et al. she should be offered therapy with an ACEI. ALL diabetic homebound patients who are not on other 1559 2007 USA anticoagulant therapy should be offered daily aspirin therapy PMe1 B01 B Smith et al. 108 unless contraindicated. IF a noncomatose, homebound patient is not expected to survive and a mechanical ventilator is withdrawn or intubation is withheld, THEN the patient should receive or have orders 1560 2007 USA PMe1 N02 N05 N for an opiate or benzodiazepine or barbiturate infusion to reduce dyspnea, and the chart should document whether the Smith et al. 108 patient has dyspnea. IF a homebound patient has asymptomatic left ventricular 1561 2007 USA dysfunction with a left ventricular ejection fraction of 40% or PMe1 C09 C Smith et al. 108 less, THEN an ACEI should be offered. IF a homebound patient has symptomatic heart failure and left 1562 2007 USA ventricular ejection fraction of 40% or less, THEN he or she PMe1 C09 C Smith et al. 108 should be offered treatment with an ACEI. IF a homebound patient has heart failure, left ventricular ejection fraction of 40% or less, and New York Heart 1563 2007 USA Association class I to III disease, THEN a beta-blocker should PMe1 C07 C be offered unless the patient has a documented contraindication (for example, uncompensated heart failure). Smith et al. 108 IF a homebound patient has heart failure, left ventricular ejection fraction of 40% or less, and no atrial fibrillation, THEN 1564 2007 USA from among the three generations of calcium-channel blocker PMe1 C08 C medications, he or she should not be treated with a first- or second-generation calcium-channel blocker. Smith et al. 108 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a homebound patient with heart failure is treated with 1565 2007 USA digoxin, THEN the digoxin level should be checked within 1 PMe7 C01 C Smith et al. 108 week of initiation or dosing change. IF a homebound patient with heart failure is treated with 1566 2007 USA digoxin, THEN the digoxin level should be checked within 1 PMe7 C01 C Smith et al. 108 week if signs of toxicity develop. IF a homebound patient has heart failure and atrial fibrillation, 1567 2007 USA THEN anticoagulation should be offered to achieve an INR of PMe1 B01 B Smith et al. 108 2.0 to 3.0. IF a homebound patient has heart failure and atrial fibrillation 1568 2007 USA AND documented contraindications to anticoagulation, THEN PMe1 B01 B Smith et al. 108 aspirin should be offered. IF a homebound patient remains hypertensive after 1569 2007 USA nonpharmacologic intervention, THEN pharmacologic PMe1 C02C03C07C08C09 C Smith et al. 108 antihypertensive treatment should be initiated. IF a homebound patient requires pharmacotherapy for treatment of hypertension in the outpatient setting, THEN a 1570 2007 USA once- or twice-daily medication should be used unless there is PMe3 C02C03C07C08C09 C documentation regarding the need for agents that require Smith et al. 108 more frequent dosing. IF a homebound patient has hypertension and has renal parenchymal disease with a serum creatinine concentration 1571 2007 USA greater than 1.5 mg/dL or more than 1g of protein/24 h of PMe1 C09 C collected urine, THEN therapy with an ACEI should be Smith et al. 108 offered. IF a homebound patient is diagnosed with hypertension and pharmacologic intervention is initiated, THEN follow-up blood 1572 2007 USA PMe7 C02C03C07C08C09 C pressure checks should occur every 2 weeks until blood Smith et al. 108 pressure control (≤140/90 mm Hg) is achieved. IF a homebound patient with hypertension is treated with pharmacologic therapy and has achieved blood pressure 1573 2007 USA PMe7 C02C03C07C08C09 C control goal, THEN follow-up blood pressure checks should Smith et al. 108 occur at least every 3 months. IF a homebound patient has symptoms of insomnia, THEN the primary care physician should assess for self-medication with 1574 2007 USA PMe7 R06 R alcohol or over-the-counter antihistamines and recommend discontinuation or avoidance of these agents. Smith et al. 108 IF a homebound patient has insomnia requiring medication, 1575 2007 USA THEN the use of long-acting benzodiazepines should be PMe1 N05 N Smith et al. 108 avoided. IF a homebound patient has symptoms of acute myocardial 1576 2007 USA infarction or unstable angina, THEN he or she should be given PMe15 B01 B aspirin therapy within 1 hour of presentation. Smith et al. 108 IF a homebound patient has established coronary heart 1577 2007 USA disease and is not receiving warfarin, THEN he or she should PMe1 B01 B Smith et al. 108 be offered antiplatelet therapy. IF a homebound patient has had an acute myocardial 1578 2007 USA PMe1 C07 C infarction, THEN he or she should be offered a beta-blocker Smith et al. 108 IF a homebound patient has documented involuntary weight loss or hypoalbuminemia (< 3.5 g/dL), THEN he or she should receive an evaluation for potentially relevant comorbid 1579 2007 USA conditions, including medications that might be associated PMe7 A03 A04 C01 G04 M03 N02 N04 N05 N06 R03 R06 S01 A C G M N R S with decreased appetite (for example, digoxin, fluoxetine, anticholinergics), depressive symptoms, and cognitive Smith et al. 108 impairment. IF a homebound patient is prescribed a new drug, THEN the 1580 2007 USA prescribed drug should have a clearly defined indication P Ge 9 N/A N/A Smith et al. 108 documented in the record. IF a homebound patient is prescribed a new drug, THEN the patient (or, if incapable, a caregiver) should receive education 1581 2007 USA P Ge 5 N/A N/A about the purpose of the drug, how to take it, and the expected side effects or important adverse reactions. Smith et al. 108 For ALL homebound patients, primary care physicians’ 1582 2007 USA outpatient medical records should contain an up-to-date P Ge 9 N/A N/A Smith et al. 108 medication list. EVERY new drug that is prescribed to a homebound patient on an ongoing basis for a chronic medical condition should 1583 2007 USA P Ge 7 N/A N/A have documentation of the response to therapy within 6 Smith et al. 108 months. ALL homebound patients should have a drug regimen review 1584 108 2007 USA P Ge 7 N/A N/A Smith et al. at least every 6 months. IF a homebound patient is prescribed warfarin, THEN an INR 1585 2007 USA should be determined within 4 days after initiation of therapy PMe7 B01 B Smith et al. 108 and at least every 6 weeks. IF a homebound patient is prescribed a thiazide or loop 1586 2007 USA diuretic, THEN he or she should have electrolytes checked PMe7 C03 C within 1 week of initiating therapy and every 6 months. Smith et al. 108 IF a homebound patient is prescribed an oral hypoglycemia 1587 2007 USA PMe1 A10 A drug, THEN chlorpropamide should not be used. Smith et al. 108 ALL homebound patients should not be prescribed a 1588 2007 USA medication with strong anticholinergic effects if alternatives PMe1 A03 A04 G04 M03 N02 N04 N05 N06 R06 S01 A G M N R S Smith et al. 108 are available. IF a homebound patient needs control of seizures, THEN 1589 108 2007 USA PMe1 N03 N Smith et al. barbiturates should not be used. IF a homebound patient requires analgesia, THEN meperidine 1590 108 2007 USA PMe1 N02 N Smith et al. should not be used. IF oral pharmacologic therapy is initiated to treat osteoarthritis in a homebound patient, THEN acetaminophen should be the 1591 2007 USA PMe1 N02 N first drug used, unless there is a documented contraindication Smith et al. 108 to use. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF oral pharmacologic therapy for osteoarthritis in a homebound patient is changed from acetaminophen to a 1592 2007 USA different oral agent, THEN there should be evidence that the PMe3 N02 N patient has had a trial of maximum-dose acetaminophen (suitable for age and comorbid conditions). Smith et al. 108 IF a patient is treated with a COX-nonselective NSAID, THEN there should be evidence that the patient was advised of the 1593 2007 USA PMe5 M01 M02 M risk for gastrointestinal bleeding, as well as cardiovascular risk Smith et al. 108 associated with these drugs. IF a homebound patient has a new diagnosis of osteoporosis, THEN during the initial evaluation period, an underlying cause 1594 2007 USA P Ge 7 N/A N/A of osteoporosis should be sought by checking medication use Smith et al. 108 and current alcohol use. IF a homebound patient has osteoporosis, THEN use of 1595 2007 USA calcium and vitamin D supplements should be recommended PMe1 A11 A12 A Smith et al. 108 at least once. IF a homebound patient is taking corticosteroids for more than 1596 2007 USA 1 month, THEN the patient should be offered calcium and PMe1 A11 A12 H02 AH Smith et al. 108 vitamin D. IF a female homebound patient is newly diagnosed with 1597 2007 USA osteoporosis, THEN the patient should be offered treatment PMe1 M05 M with bisphosphonates within 3 months of diagnosis. Smith et al. 108 IF a homebound patient with chronic pain is treated with opioids, THEN he or she should be offered a bowel regimen, 1598 2007 USA PMe1 A06 N02 AN or the medical record should document the potential for constipation or explain why bowel treatment is not needed. Smith et al. 108 IF a homebound patient with no history of allergy to the pneumococcal vaccine is not known to have already received 1599 2007 USA a pneumococcal vaccine or if the patient received it more than PMe1 J07 J 5 years ago (if before age 65 years), THEN a pneumococcal Smith et al. 108 vaccine should be offered. IF a homebound patient has no history of anaphylactic hypersensitivity to eggs or to other components of the 1600 2007 USA PMe1 J07 J influenza vaccine, THEN the patient should be offered an Smith et al. 108 annual influenza vaccination. IF pneumococcal or influenza vaccination rates among patients of a health delivery organization are low (60% of 1601 2007 USA persons at risk for pneumococcal and influenza disease), PMe9 J07 J THEN methods to increase the rate of vaccination should be Smith et al. 108 used. IF a health care organization cares for homebound patients, 1602 2007 USA THEN it should have a formal plan to offer and encourage SMe9 J07 J Smith et al. 108 influenza vaccination among its employees. IF a homebound patient with pneumonia has unstable vital signs despite a trial of antibiotic therapy and does not have a 1603 2007 USA do-not-hospitalize order, THEN the patient should be PMe9 J01 J transferred to the hospital or the record should document why Smith et al. 108 that it is not indicated. IF a homebound patient has a stage 2 or greater pressure 1604 2007 USA ulcer, THEN topical (i.e., hydrogen peroxide, PMe1 D08 D -based solutions) should not be ordered for wound care. Smith et al. 108 IF a homebound patient uses tobacco regularly, THEN he or 1605 2007 USA she should be offered counseling and/or pharmacologic PMe1 N07 N Smith et al. 108 therapy at least once to stop tobacco use. IF a homebound patient has atrial fibrillation for more than 48 hours and has any “high-risk” condition (impaired left ventricular function; female older than 75 years of age; hypertension or systolic blood pressure greater than 160 mm 1606 2007 USA PMe1 B01 B Hg; or prior ischemic stroke, transient ischemic attack, or systemic embolism), THEN he or she should be offered oral anticoagulant therapy or antiplatelet therapy if the medical record documents a reason not to give anticoagulant therapy. Smith et al. 108 IF a homebound patient has a presumed stroke, THEN CT or MRI of the head should be recommended and performed 1607 2007 USA PMe7 B01 B before initiation or continuation of thrombolytic treatment, Smith et al. 108 anticoagulant therapy, or antiplatelet therapy. IF a homebound patient is taking warfarin for atrial fibrillation, 1608 2007 USA THEN an INR should be checked within 4 days of the first PMe7 B01 B Smith et al. 108 dose and at least every 6 weeks. IF a homebound patient is diagnosed with acute atherothrombotic ischemic stroke or with a transient ischemic 1609 2007 USA attack, THEN antiplatelet treatment should be offered within PMe15 B01 B 48 hours after the stroke or transient ischemic attack, unless the patient is already receiving anticoagulant treatment. Smith et al. 108 (Benign prostatic hypertrophy)IF a male VE with BPH has an AUA SI score ≤ 7, the symptoms are not bothersome, and the patient is not known to have bilateral hydronephrosis, bladder 1610 2007 USA PMe1 G04 G stones, hematuria attributable to the prostate or urinary tract infection, THEN he should not be prescribed medications or Wenger et al. 109 surgery for BPH. (Breast Cancer) IF a female VE has a new diagnosis of breast cancer, THEN there should be documentation of a discussion regarding: 1611 2007 USA • Surgical options and goals of therapy PMe5 L01 L02 L • Post-treatment quality of life • Functional outcomes Wenger et al. 109 • Risk and benefits of adjuvant therapy (Breast Cancer) IF a female VE is diagnosed with locally invasive breast cancer and chemotherapy is planned, THEN 1612 2007 USA PMe7 L01 L at the time of diagnosis HER- 2/neu receptor status should be Wenger et al. 109 evaluated. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Breast Cancer) IF a female VE is diagnosed with locally invasive breast cancer, chemotherapy is planned, and she 1613 2007 USA has a score of 2+ for HER-2/neu over-expression by PMe7 L01 L immunohistochemistry testing, THEN HER- 2/neu receptor Wenger et al. 109 status should be confirmed by FISH. (Breast Cancer) IF a female VE is diagnosed with early stage locally invasive breast cancer (Stage I- III) and chemotherapy 1614 2007 USA is planned, THEN the patient should undergo axillary staging PMe7 L01 L with either a sentinel lymph node biopsy or a complete axillary lymph node dissection at the time of surgery. Wenger et al. 109 (Breast Cancer) IF a female VE is diagnosed with invasive breast cancer with a tumor >5cm OR ≥4 positive lymph nodes 1615 2007 USA and undergoes mastectomy, THEN postoperative radiation PMe1 L01 L therapy should be discussed within 2 months after surgery or Wenger et al. 109 after chemotherapy. (Breast Cancer) IF a female VE is diagnosed with estrogen 1616 2007 USA receptor-positive locally invasive breast cancer of >1 cm size, PMe1 L02 L THEN adjuvant hormonal therapy should be offered. Wenger et al. 109 (Breast Cancer) IF a female VE with a life expectancy >5 years is diagnosed with locally invasive breast cancer with ≥4 1617 2007 USA PMe1 L01 L positive lymph nodes, THEN adjuvant chemotherapy should Wenger et al. 109 be offered. (Breast Cancer) IF a female VE with normal cardiac function and a life expectancy >5 years is diagnosed with locally 1618 2007 USA invasive breast cancer with positive lymph nodes and HER- PMe1 L01 L 2/neu receptor over-expression, THEN adjuvant Wenger et al. 109 chemotherapy with trastuzumab should be offered. (Breast Cancer) IF a female VE is diagnosed with advanced 1619 2007 USA breast cancer with symptomatic or lytic bone metastasis, PMe1 M05 M THEN bisphosphonate treatment should be offered. Wenger et al. 109 (Breast Cancer) IF a female VE is diagnosed with advanced estrogen receptor-positive breast cancer with bone metastasis 1620 2007 USA PMe1 L02 L and without extensive visceral involvement, THEN endocrine Wenger et al. 109 therapy should be offered. (Breast Cancer) IF a female VE has symptomatic multifocal metastatic hormone-refractory breast cancer OR symptomatic 1621 2007 USA hormone receptor-negative breast cancer with extensive PMe1 L01 L visceral metastasis, THEN treatment with systemic Wenger et al. 109 chemotherapy should be offered. (Breast Cancer) IF a female VE with normal cardiac function with HER-2/neu-positive metastatic breast cancer is treated 1622 2007 USA PMe1 L01 L with systemic chemotherapy, THEN trastuzumab should be Wenger et al. 109 offered. (COPD) IF a VE has COPD ( stage >I), THEN s/he 1623 2007 USA PMe1 R03 R Wenger et al. 109 should be prescribed a rapid-acting bronchodilator. (COPD) IF a VE with COPD is given a new inhaler device, 1624 2007 USA spacer, or nebulizer, THEN training to use the device should PMe5 R03 R Wenger et al. 109 be documented. (COPD) IF a VE with moderate-very severe COPD (GOLD stage II-IV) has symptoms not controlled by PRN 1625 2007 USA PMe1 R03 R bronchodilator use or had ≥ 2 exacerbations in the past year, THEN a long-acting bronchodilator should be prescribed. Wenger et al. 109 (COPD) IF a VE with severe-very severe COPD (GOLD stage III-IV) has ≥ 2 exacerbations requiring antibiotics or oral 1626 2007 USA corticosteroids in the past year, THEN (in addition to a long- PMe1 H02 J01 R03 HJR acting bronchodilator) inhaled steroids (if not on oral steroids) Wenger et al. 109 should be prescribed.

(COPD) IF a VE with COPD has a pO2 < 55 mmHg or an O2 1627 2007 USA saturation<88% (not during an exacerbation), THEN long-term PMe1 V03 V Wenger et al. 109 oxygen therapy should be offered. (COPD) IF a VE with COPD is prescribed long-term oxygen 1628 2007 USA therapy, THEN encouragement to use it >18 hours/day PMe5 V03 V (including portable oxygen) should be documented. Wenger et al. 109 (Colorectal Cancer Care) IF a VE has a new diagnosis of colorectal cancer, THEN there should be documentation of a discussion regarding: • Surgical options and goals of surgery 1629 2007 USA PMe5 L01 L • Post treatment quality of life • Functional outcomes • Risks and benefits of adjuvant therapy (if colon cancer) or Wenger et al. 109 neoadjuvant therapy (if rectal cancer) (Colorectal Cancer Care) IF a VE undergoes surgery for colorectal cancer, THEN a qualified physician (e.g. surgeon, oncologist, radiation oncologist) should discuss with the 1630 2007 USA PMe5 L01 L patient/caregiver final pathology (e.g., stage, status of lymph nodes, margins), and indications for further treatment (e.g., Wenger et al. 109 chemotherapy, radiation therapy). (Colorectal Cancer Care) IF a VE with a new diagnosis of rectal cancer is to be treated surgically, THEN the surgeon 1631 2007 USA PMe7 L01 L should preoperatively (or pre-neoadjuvant therapy) assess the mass (e.g., digital rectal exam or flexible sigmoidoscopy). Wenger et al. 109 (Colorectal Cancer Care) IF a VE has stage III colon cancer, 1632 2007 USA THEN adjuvant chemotherapy should be given within 4 PMe1 L01 L Wenger et al. 109 months of surgery. (Colorectal Cancer Care) IF a VE is thought to have stage II or III mid-low rectal cancer and is a candidate for surgery, 1633 2007 USA PMe1 L01 L THEN preoperative neoadjuvant chemotherapy and radiation Wenger et al. 109 therapy should be given. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Colorectal Cancer Care) IF a VE had surgical resection for stage II or III rectal cancer and did not receive neoadjuvant 1634 2007 USA radiation and/or chemotherapy, THEN postoperative adjuvant PMe1 L01 L chemotherapy and/or radiation therapy should be provided Wenger et al. 109 within 4 months of surgery. (Continuity and Coordination of Care) IF a VE outpatient is prescribed a new chronic disease medication, and s/he has a follow-up visit with the prescribing physician, THEN 1 of the following should be noted at the follow-up visit: 1635 2007 USA • Medication is being taken P Ge 5 N/A N/A • Patient was asked about the medication (e.g., side effects, adherence, availability) • Medication was not started because it was not needed or Wenger et al. 109 changed. (Continuity and Coordination of Care) IF a VE is under the outpatient care of ≥2 physicians, and one physician 1636 2007 USA prescribed a new chronic disease medication or a change in P Ge 9 N/A N/A prescribed medication, THEN the non-prescribing physician should acknowledge the medication change at the next visit. Wenger et al. 109 (Continuity and Coordination of Care) IF a VE is discharged from a hospital to home and received a new chronic disease 1637 2007 USA medication or a change in medication prior to discharge, P Ge 6 N/A N/A THEN the outpatient medical record should document the medication change within 6 weeks of discharge. Wenger et al. 109 (Continuity and Coordination of Care) IF a VE is discharged from a hospital to home with a new medication that requires a 1638 2007 USA serum medication level to be checked, THEN the medical P Ge 7 N/A N/A record should document the medication level, that the medication was stopped, or that the level was not needed. Wenger et al. 109 (Dementia) IF a VE screens positive for dementia, THEN the physician should review the patient’s medications (including 1639 2007 USA P Ge 7 N/A N/A over-the-counter) for any that may be associated with mental Wenger et al. 109 status changes. (Dementia) IF a VE screens positive for dementia and is taking medications that are commonly associated with mental 1640 2007 USA P Ge 8 N/A N/A status changes in the elderly, THEN the physician should discontinue or justify continuing these medications. Wenger et al. 109 (Dementia) IF a VE has been diagnosed with mild to moderate Alzheimer’s disease, mild to moderate vascular dementia, or 1641 2007 USA Lewy body dementia, THEN there should be a documented PMe5 N06 N discussion with the patient and/or caregiver about Wenger et al. 109 cholinesterase inhibitor treatment (Dementia) IF a VE with dementia has behavioral symptoms, THEN specific target symptoms should be documented and behavioral interventions instituted first or concurrently with 1642 2007 USA PMe7 N06 N pharmacotherapy, OR if treating first with a pharmacologic intervention, then severe symptoms or safety concerns should Wenger et al. 109 be present and documented. (Dementia) IF a VE with dementia and behavioral symptoms 1643 2007 USA is newly treated with an antipsychotic, THEN there should be PMe5 N05 N Wenger et al. 109 a documented risk-benefit discussion. (Depression) IF a VE is diagnosed with depression, THEN antidepressant treatment, psychotherapy, or ECT should be offered within 2 weeks after diagnosis unless there is 1644 2007 USA documentation within that period that the patient has PMe1 N06 N improved, or unless the patient has substance abuse or dependence, in which case treatment may wait until 8 weeks Wenger et al. 109 after the patient is in a drug- or alcohol-free state. (Depression) IF a VE is started on antidepressant medication, THEN the following medications should not be used as 1st- or 2nd-line therapy: tertiary amine tricyclics (amitriptyline, 1645 2007 USA imipramine, doxepin, clomipramine, trimipramine); PMe1 N05 N06 N monoamine oxidase inhibitors (unless atypical depression is present); benzodiazepines; or stimulants (except Wenger et al. 109 methylphenidate). (Depression) IF a VE has depression with psychotic features, THEN s/he should be referred to a psychiatrist OR should 1646 2007 USA PMe1 N05 N06 N receive treatment with a combination of an antidepressant and Wenger et al. 109 an antipsychotic, or with ECT. (Depression) IF a VE with a history of cardiac disease is started an a tricyclic medication, THEN a baseline 1647 2007 USA PMe7 N06 N electrocardiogram should be performed prior to initiation if not Wenger et al. 109 done in the prior 3 months. (Depression) IF a vulnerable elder is taking a SSRI, THEN a MAOI should not be used for at least 2 weeks after 1648 2007 USA PMe1 N06 N termination of the SSRI (and for at least 5 weeks after Wenger et al. 109 termination of fluoxetine). (Depression) IF a VE is taking a MAOI, THEN he or she should not receive medications that have the potential for 1649 2007 USA PMe1 N06 N serious interactions with MAOIs or for at least 2 weeks after Wenger et al. 109 termination of the MAOI. (Depression) IF a VE is newly treated for depression, THEN the following should be documented at the first follow-up visit to the same physician or to a mental health provider within 4 weeks of treatment initiation: 1650 2007 USA PMe7 N06 N • Degree of response to at least 2 of the 9 DSM-IV target symptoms for major depression • Medication side effects, if he or she is taking antidepressant Wenger et al. 109 medications Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Depression) IF a vulnerable elder has no meaningful symptom response after 6 weeks of depression treatment, THEN one of the following treatment options should be initiated by the 8th week of treatment: medication dose should 1651 2007 USA be optimized or changed, or the patient should be referred to PMe13 N06 N a psychiatrist (if initial treatment was medication); or medication should be initiated or referral to a psychiatrist should be offered (if initial treatment was psychotherapy Wenger et al. 109 alone). (Depression) IF a vulnerable elder with depression responds only partially after 12 weeks of treatment, THEN one of the following treatment options should be instituted by the 16th week of treatment: switch to a different medication class or 1652 2007 USA add a second medication to the first (if initial treatment PMe1 N06 N includes medication); add psychotherapy (if the initial treatment was medication); try medication (if initial treatment was psychotherapy without medication); consider ECT; or Wenger et al. 109 refer to a psychiatrist. (Depression) IF a VE with depression has responded to antidepressant medication, THEN s/he should be continued 1653 2007 USA on the drug at the same dose for at least 6 months, and make PMe47 N06 N at least 1 clinician contact (office visit or phone) during that Wenger et al. 109 time period. (Depression) IF a VE has experienced 3 or more episodes of depression, THEN s/he should receive maintenance 1654 2007 USA antidepressant medication with the same type and dose of PMe47 N06 N medication for at least 24 months with at least 4 office or Wenger et al. 109 telephone visits for depression during that period. (Diabetes Mellitus) IF a diabetic VE does not have established 1655 2007 USA renal disease and is not receiving an ACEI or ARB, THEN a PMe7 C09 C test for proteinuria should be done annually. Wenger et al. 109 (Diabetes Mellitus) IF a diabetic VE has proteinuria, THEN an 1656 2007 USA PMe1 C09 C Wenger et al. 109 ACEI or ARB should be prescribed. (Diabetes Mellitus) IF a diabetic VE has a persistent (on 2 consecutive visits) elevation of systolic BP >130 mm Hg, 1657 2007 USA THEN an intervention (pharmacologic, lifestyle, compliance, PMe1 C02C03C07C08C09 C etc.) should occur or there should be documentation of a reversible cause/other justification for the elevation. Wenger et al. 109 (Diabetes Mellitus) IF a diabetic VE is not on 1658 2007 USA anticoagulant/antiplatelet therapy, THEN daily aspirin should PMe1 B01 B Wenger et al. 109 be prescribed. (Diabetes Mellitus) IF a diabetic VE has fasting LDL >130 1659 2007 USA mg/dl, THEN a pharmacologic or lifestyle intervention should PMe1 C10 C Wenger et al. 109 be offered within 3 months. (End of life Care) IF a VE with metastatic cancer or oxygen dependent pulmonary disease has dyspnea refractory to non- 1660 2007 USA PMe1 N02 N opiate medications, THEN opiate medications should be Wenger et al. 109 offered. (End of life Care) IF a noncomatose VE is not expected to survive and a mechanical ventilator is withdrawn or withheld, 1661 2007 USA THEN the chart should document whether the patient has PMe1 N02 N05 N dyspnea and the patient should receive (or have orders available for) an opiate/benzodiazepine/barbiturate infusion. Wenger et al. 109 (End of life Care) IF a VE with end-stage metastatic cancer is treated with opiates for pain, THEN the medical record should 1662 2007 USA PMe7 N02 N document a plan for management of worsening or emergent Wenger et al. 109 pain. (Falls and Mobility Problems) IF a VE reports a history of ≥ 2 falls (or 1 fall with injury) in the past year, THEN there should be documentation of a basic fall history (circumstances, 1663 2007 USA P Ge 7 N/A N/A medications, chronic conditions, mobility, alcohol intake) within 3 months of the report (or within 4 weeks of the report, if the most recent fall occurred in the past 4 weeks). Wenger et al. 109 (Falls and Mobility Problems) IF a VE reports a history of ≥ 2 falls (or 1 fall with injury) in the past year and is taking a 1664 2007 USA benzodiazepine, THEN there should be PMe5 N05 N documentation of a discussion of related risks and assistance offered to reduce/discontinue benzodiazepine use. Wenger et al. 109 (Heart Failure) IF a VE has a LVEF <40%, THEN s/he should 1665 2007 USA PMe1 C09 C Wenger et al. 109 receive an ACEI (or an ARB if ACEI intolerant). (Heart Failure) IF a VE is newly diagnosed with heart failure, THEN s/he should have a history taken at diagnosis/hospitalization that documents the following: • Symptoms of volume overload • Current symptoms of chest pain/angina • Prior myocardial infarction, coronary artery disease, or revascularization • Hypertension 1666 2007 USA • Diabetes P Ge 7 N/A N/A • Hypercholesterolemia • Valvular heart disease • • Alcohol use • Smoking • Current medications • NYHA functional class or other description of functional Wenger et al. 109 status (Heart Failure) IF a VE has heart failure and LVEF <40%, 1667 2007 USA THEN s/he should be treated with a beta-blocker known to PMe1 C07 C Wenger et al. 109 prolong survival (carvedilol, metoprolol or bisoprolol). (Heart Failure) IF a VE has heart failure, LVEF <40% and no 1668 2007 USA atrial fibrillation, THEN s/he should not be treated with a 1st- PMe1 C08 C Wenger et al. 109 or 2nd-generation calcium channel blocker. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Heart Failure) IF a VE has heart failure and LVEF <40%, THEN s/he should not be treated with a type I antiarrhythmic 1669 2007 USA PMe1 C01 C agent unless an implantable cardioverter defibrillator is in Wenger et al. 109 place. (Heart Failure) IF a VE with heart failure is taking digoxin and 1670 2007 USA has signs of toxicity, THEN a digoxin level should be checked PMe7 C01 C Wenger et al. 109 or digoxin discontinued within 1 week. (Heart Failure) IF a VE is newly diagnosed or hospitalized with heart failure, THEN patient counseling in the following areas should be provided and documented: • Medication use, dosage, intervals, side effects • Low-salt diet 1671 2007 USA • Exercise/physical activity P Ge 5 N/A N/A • Smoking cessation • Weight monitoring • Symptom management • Avoiding/minimizing use of NSAIDs Wenger et al. 109 • Prognosis/end-of-life issues (Hospital Care & Surgery) IF a hospitalized VE is at very high risk for venous thrombosis, THEN s/he should be on DVT 1672 2007 USA PMe1 B01 B prophylaxis (pharmacologic or sequential/intermittent Wenger et al. 109 compression). (Hospital Care & Surgery) IF a VE falls during hospitalization, THEN the following should be documented within 24 hours: 1673 2007 USA • Presence or absence of prodromal symptoms P Ge 7 N/A N/A • Review of medications or drugs potentially contributing to the fall. Wenger et al. 109 (Hospital Care & Surgery) IF a VE is admitted to the hospital 1674 2007 USA for pneumonia, THEN antibiotics should be administered PMe15 J01 J Wenger et al. 109 within 4 hours of arrival. (Hospital Care & Surgery) IF a VE is admitted to the hospital

1675 2007 USA with community-acquired pneumonia with hypoxia (O2 PMe1 V03 V saturation <90%), THEN oxygen should be administered. Wenger et al. 109 (Hospital Care & Surgery) IF a VE hospitalized with community-acquired pneumonia is switched from parenteral to oral antimicrobial therapy, THEN the oral medication should have equivalent/ near-equivalent OR there should be documentation of the following: 1676 2007 USA PMe7 J01 J • Signs of clinical improvement • Ability to tolerate other oral medications/food/fluids • Hemodynamic stability: Heart rate < 100, SBP > 90,

Respiratory rate < 24, Temperature ≤ 37.8° C (100° F), O2 saturation > 90% on RA Wenger et al. 109 (PREOPERATIVE CARE) IF a diabetic VE is to have elective 1677 2007 USA major surgery, THEN the diabetes regimen and adequacy of PMe7 A10 A diabetes control should be documented preoperatively. Wenger et al. 109 (PREOPERATIVE CARE) IF a VE has elective major surgery, THEN prophylactic antibiotics should be administered within 1 1678 2007 USA PMe45 J01 J hour before incision (2 hours for vancomycin /fluoroquinolone) AND discontinued within 24 hours after the end of surgery. Wenger et al. 109 (PREOPERATIVE CARE) IF a VE with coronary artery disease has elective major surgery, THEN pre-operative beta 1679 2007 USA PMe14 C07 C blockade should be considered and if initiated, it should be Wenger et al. 109 continued until discharge. (PREOPERATIVE CARE) IF a VE has sustained a hip 1680 2007 USA PMe1 B01 B fracture, THEN an anticoagulant regimen should be started. Wenger et al. 109 (PREOPERATIVE CARE) IF a VE is to have a total hip 1681 2007 USA replacement, THEN an anticoagulation regimen should be PMe15 B01 B Wenger et al. 109 started preoperatively or on the evening after surgery. (Hypertension) IF a VE is newly diagnosed with HTN AND is taking an NSAID or COX-2 inhibitor, THEN there should be 1682 2007 USA documentation within 6 months of dose reduction, an attempt PMe3 M01 M02 M to use an alternative medication, or justification for continued Wenger et al. 109 use. (Hypertension) IF a VE with HTN has persistent (on 2 consecutive visits) elevation of systolic BP above goal*, THEN an intervention (pharmacologic, lifestyle, compliance, etc.) should occur or there should be documentation of a reversible 1683 2007 USA cause or other justification for the elevation. PMe1 C02C03C07C08C09 C *Goal systolic BP (mm Hg): - Diabetes/chronic renal disease-130 - Home ambulatory monitoring-135 - All other patients-140 or other specified goal Wenger et al. 109 (Hypertension) IF a VE’s HTN medication regimen is changed (new medication or dose change) AND within 1 week s/he reports dizziness, syncope/near syncope, near-fall or fall, 1684 2007 USA PMe17 C02C03C07C08C09 C THEN s/he should be evaluated for orthostatic hypotension at the time of the report (or within 1 week if outside the office) Wenger et al. 109 OR the medication regimen changed. (Hypertension) IF a VE with HTN has ischemic heart disease, 1685 2007 USA THEN treatment with a beta-blocker should be recommended PMe1 C07 C Wenger et al. 109 OR documentation why not. (Hypertension) IF a VE with HTN has a history of heart failure, left ventricular hypertrophy, ischemic heart disease, chronic 1686 2007 USA PMe1 C09 C kidney disease or CVA, THEN s/he should be treated with an ACEI or ARB OR documentation why not. Wenger et al. 109 (Ischemic Heart Disease) IF a VE has an acute coronary 1687 2007 USA syndrome, THEN s/he should be given aspirin within 1 hour of PMe15 B01 B Wenger et al. 109 presentation. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Ischemic Heart Disease) IF a VE has non-ST elevation acute coronary syndrome (unstable angina or non-ST elevation 1688 2007 USA PMe14 B01 B AMI), and CABG is not planned, THEN s/he should be treated with aspirin and clopidogrel for at least 3 months. Wenger et al. 109 (Ischemic Heart Disease) IF a VE has an acute coronary 1689 2007 USA syndrome, THEN s/he should be given a beta-blocker within PMe15 C07 C Wenger et al. 109 12 hours. (Ischemic Heart Disease) IF a VE has a myocardial infarction (STEMI or NSTEMI) complicated by heart failure or LVEF 1690 2007 USA <40%, THEN s/he should be given an ACEI/ARB within 36 PMe145C09 C hours of presentation AND advised to continue this treatment Wenger et al. 109 for >4 weeks. (Ischemic Heart Disease) IF a VE with ischemic heart 1691 2007 USA disease has an LDL >100 mg/dl, THEN s/he should be offered PMe1 C10 C Wenger et al. 109 cholesterol lowering medication. (Ischemic Heart Disease) IF a VE with ischemic heart 1692 2007 USA disease is not taking warfarin, THEN s/he should be offered PMe1 B01 B Wenger et al. 109 daily aspirin or other antiplatelet therapy. (Ischemic Heart Disease) IF a VE has had a myocardial infarction (STEMI or NSTEMI), THEN s/he should be offered a 1693 2007 USA PMe14 C07 C beta-blocker and advised to continue treatment for ≥ 2 years Wenger et al. 109 following infarction. (Ischemic Heart Disease) IF a VE has ischemic heart 1694 2007 USA disease, THEN s/he should be offered ACEI/ARB therapy and PMe14 C09 C Wenger et al. 109 advised to continue the treatment indefinitely. (Ischemic Heart Disease) IF a female VE with ischemic heart disease is currently taking combination estrogen/ 1695 2007 USA progesterone therapy, THEN she should be counseled about PMe15 G03 G possible increased cardiovascular risk OR this therapy should Wenger et al. 109 be discontinued. (Medication Use) ALL VEs should have an up-to-date medication list readily available in the medical record, 1696 2007 USA P Ge 9 N/A N/A accessible by all healthcare providers, and including over-the- Wenger et al. 109 counter medications. (Medication Use) ALL VEs should have an annual drug 1697 2007 USA P Ge 7 N/A N/A Wenger et al. 109 regimen review. (Medication Use) IF a VE is prescribed a drug, THEN the 1698 2007 USA P Ge 9 N/A N/A Wenger et al. 109 prescribed drug should have a clearly defined indication. (Medication Use) IF a VE is prescribed a drug, THEN the VE 1699 2007 USA (or a caregiver) should receive appropriate education about its P Ge 5 N/A N/A Wenger et al. 109 use. (Medication Use) IF a VE is prescribed an ongoing medication 1700 2007 USA for a chronic medical condition, THEN there should be a P Ge 7 N/A N/A Wenger et al. 109 documentation of response to therapy. (Medication Use) IF a VE receives a new prescription for warfarin, THEN s/he should receive education about diet and 1701 2007 USA PMe5 B01 B drug interactions and the risk of bleeding complications OR Wenger et al. 109 referred to an anticoagulation clinic. (Medication Use) IF a VE is prescribed warfarin, THEN an 1702 2007 USA INR should be determined within 4 days after initiation of PMe7 B01 B Wenger et al. 109 therapy and at least every 6 weeks thereafter. (Medication Use) IF a VE is prescribed an ACEI, THEN s/he should have serum creatinine and potassium monitored within 1703 2007 USA PMe7 C09 C 2 weeks after initiation of therapy and at least yearly Wenger et al. 109 thereafter. (Medication Use) IF a VE is prescribed a loop diuretic, THEN 1704 2007 USA s/he should have electrolytes checked within 2 weeks after PMe7 C03 C Wenger et al. 109 initiation and at least yearly thereafter. (Medication Use) IF a VE requires a new analgesic, THEN 1705 2007 USA PMe1 N02 N Wenger et al. 109 s/he should not be prescribed propoxyphene. (Medication Use) IF a VE is taking a benzodiazepine (>1 month), THEN there should be annual documentation of 1706 2007 USA PMe5 N05 N discussion of risks and attempt to taper and discontinue the Wenger et al. 109 benzodiazepine. (Medication Use) ALL VEs should not be prescribed any 1707 2007 USA medication with strong anticholinergic effects if alternatives PMe1 A03 A04 G04 M03 N02 N04 N05 N06 R06 S01 A G M N R S Wenger et al. 109 are available. (Medication Use) IF a VE does not require seizure control, 1708 2007 USA PMe1 N05 N Wenger et al. 109 THEN barbiturates should not be used. (Medication Use) IF a VE requires analgesia, THEN 1709 2007 USA PMe1 N02 N Wenger et al. 109 meperidine should not be prescribed. (Medication Use) IF a VE receives THEN it should 1710 2007 USA PMe4 M01 M Wenger et al. 109 not be prescribed for >5 days. (Medication Use) IF a VE receives prescription pharmacological treatment for back or neck pain, THEN 1711 2007 USA , methocarbamol, , PMe4 M03 M chlorzoxasone, orphenadine, tizanidine, or metaxolone should Wenger et al. 109 not be prescribed for >1 week. (Medication Use) IF a VE has had a recent stroke or myocardial infarction, has peripheral arterial disease, or acute coronary syndrome that will be treated medically or with a 1712 2007 USA PMe1 B01 B percutaneous angioplasty, and the patient requires antiplatelet therapy, THEN clopidogrel should be prescribed rather than Wenger et al. 109 ticlopidine. (Medication Use) IF a VE has iron deficiency anemia, THEN 1713 2007 USA no more than 1 tablet daily of low-dose oral iron should be PMe13 B03 B Wenger et al. 109 prescribed (Medication Use) IF a VE is started on an antipsychotic drug, 1714 2007 USA THEN there should be documentation of an assessment of PMe7 N05 N Wenger et al. 109 response within 1month. (Medication Use) IF a VE is prescribed chronic high-dose acetaminophen (≥ 3 grams/day) OR a VE with liver disease is 1715 2007 USA PMe5 N02 N prescribed chronic acetaminophen THEN s/he should be Wenger et al. 109 advised of the risk of liver toxicity. (Medication Use) IF a VE is prescribed an NSAID (non- 1716 2007 USA selective or selective), THEN gastrointestinal bleeding risks PMe5 M01 M02 M Wenger et al. 109 should be discussed and documented. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Medication Use) IF a VE is prescribed low-dose (≤ 325 1717 2007 USA mg/day) aspirin, THEN gastrointestinal bleeding risks should PMe5 B01 B Wenger et al. 109 be discussed and documented. (Medication Use) IF a VE with a risk factor for gastrointestinal bleeding (age ≥75, peptic ulcer disease, history GI bleeding, 1718 2007 USA warfarin use, chronic glucocorticoid use) is treated with a non- PMe1 A02 B01 M01 M02 ABM selective NSAID, THEN s/he should be treated concomitantly with either misoprostol or a proton pump inhibitor. Wenger et al. 109 (Medication Use) IF a VE with >2 risk factors for gastrointestinal bleeding (age ≥75, peptic ulcer disease, history GI bleeding, warfarin use, chronic glucocorticoid use) 1719 2007 USA PMe1 A02 B01 H02 ABH is treated with daily aspirin, THEN s/he should be treated concomitantly with either misoprostol or a proton pump Wenger et al. 109 inhibitor (Osteoarthritis) IF a VE is started on pharmacologic therapy to 1720 2007 USA PMe1 N02 N treat OA, THEN acetaminophen should be tried first. Wenger et al. 109 (Osteoporosis) ALL VEs at an initial primary care visit should 1721 2007 USA be counseled about intake of calcium and vitamin D, and PMe5 A11 A12 A Wenger et al. 109 weight-bearing exercises. (Osteoporosis) IF a male VE without a diagnosis of osteoporosis has any of the following risk factors for osteoporosis, • > 3 months of systemic glucocorticoid treatment • Primary hyperparathyroidism 1722 2007 USA PMe7 G03 H02 GH • Osteoporosis in a first degree relative • Hypogonadism • GNRH antagonist use • Osteopenia on x ray Wenger et al. 109 THEN a DXA scan should be performed (Osteoporosis) IF a VE without osteoporosis is taking ≥ 7.5 mg/day of prednisone (or equivalent) for ≥ 1 month, THEN 1723 2007 USA PMe1 A11 A12 H02 AH s/he should be prescribed calcium and vitamin D Wenger et al. 109 supplements. (Osteoporosis) IF a VE without osteoporosis is taking ≥ 7.5 1724 2007 USA mg/day of prednisone (or equivalent) for ≥ 3 months, THEN PMe1 H02 M05 HM Wenger et al. 109 s/he should be prescribed bisphosphonate therapy. (Osteoporosis) IF a female VE is newly diagnosed with osteoporosis, THEN she should receive a workup including the following: • Medication use • Alcohol use • CBC 1725 2007 USA PGe7N/A N/A • Liver function tests • Renal function • Calcium • Phosphorus • Vitamin D 25-OH Wenger et al. 109 • TSH (Osteoporosis) IF a VE has osteoporosis, THEN s/he should 1726 2007 USA PMe1 A11 A12 A Wenger et al. 109 be prescribed calcium and vitamin D supplements. (Osteoporosis) IF a female VE has osteoporosis, THEN she should be treated with bisphosphonates, raloxifene, calcitonin, 1727 2007 USA PMe1 A11 A12 G03 H05 M05 AGHM hormone replacement therapy or teriparatide (if this is a new Wenger et al. 109 diagnosis, within 3 months). (Osteoporosis) IF a male VE has osteoporosis and is 1728 2007 USA hypogonadal and has no history of prostate cancer, THEN he PMe1 G03 G Wenger et al. 109 should be prescribed testosterone therapy. (Osteoporosis) IF a male VE has osteoporosis, THEN he should be treated with bisphosphonates, calcitonin or PTH or, 1729 2007 USA PMe1 G03 H05 M05 GHM if hypogonadal, testosterone (if this is a new diagnosis, within Wenger et al. 109 3 months). (Pain Management) IF a VE presents for a cancer-related 1730 2007 USA physician visit, including visits for chemotherapy or radiation, PMe7 L01 L Wenger et al. 109 THEN pain should be assessed. (Pain Management) IF a VE is new to a primary care practice and has persistent pain, THEN there should be 1731 2007 USA documentation of patient education within 6 months that PMe5 M01 M02 N02 MN explains the likely cause of symptoms and how to use Wenger et al. 109 medication or other therapies. (Pain Management) IF a VE with persistent pain is treated with opioids, THEN 1 of the following should be prescribed/noted: 1732 2007 USA • Stool softener or laxative PMe1 A06 N02 AN • Increased fiber, stool-softening foods • Documentation of the potential for constipation and/or why Wenger et al. 109 bowel treatment is not needed. (Pain Management) IF a VE is started on new opioid therapy 1733 2007 USA for persistent pain, THEN efficacy and side effects should be PMe7 N02 N Wenger et al. 109 assessed within 1 month. (Pressure Ulcers) IF a VE with a full-thickness stage III or IV pressure ulcer presents with systemic signs and symptoms of infection, such as elevated temperature, elevated white blood count, and/or confusion and agitation, AND it is likely the 1734 2007 USA sepsis is due to the wound, THEN the pressure ulcer should PMe1 J01 J be debrided to eliminate necrotic debris within 24 hours AND a tissue biopsy, needle aspiration, or quantitative swab after debridement should be obtained for bacterial culture and appropriate systemic antibiotics initiated. Wenger et al. 109 (Screening and Prevention) All VEs should be offered an 1735 2007 USA PMe1 J07 J Wenger et al. 109 annual influenza vaccination. (Screening and Prevention) ALL VEs should have 1736 2007 USA documentation whether they have received a pneumococcal PMe1 J07 J Wenger et al. 109 vaccination, and if so, at what age. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Screening and Prevention) IF a VE has not received a pneumococcal vaccination or received it >5 years ago and 1737 2007 USA PMe1 J07 J prior to age 65, THEN s/he should be offered pneumococcal Wenger et al. 109 vaccination. (Screening and Prevention) IF a female VE is on hormone 1738 2007 USA therapy, THEN there should be documentation that the risks PMe5 G03 L02 GL Wenger et al. 109 and benefits were discussed since January 2003. (Sleep Disorders) IF a VE has sleep problems, THEN s/he 1739 2007 USA should not be treated with sleep aids containing PMe1 R06 R Wenger et al. 109 antihistamines. (Sleep Disorders) IF a VE is new to a primary care practice and is chronically (> 3 months) taking an over-the-counter 1740 2007 USA sleep aid containing antihistamine for sleep problems, THEN PMe1 R06 R advice to discontinue the medication should be documented Wenger et al. 109 within 6 months. (Sleep Disorders) IF a VE is new to a primary care practice and is chronically (> 3 months) taking a benzodiazepine for 1741 2007 USA PMe3 N05 N sleep problems, THEN advice to taper off and discontinue the medication should be documented within 6 months. Wenger et al. 109 (Sleep Disorders) IF a VE has pain that disturbs his/her ability to fall asleep or maintain sleep, THEN 1742 2007 USA PMe1 M01 M02 N02 MN pharmacologic/nonpharmacologic pain management should Wenger et al. 109 be recommended (Stroke & AF) IF a VE has chronic atrial fibrillation and is 1743 2007 USA medium to high-risk for stroke, THEN anticoagulation should PMe1 B01 B Wenger et al. 109 be offered. (Stroke & AF) IF a VE has chronic atrial fibrillation, medium to high-risk for stroke, and has a contraindication to 1744 2007 USA PMe1 B01 B anticoagulation, THEN antiplatelet therapy should be Wenger et al. 109 prescribed. (Stroke & AF) IF a VE is prescribed anticoagulants for atrial 1745 2007 USA fibrillation, THEN there should be documentation that the goal PMe9 B01 B Wenger et al. 109 of INR is 2.0-3.0 or reason for other goal. (Stroke & AF) IF a VE has had a TIA or ischemic stroke, THEN outpatient antiplatelet or anticoagulant therapy should 1746 2007 USA PMe1 B01 B be prescribed within 3 months after stroke/TIA or entering a Wenger et al. 109 new practice. (Stroke & AF) IF a female VE has had a TIA or stroke and is taking hormone replacement therapy, THEN hormone 1747 2007 USA PMe1 G03 G replacement therapy should be discontinued or a reason Wenger et al. 109 (other than stroke prevention) documented. (Stroke & AF) IF a VE is hospitalized with a new acute 1748 2007 USA ischemic stroke, THEN aspirin should be given within 48 PMe15 B01 B Wenger et al. 109 hours (if not already on anticoagulant therapy). (Stroke & AF) IF a VE is hospitalized with an acute stroke and 1749 2007 USA inclusion and exclusion criteria are met, THEN thrombolytic PMe1 B01 B Wenger et al. 109 therapy should be offered. (Stroke & AF) IF a VE with a new stroke is started on 1750 2007 USA intravenous tPA for thrombolysis, THEN inclusion and PMe7 B01 B Wenger et al. 109 exclusion criteria should be met. (Undernutrition) ALL VEs in stable health states should take 1751 2007 USA PMe13 A11 A 800 IU (or equivalent) of vitamin D supplementation daily. Wenger et al. 109 (Undernutrition) IF a VE has involuntary weight loss of ≥10% in ≤1 year or hypoalbuminemia (< 3.5 g/dL), THEN s/he should be evaluated for potentially relevant comorbid conditions, including assessment of: • Medications associated with decreased appetite 1752 2007 USA • Depression P Ge 7 N/A N/A • Cognitive impairment • Thyroid function • Screen for cancer • Diabetes Wenger et al. 109 • Malabsorption (Undernutrition) IF a hospitalized VE is malnourished or at 1753 2007 USA risk, THEN s/he should receive oral protein and energy PMe134V06 V Wenger et al. 109 supplementation of ≥400 kcal/day for ≥35 days. (Urinary Incontinence) IF a VE has new UI or established UI with bothersome symptoms AND the UI is treated with 1754 2007 USA PMe9 G04 G medication or surgery, THEN classification of the type Wenger et al. 109 of/suspected reason(s) for UI should be documented. (Vision) IF a VE who has been prescribed an ocular therapeutic regime (e.g. topical ophthalmologic medications) 1755 2007 USA is hospitalized or in a nursing home, THEN there should be PMe6 S01 S documentation that the therapeutic regime was administered Wenger et al. 109 as prescribed. Patients with nonvalvular AF or atrial flutter for whom assessment of the specified thromboembolic risk factors documented 1 or more high-risk factor or more than 1 moderate-risk factor. The assessment of patients with nonvalvular AF for thromboembolic risk factors should include All patients with nonvalvular AF or atrial flutter at high risk of the following criteria: thromboembolism (i.e., those with any high-risk factor or more 1756 2008 USA Risk Factors/Weighting PMe1 B01 B than 1 moderate-risk factor) for whom warfarin was Prior stroke, TIA, or systemic embolism/High risk prescribed. Age 75 y/Moderate risk Hypertension Moderate risk/Moderate risk Diabetes mellitus/Moderate risk Heart failure or impaired left ventricular systolic Estes et al. 110 function/Moderate risk The number of calendar months in which the patient was The number of calendar months in which at least 1 INR 1757 110 2008 USA PMe7 B01 B Estes et al. receiving warfarin therapy during the reporting year. measurement was made () IF a patient undergoes cancer-directed resection, THEN adjuvant chemotherapy with or without 1758 2009 USA radiation should be considered or administered, or a valid PMe1 L01 L reason should be documented for not receiving adjuvant Bilimoria et al. 111 therapy Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Pancreatic cancer) IF a patient does not undergo resection, THEN chemotherapy or chemoradiation should be considered 1759 2009 USA PMe1 L01 L or administered or a valid reason should be documented for Bilimoria et al. 111 not receiving non-surgical therapy (Pancreatic cancer) IF an institution treats pancreatic cancer, 1760 2009 USA THEN the institution should have radiation therapy and SMe9 L01 L chemotherapy services available within their institution Bilimoria et al. 111 (Pain) If a patient is starting initial pharmacologic treatment for cancer pain, then education about pain and/or its 1761 2009 USA management should be provided, because optimal PMe5 M01 M02 N02 MN management of pain depends on adherence, which is affected Lorenz et al. 112 by education. (Pain) If a patient with cancer pain is started on a long-acting opioid formulation, then a short-acting opioid formulation for 1762 2009 USA breakthrough pain should also be provided, because PMe1 N02 N intermittent worsening of pain is common, and breakthrough medications can improve overall pain control. Lorenz et al. 112 (Pain) If a patient with cancer pain is started on chronic opioid treatment, then he or she should be offered either a prescription or non-prescription bowel regimen within 24 hours 1763 2009 USA PMe15 A06 N02 AN or there should be documented contraindication to a bowel regimen, because opioid frequently cause Lorenz et al. 112 constipation that may cause discomfort. (Pain) If a patient is being treated for cancer pain with opioids and care changes to a different setting, then the dose of opioids provided in the next setting of care should be equivalent or there should be a documented reason for 1764 2009 USA PMe6 N02 N modifying the dose, because opioids are often not appropriately continued from one setting to another, or dose conversions are made incorrectly, which can cause Lorenz et al. 112 uncontrolled pain. (Pain) If a patient has severe sustained or worsening cancer pain or adverse effects, then there should be a change in the 1765 2009 USA pain regimen or documentation of why the pain regimen was PMe123N02 N not changed, because dose changes, different routes, or different medications are often necessary for pain control. Lorenz et al. 112 (Pain) If a patient’s outpatient cancer pain regimen is changed, then there should be an assessment of the effectiveness of treatment at or before the next outpatient visit 1766 2009 USA PMe7 N02 N with that provider or at another cancer-related outpatient visit, because pain regimens often need to be adjusted or changed to achieve pain relief with the least amount of side effects. Lorenz et al. 112 (Pain) If a hospitalized patient has a change in his or her pain regimen to treat severe, sustained cancer pain, then there should be an assessment of whether or not the change in 1767 2009 USA PMe7 N02 N treatment reduced the pain within four hours, because further changes in the pain regimen are often necessary to control Lorenz et al. 112 pain. (Pain) If a cancer patient has new neurologic symptoms or findings on physical examination consistent with spinal cord compression, then he or she should be treated with steroids 1768 2009 USA PMe15 H02 H as soon as possible, but within 24 hours or a contraindication to steroids should be documented, because treatment can Lorenz et al. 112 prevent or slow paralysis. (Pain) If a patient with cancer undergoes chemotherapy or radiotherapy, or is newly diagnosed with advanced disease, then he or she should be screened for depression within one 1769 2009 USA month after the initiation of treatment or documentation of the PMe7 L01 L new diagnosis, because persons undergoing treatment and those diagnosed with progressive disease are at high risk of depression. Lorenz et al. 112 (Nausea and Vomiting) If a patient with cancer undergoing moderately or highly emetic chemotherapy or with advanced cancer affecting the or abdomen is seen 1770 2009 USA for a visit in a cancer-related outpatient setting, then the PMe7 L01 L presence or absence of nausea or vomiting should be assessed at every visit, because nausea and vomiting are common and can be effectively treated. Lorenz et al. 112 (Nausea and Vomiting) If a patient with cancer undergoing moderately or highly emetic chemotherapy or with advanced cancer affecting the gastrointestinal tract or abdomen is 1771 2009 USA admitted to a hospital, then the presence or absence of PMe7 L01 L nausea or vomiting should be assessed within 24 hours, because nausea and vomiting are common and can be Lorenz et al. 112 effectively treated. (Nausea and Vomiting) If a patient with cancer is undergoing chemotherapy treatment with a high acute emetic risk, then a three-drug regimen including single doses of a 5-HT3 receptor antagonist, dexamethasone, and a selective neurokinin-1 1772 2009 USA PMe1 A01 A04 L01 AL receptor blocker should be given immediately before chemotherapy, because the use of a three-drug regimen significantly reduces the likelihood of acute nausea and Lorenz et al. 112 vomiting. (Nausea and Vomiting) If a patient with cancer is undergoing chemotherapy treatment with a high delayed emetic risk, then a two-drug regimen including a single dose of dexamethasone 1773 2009 USA and a selective neurokinin-1 receptor blocker should be given PMe15 A01 A04 L01 AL on both Days 2 and 3 postchemotherapy, because the use of a two-drug regimen significantly reduces the likelihood of delayed nausea and vomiting. Lorenz et al. 112 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka

(Nausea and Vomiting) If a patient with breast cancer is undergoing chemotherapy treatment of moderate acute and delayed emetic risk with an anthracycline and , then a three-drug regimen including single doses of a 5-HT3 receptor antagonist, dexamethasone and a 1774 2009 USA PMe15 A01 A04 L01 AL selective neurokinin-1 receptor blocker should be given immediately before chemotherapy, and a selective neurokinin- 1 receptor blocker should be given on both Days 2 and 3 postchemotherapy, because the use of a selective neurokinin- 1 receptor blocker prevents both acute and delayed emesis. Lorenz et al. 112 (Nausea and Vomiting) If a patient with cancer is undergoing chemotherapy treatment with a moderate acute emetic risk, then a two-drug regimen including a 5-HT3 receptor 1775 2009 USA antagonist and dexamethasone should be given immediately PMe15 A01 A04 L01 AL before chemotherapy, because the use of this two-drug regimen significantly reduces the likelihood of acute nausea Lorenz et al. 112 and vomiting. (Nausea and Vomiting) If a patient with cancer is undergoing chemotherapy treatment with a moderate delayed emetic risk, then either a 5-HT3 receptor antagonist or dexamethasone 1776 2009 USA PMe15 A01 A04 L01 AL should be given on each of Days 2 - 4 after chemotherapy, because the use of either of them significantly reduces the likelihood of delayed nausea and vomiting. Lorenz et al. 112 (Nausea and Vomiting) If an outpatient with cancer is undergoing chemotherapy with a moderately to highly emetic chemotherapy regimen, then postchemotherapy communication plan between the health care professional and 1777 2009 USA PMe5 L01 L patient should be provided for reporting symptoms, because even with optimal therapy, a substantial portion of patients who experience acute symptoms may require rescue Lorenz et al. 112 treatment. (Nausea and Vomiting) If an outpatient with cancer not receiving chemotherapy or radiation has an initial episode of 1778 2009 USA nausea or vomiting, then the clinician should assess for PMe7 L01 L underlying causes, because addressing secondary causes can facilitate effective treatment for nausea or vomiting. Lorenz et al. 112 (Nausea and Vomiting) If a patient with cancer not receiving chemotherapy or radiation reports new nausea or vomiting on admission to the hospital, then within 24 hours, potential 1779 2009 USA PMe7 L01 L underlying causes should be assessed, because addressing secondary causes can facilitate effective treatment for nausea Lorenz et al. 112 or vomiting. (Nausea and Vomiting) If an inpatient with cancer not receiving chemotherapy or radiation has nausea or vomiting, 1780 2009 USA then within 24 hours of the initial report of nausea and PMe1 L01 L vomiting, the patient should be offered a change in therapy, because nausea and vomiting can be effectively treated. Lorenz et al. 112 (Nausea and Vomiting) If an outpatient with cancer not receiving chemotherapy or radiation is treated for nausea or vomiting with an antiemetic medication, then the effectiveness 1781 2009 USA PMe7 A04 L01 AL of treatment should be evaluated before or on the next visit to the same outpatient site, because antiemetic medications often need to be adjusted to effectively treat the symptom. Lorenz et al. 112 (Nausea and Vomiting) If a hospitalized patient with cancer not receiving chemotherapy or radiation is treated for nausea or vomiting with an antiemetic medication, then the 1782 2009 USA PMe7 A04 L01 AL effectiveness of the treatment should be evaluated within 24 hours of the initial treatment, because antiemetic medications often need to be adjusted to effectively treat the symptom. Lorenz et al. 112 (Nausea and Vomiting) If a hospitalized patient with cancer has complete malignant bowel obstruction, then the patient should be offered at least one of the following treatments during the admission: surgery, stenting, decompression 1783 2009 USA PMe1 L01 L percutaneous gastrostomy tube, nasogastric tube, octreotide, or chemotherapy for or other chemotherapy- sensitive tumors, because these directed treatments can improve associated symptoms. Lorenz et al. 112 (Fatigue/Anemia) If a cancer patient is seen for an initial visit or any visit while undergoing chemotherapy at a cancer- related outpatient site, then there should be an assessment of 1784 2009 USA PMe7 L01 L the presence or absence of fatigue, because fatigue is a common symptom in cancer and some common contributory causes can be effectively treated. Lorenz et al. 112 (Dyspnea) If a patient with advanced cancer has documentation of dyspnea despite treatment with nonopioid medications or underlying causes, then they should be offered 1785 2009 USA opioids within one month or there should be documentation of PMe1 N02 N contraindications to opioid therapy, because opioids have been shown to effectively relieve dyspnea, particularly for patients with chronic obstructive pulmonary disease. Lorenz et al. 112 (Mucositis) If a patient with cancer is receiving high-dose chemotherapy and/or total body irradiation followed by stem 1786 2009 USA cell transplantation, then prophylactic use of palifermin should PMe1 L01 V03 LV be offered, because palifermin reduces the severity and Lorenz et al. 112 duration of mucositis in these patients. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Diarrhea) If a patient with cancer is undergoing chemotherapy and has diarrhea, then to classify the diarrhea as complicated or uncomplicated, all of the following should be assessed: history of onset and duration,・number of stools and stool composition, and・at least one of the associated 1787 2009 USA PMe7 L01 L symptoms (fever, dizziness, abdominal pain/cramping, nausea/vomiting, decreased performance status, sepsis, fever, bleeding, or dehydration), because characterization of the diarrhea is required to determine the appropriate Lorenz et al. 112 intervention. (Diarrhea) If a patient with cancer is undergoing chemotherapy with a high risk (>10%) of chemotherapy- induced diarrhea, then an antidiarrheal agent should be 1788 2009 USA prescribed on or before treatment is initiated, because PMe1 A07 L01 AL chemotherapy-induced diarrhea is common with these agents, and aggressive use of antidiarrheal agents can ameliorate the Lorenz et al. 112 diarrhea significantly (Diarrhea) If a patient with cancer is undergoing chemotherapy with significant risk (>10%) of chemotherapy- induced diarrhea in an outpatient setting, then a postchemotherapy communication plan between the health 1789 2009 USA care professional and patient should be established for PMe5 A07 L01 AL reporting symptoms, because even with optimal antidiarrheal therapy, a significant portion of patients may develop a complicated diarrhea that would require treatment with Lorenz et al. 112 octreotide and/or hospitalization. (Delirium) If a hospitalized patient with cancer over the age of 65 years or with advanced cancer has delirium, then there should be an assessment for the presence or absence of at least one of the following potential causes and their 1790 2009 USA P Ge 7 N/A N/A association with delirium: medication effects, CNS disease, infection, or metabolic processes, because delirium is often caused by conditions that can be treated to improve the Lorenz et al. 112 symptom. (Delirium) If a patient with advanced cancer has terminal restlessness, then treatment with an antipsychotic should be 1791 2009 USA initiated or there should be treatment for a potential underlying PMe1 N05 N cause, because these drugs may be effective and this symptom can be distressing to patients and families. Lorenz et al. 112 (Fever/) If an older patient (age >60 years) is undergoing chemotherapy for aggressive non-Hodgkin’s lymphoma, then white blood cell colony-stimulating factors 1792 2009 USA should be used in the first and subsequent cycles, because PMe1 L01 L03 L the use of white blood cell colony-stimulating factors allows older patients to receive their chemotherapy on schedule and at the correct dose, and reduces febrile neutropenic events. Lorenz et al. 112 (Fever/Neutropenia) If a patient with cancer and on chemotherapy presents with a fever (>100.5°F) during the expected nadir of the course of treatment, then there should 1793 2009 USA PMe7 L01 L be an evaluation for neutropenia (white blood count and absolute neutrophil count) within 24 hours, because febrile neutropenia is associated with an increased risk of mortality. Lorenz et al. 112 (Skin Rash) If a patient with cancer is undergoing radiation treatments develops radiation-induced dermatitis with dry skin and without skin breakdown, then treatment with plain, non- 1794 2009 USA PMe1 D02 D scented, lanolin-free hydrophilic cream should be offered, because treatment with the cream can maintain skin moisture Lorenz et al. 112 and pliability. (Information and Care Planning) If a patient with advanced cancer has not participated in advance care planning and is to begin a new chemotherapy regimen, then advance care planning should occur, because patients with advanced 1795 2009 USA cancer and those receiving chemotherapy are at high risk for PMe5 L01 L delirium, and their preferences for treatment or surrogate decision makers should be decided while they have decision- making capacity, as this is consistent with patients’ desires in Lorenz et al. 112 survey studies. (Information and Care Planning) If a patient with cancer undergoes chemotherapy, then before chemotherapy, he or she should be informed about the risks and benefits of 1796 2009 USA treatment, including likely symptoms and side effects, and PMe5 L01 L whether the treatment intent is curative or palliative, because patients should be provided with adequate information to participate in decisions about their own care. Lorenz et al. 112 (Elderly Issues) If an elderly patient undergoes elective or nonelective inpatient surgery and has a new definite or suspected diagnosis of delirium in the postoperative period, then an evaluation for the following core group of precipitating factors for delirium should be undertaken within 4 h from time of identification of delirium episode: Presence of infection including sepsis, pneumonia, urinary 1797 2009 USA PMe7 N05 N tract infection, wound infection, central line infection, intra- abdominal infection Electrolyte abnormalities (Na, K, BUN, Cr, glucose) Hypoxia Uncontrolled pain Urinary retention or fecal impaction McGory et al. 113 Use of -hypnotic drugs Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Elderly Issues) If an elderly patient undergoes elective inpatient surgery, then the following indications require inpatient follow-up for further evaluation, unless a preoperative evaluation says inpatient follow-up is not needed: Risk of malnutrition 1798 2009 USA Impaired cognition P Ge 7 N/A N/A Depression Impaired functional status Abnormal ambulation, unsteady gait, or fall risk High risk for delirium (presence of 3 or more risk factors) Polypharmacy McGory et al. 113 (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient is undergoing elective inpatient surgery and is taking one of the following classes of medications, then specific instructions regarding preoperative management of the following classes of medications should be given to the patient: Anticoagulation medications 1799 2009 USA Diabetes medications PMe5 A10 B01 C01 C03 C07 C08 C09 G03 ABCG Cardiovascular medications Hormonal medications Ask about herbal medications Preoperative management if taking herbal medications Ask about over the counter medications Preoperative management if taking over the counter McGory et al. 113 medications (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient is undergoing elective or nonelective inpatient 1800 2009 USA surgery and takes a beta blocker as an outpatient, then unless PMe4 C07 C contraindicated, beta blocker therapy should be continued postoperatively until discharge from the hospital McGory et al. 113 (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient is undergoing elective or nonelective inpatient 1801 2009 USA PMe15 J01 J surgery, then intravenous antibiotic prophylaxis should be McGory et al. 113 started within 1h of skin incision (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient is undergoing elective or nonelective inpatient 1802 2009 USA surgery, then intravenous antibiotic prophylaxis should be PMe4 J01 J discontinued within 24 h after surgery (48 h for cardiac McGory et al. 113 surgery) (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient is undergoing elective or nonelective inpatient 1803 2009 USA surgery and complex congenital heart disease, a prosthetic PMe1 J01 J valve, or a previous episode of endocarditis, then endocarditis McGory et al. 113 prophylaxis should be given (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient undergoes elective or nonelective inpatient surgery and does not have cancer or previous venous thromboembolism, then preoperative and postoperative deep 1804 2009 USA PMe1 B01 B venous thrombosis prophylaxis should be provided with low dose unfractionated heparin or low molecular weight heparin according to the Seventh ACCP Conference on Antithrombotic Therapy or document why not appropriate McGory et al. 113 (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient undergoes elective or nonelective inpatient surgery and has cancer or previous venous thromboembolism, then preoperative and postoperative deep venous thrombosis prophylaxis should be provided with low 1805 2009 USA PMe1 B01 B dose unfractionated heparin or low molecular weight heparin, in addition to mechanical prophylaxis (intermittent pneumatic compression and/or graduated compression stockings) according to the Seventh ACCP Conference on Antithrombotic Therapy or document why not appropriate McGory et al. 113 (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient undergoes elective or nonelective inpatient surgery and has cancer, then deep venous thrombosis 1806 2009 USA PMe14 B01 B prophylaxis should be provided with low molecular weight heparin for 2 week after hospital discharge or document why McGory et al. 113 not appropriate (Medication Use in Elderly Patients Undergoing Surgery)If an elderly patient with anemia is undergoing elective inpatient surgery, then a treatment plan to address the anemia with one 1807 2009 USA or more of the following should be outlined prior to surgery: PMe1 A11 B03 B05 AB Iron and Erythropoietin and iron Blood transfusion if hemoglobin <7 g/dL McGory et al. 113 (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient undergoes elective or nonelective inpatient 1808 2009 USA surgery, then the inpatient medical record should contain the P Ge 9 N/A N/A most recent outpatient medications with dosages or document McGory et al. 113 why not available Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient undergoes elective or nonelective inpatient surgery, then the patient or caretaker should receive the following: A complete list of all medications and dosages to continue upon discharge from the hospital A discussion with the patient or caretaker about the purpose of the drug, how to take it, and the expected side effects or 1809 2009 USA P Ge 5 N/A N/A important adverse reactions for all medications prescribed for outpatient use A discussion with the patient or caretaker about the purpose of the drug, how to take it, and the expected side effects or important adverse reactions for new medications prescribed for outpatient use Documentation of medication reconciliation between McGory et al. 113 outpatient and inpatient medications (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient undergoes elective or nonelective inpatient 1810 2009 USA surgery, then the patient should not be prescribed any PMe1 A03N04R03S01 ANRS potentially inappropriate medications according to the Beers Criteria, unless documented why the medication is appropriate McGory et al. 113 (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient undergoes elective or nonelective inpatient 1811 2009 USA P Ge 1 N/A N/A surgery, then standardized elderly-specific postoperative McGory et al. 113 orders should be used (Medication Use in Elderly Patients Undergoing Surgery) If an elderly patient is undergoing elective inpatient surgery, then 1812 2009 USA PMe5 N02 N use of epidural analgesia should be discussed with the patient if there are no contraindications McGory et al. 113 (Postoperative Management of Elderly Patients) If an elderly patient undergoes elective or nonelective inpatient surgery and he or she is eligible for vaccination (that is, the patient is 1813 2009 USA PMe1 J07 J not up-to-date with pneumococcal or influenza vaccination), then the patient should be offered vaccination against pneumococcus (year round) and influenza (during flu season) McGory et al. 113 IF a patient with SLE is on immunosuppressive therapy THEN 1814 2009 USA an inactivated influenza vaccination should be administered PMe1 J07 L04 JL annually, unless patient refusal or contraindications are noted. Yazdany et al. 114 IF a patient with SLE is on immunosuppressive therapy THEN 1815 2009 USA a pneumococcal vaccine should be administered, unless PMe1 J07 L04 JL Yazdany et al. 114 patient refusal or contraindications are noted. IF a patient with SLE has received prednisone (or other glucocorticoid equivalent) ≥7.5 mg/day for ≥3 months THEN 1816 2009 USA the patient should have BMD testing documented in the PMe7 H02 H medical record, unless the patient is currently receiving Yazdany et al. 114 antiresorptive or anabolic therapy IF a patient with SLE has received prednisone (or other glucocorticoid equivalent) ≥7.5 mg/day for ≥3 months THEN 1817 2009 USA PMe1 A11 A12 H02 AH supplemental calcium and vitamin D should be prescribed or Yazdany et al. 114 recommended and documented. IF a patient with SLE has received prednisone (or other glucocorticoid equivalent) ≥7.5 mg/day for ≥1 month, and has a central T score less than or equal to -2.5 or a history of 1818 2009 USA fragility fracture PMe1 H02 M05 HM THEN the patient should be treated with an antiresorptive or anabolic agent, unless patient refusal or contraindications are Yazdany et al. 114 noted. IF a patient is prescribed a new medication for SLE (e.g., NSAIDs, DMARDs, or glucocorticoids) 1819 2009 USA PMe5 H02 M05 L04 HML THEN a discussion with the patient about the risks versus Yazdany et al. 114 benefits of the chosen therapy should be documented. IF a patient with SLE is newly prescribed an NSAID, DMARD, or glucocorticoid 1820 2009 USA PMe7 H02 M01 M02 L04 HML THEN baseline studies should be documented within an Yazdany et al. 114 appropriate period of time from the original prescription IF a patient with SLE has established treatment with an 1821 2009 USA NSAID, DMARD, or glucocorticoid PMe7 H02 M01 M02 L04 HML Yazdany et al. 114 THEN monitoring for drug toxicity should be performed IF a patient with SLE is taking prednisone (or other steroid equivalent) ≥10 mg for ≥3 months THEN an attempt should be made to taper the prednisone, 1822 2009 USA PMe3 H02 H add a steroid-sparing agent, or escalate the dose of an existing steroid-sparing agent, unless patient refusal or Yazdany et al. 114 contraindications are noted. IF a patient is diagnosed with proliferative SLE nephritis (WHO or ISN/RPS class III or IV) THEN therapy with corticosteroids combined with another immunosuppressant 1823 2009 USA PMe1 H02 L04 HL agent should be provided and documented within 1 month of this diagnosis, unless patient refusal or contraindications are Yazdany et al. 114 noted. IF a patient with SLE has renal disease (proteinuria ≥300 mg/day or eGFR <60 ml/minute) and ≥2 BP readings, including the last reading, with systolic BP >130 mm Hg or 1824 2009 USA diastolic BP >80 mm Hg over 3 months THEN pharmacologic PMe1 C02C03C07C08C09 C therapy for hypertension should be initiated or the current regimen should be changed or escalated, unless patient refusal or contraindications are noted. Yazdany et al. 114 IF a patient with SLE has proteinuria ≥300 mg/day THEN the 1825 2009 USA patient should be treated with an ACEI or ARB, unless patient PMe1 C09 C Yazdany et al. 114 refusal or contraindications are noted. IF a patient has had pregnancy complications as a result of APS THEN the patient should be offered aspirin and heparin 1826 2009 USA PMe1 B01 B (i.e., heparin or low molecular weight heparin) during Yazdany et al. 114 subsequent . Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka

IF a woman between 18 and 45 years of age is started on any of the following medications for SLE: chloroquine, quinacrine, methotrexate, azathioprine, leflunomide, mycophenolate mofetil, cyclosporine, cyclophosphamide, or 1827 2009 USA THEN a discussion with the patient about the potential PMe5 L01 L04 P01 LP teratogenic risks of therapy and about contraception should be documented prior to drug initiation, unless the patient is unable to conceive (e.g., has had a hysterectomy, oophorectomy, , or is postmenopausal). Yazdany et al. 114 If a person with MS has increased symptomatic post-void residual urine, THEN interventions (such as pharmacotherapy 1828 2010 USA PMe1 G04 G or non-harmacotherapy treatment) should be considered to Cheng et al. 115 decrease post-void residual urine. If a person with MS has asymptomatic bacteriuria, THEN the 1829 2010 USA asymptomatic bacteriuria should not be treated with PMe1 J01 J Cheng et al. 115 . If a person with MS has a recurrence of urinary tract infection 1830 2010 USA after initial treatment, THEN urine culture with antibiotic PMe7 J01 J Cheng et al. 115 susceptibility testing should be considered. If a person with MS has constipation, THEN lifestyle changes, including increased fluid intake, dietary changes, exercise, and timing of evacuation, should be advised, and if these are 1831 2010 USA PMe7 A06 A inadequate, pharmacological agents, bulking agents, suppositories, and/or assessment for constipating Cheng et al. 115 medications/medication review. If a person with MS has new or worsening cognitive deficits that impact function, THEN one of the following should be done: review of medications, review of medical status, 1832 2010 USA P Ge 7 N/A N/A assessment for depression, offer of formal cognitive assessment, offer of advice to the patient regarding the vulnerability to financial or other abuse that may arise. Cheng et al. 115 If a person with MS has depression, THEN the health care 1833 2010 USA provider should institute, or refer to experts who will institute, PMe1 N06 N Cheng et al. 115 pharmacotherapy or psychotherapy. If a person with MS is determined to have secondary causes 1834 2010 USA of fatigue, THEN providers should review and consider P Ge 7 N/A N/A modifying medications that may exacerbate fatigue. Cheng et al. 115 IF a person with multiple sclerosis is diagnosed with primary 1835 2010 USA fatigue, THEN they should consider pharmacologic or non- PMe1 N04 N06 N Cheng et al. 115 pharmacologic treatment. IF a male person with MS has erectile dysfunction that 1836 2010 USA concerns him, THEN pharmacotherapy or non- PMe1 G04 G Cheng et al. 115 pharmacotherapy should be considered. If a person with MS has persistent spasticity and/or spasms, 1837 2010 USA THEN the person should be referred for rehabilitation therapy PMe1 N03 N Cheng et al. 115 and/or institute pharmacotherapy. IF a person is diagnosed with CIS and at least 2 MRI lesions 1838 2010 USA consistent with MS, THEN beta treatment or PMe1 L03 L glatiramer acetate should be offered within 3 months. Cheng et al. 115 If a person with MS is prescribed interferon beta therapy, 1839 2010 USA THEN a CBC with platelets and LFTs should be checked at PMe7 L03 L Cheng et al. 115 least once a year. If a person with MS is newly prescribed high-dose interferon 1840 2010 USA beta therapy, THEN a CBC with LFTs should be checked at PMe7 L03 L Cheng et al. 115 least four times a year. If a person with MS is prescribed or natalizumab for relapsing-remitting MS, THEN there should be 1841 2010 USA PMe1 L01 L04 L03 L documentation that a first-line treatment (interferon beta or glatiramer acetate) was either ineffective or intolerable. Cheng et al. 115 If a person with MS is prescribed mitoxanthrone, THEN the 1842 2010 USA patient should undergo FDA-recommended cardiac PMe7 L01 L Cheng et al. 115 monitoring. If a person with MS is prescribed a new medication relevant to MS symptoms or disease course, THEN one of the following 1843 2010 USA should be noted at the follow-up visit: medication is being PMe7 L01 L taken, patient was asked about medication, medication was not started because it was not needed or changed Cheng et al. 115 If a person with MS is between the ages of 19 and 49 and has another risk factor present on the basis of medical, 1844 2010 USA occupational, lifestyle, or other indications, or the person is 50 PMe1 J07 J years or older, THEN they should have an influenza shot Cheng et al. 115 performed annually. If a person with MS is between the ages of 19 and 64 and has another risk factor present on the basis of medical, 1845 2010 USA occupational, lifestyle, or other indications, THEN they should PMe1 J07 J receive 1 or 2 doses of the pneumococcal Cheng et al. 115 vaccine. If a person with MS is 65 years or older, THEN they should 1846 2010 USA PMe1 J07 J receive 1 dose of the pneumococcal polysaccharide vaccine. Cheng et al. 115 If patients with ulcer-related bleeding have active spurting, oozing, or visible vessel and normal INR (<1.5), then they should receive endoscopic hemostasis using any of the 1847 2010 USA PMe1 C01 C following modalities: hemoclip, thermal therapy, epinephrine and contact thermal therapy, or combination epinephrine and Kanwal et al. 116 hemoclip If patients with ulcer-related bleeding have active spurting, oozing, or visible vessel and INR 1.5–2.0, then they should 1848 2010 USA receive endoscopic hemostasis using any of the following PMe1 C01 C modalities: hemoclip or combination epinephrine and Kanwal et al. 116 hemoclipd Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka If patients with ulcer-related bleeding have low-risk stigmata of 1849 2010 USA bleeding on endoscopy, then they should receive PPI after PMe1 A02 A Kanwal et al. 116 index endoscopy If patients receive successful hemostasis for high-risk stigmata of ulcer bleeding, then they should receive an IV 1850 2010 USA PMe14 A02 A bolus of PPI followed by continuous IV infusion for a minimum Kanwal et al. 116 of 48 hours If patients have bleeding peptic ulcers and documented H. pylori infection, then they should be treated with a 1851 2010 USA PMe1 J01 J recommended antibiotic combination within 1 month of the Kanwal et al. 116 positive result If patients with peptic ulcer bleeding are prescribed aspirin, 1852 2010 USA nonsteroidal anti-inflammatory drugs, or cyclooxygenase-2 PMe1 A02 B01 M01 M02 ABM inhibitors, then they should also receive a PPI. Kanwal et al. 116 If patients have clinically apparent (ie, moderate to severe) ascites and normal renal function, then they should be 1853 2010 USA PMe1 C03 C managed with both salt restriction and diuretics (including a Kanwal et al. 117 combination of spironolactone and loop diuretics). If patients with ascites have serum sodium of 110 mEq/L or 1854 2010 USA less, then they should be managed with discontinuation of PMe1 C03 C Kanwal et al. 117 diuretics and fluid restriction. If hospitalized patients with ascites have an ascitic fluid 1855 2010 USA polymorphonuclear count of ≥250 cells/mm3, then they should PMe15 J01 J receive empiric antibiotics within 6 hours of the test result. Kanwal et al. 117 If ambulatory patients with ascites have an ascitic fluid 1856 2010 USA polymorphonuclear count of ≥250 cells/mm3, then they should PMe15 J01 J receive empiric antibiotics within 24 hours of the test result. Kanwal et al. 117 If patients have a documented episode of spontaneous bacterial peritonitis, then they should receive long-term 1857 2010 USA PMe1 J01 J outpatient antibiotics with first prescription within 1 week of Kanwal et al. 117 hospital discharge. If patients are admitted with or develop GI bleeding as an 1858 2010 USA inpatient, then they should receive antibiotics within 24 hours PMe15 J01 J Kanwal et al. 117 of admission or presentation. If patients have ascitic fluid total protein <1.1 gm/dL and 1859 2010 USA serum bilirubin of >2.5 mg/dL, then they should receive PMe1 J01 J Kanwal et al. 117 prophylactic antibiotics. If patients have compensated , no documented history of previous GI bleeding, and no contraindications to b- 1860 2010 USA PMe1 C07 C blockers, then they should not receive nonselective beta- Kanwal et al. 117 blockers for primary variceal prophylaxis. If patients without prior variceal bleeding are found to have no 1861 2010 USA varices on EGD, then they should not receive nonselective PMe1 C07 C Kanwal et al. 117 beta-blockers to prevent bleeding. If patients have cirrhosis, no documented history of previous GI bleeding, and have medium/large varices on endoscopy, 1862 2010 USA PMe1 C07 C then they should receive either nonselective beta-blockers or Kanwal et al. 117 EVL within 1 month of varices diagnosis. If patients with cirrhosis are admitted with or develop suspected variceal bleeding, then they should receive 1863 2010 USA PMe15 H01 H somatostatin or analogues (somatostatin, octreotide, Kanwal et al. 117 ) within 12 hours of presentation. If patients with cirrhosis survive an episode of acute variceal hemorrhage, then they should receive one of the following 1864 2010 USA therapies to prevent recurrence of variceal hemorrhage: EVL PMe1 C07 C every 1–2 weeks until obliteration, beta-blockers, or a Kanwal et al. 117 combination of EVL and beta-blockers. (Palliative Care) Percent of patients with pain on admission 1865 2010 USA who had an order for regularly scheduled (not PRN) pain PMe15 M01 M02 N02 MN Schenck et al. 118 medication in 24 hours (Palliative Care) Percent of patients with bowel regimen 1866 2010 USA initiated within 24 hours of opiates among those treated with PMe15 A06 N02 AN Schenck et al. 118 narcotics (Palliative Care) Attending to family needs for information 1867 2010 USA PMe5 N02 N Schenck et al. 118 about medication, treatment and symptoms (Palliative Care) Percent of patients on opioids for whom a 1868 2010 USA PMe1 A06 N02 AN Schenck et al. 118 bowel regimen is established (Palliative Care) Percent of patients on opioids who have a 1869 2010 USA PMe15 A06 N02 AN Schenck et al. 118 bowel regimen initiated within 1 day of opioid initiation (Palliative Care) For patients who screen positive for 1870 2010 USA depression, the percent who receive further assessment, PMe1 N06 N Schenck et al. 118 counseling or medication treatment (Palliative Care) For patients diagnosed with depression, the 1871 2010 USA percent who receive interpersonal or medication treatment PMe1 N06 N Schenck et al. 118 within two weeks of diagnosis IF a patient has systemic sclerosis, THEN annual inactive influenza vaccine should be offered unless contraindications 1872 2011 USA PMe1 J07 J are documented, BECAUSE this can prevent or decrease the Khanna et al. 119 severity of influenza infection. IF a patient has systemic sclerosis, THEN pneumococcal vaccine should be offered every 5 years unless 1873 2011 USA PMe1 J07 J contraindications are documented, BECAUSE this can prevent or decrease the severity of pneumococcal infection. Khanna et al. 119 IF a patient has systemic sclerosis and is diagnosed with clinical symptoms of diastolic dysfunction and symptomatic heart failure, THEN a treatment (e.g. ACEI, diuretic, beta- 1874 2011 USA PMe1 C03 C07 C09 C blocker) or a referral to a cardiologist should be offered within 3 months BECAUSE treatment can improve morbidity Khanna et al. 119 associated with diastolic dysfunction. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a patient has systemic sclerosis and has NYHA/WHO functional class II-IV due to pulmonary arterial hypertension diagnosed by RHC, THEN treatment (endothelin blockers, 1875 2011 USA PMe1 B01 C02 G04 BCG prostacyclin analogs and /or PDE-5 inhibitors) should be initiated within 3 months BECAUSE these therapies improve morbidity associated with . Khanna et al. 119 IF a patient has systemic sclerosis and is diagnosed with GERD, THEN anti-acid therapy with a PPI or H2 blocker should be offered within 3 months of the GERD diagnosis 1876 2011 USA PMe1 A02 A BECAUSE these therapies can improve symptoms and quality of life and decrease long-term complications associated with Khanna et al. 119 GERD. IF a patient has systemic sclerosis and has symptoms of early satiety, post-prandial abdominal bloating, post-prandial vomiting or regurgitation for at least 1 month, THEN a test for impaired gastric emptying (e.g. upper endoscopy, gastric 1877 2011 USA PMe1 A02 A03 A emptying study, upper GI series) or an empiric trial of therapy (e.g. prokinetics, PPI) should be offered within 6 months BECAUSE this can to earlier diagnosis and initiation of treatment which can improve symptoms and quality of life. Khanna et al. 119 IF a patient has systemic sclerosis and unintentional weight loss (≥5%) over 3 months with symptoms of nausea or vomiting, bloating, or diarrhoea for 4 weeks, THEN a test for malabsorption or bacterial overgrowth (e.g. lactulose breath 1878 2011 USA test, glucose breath test, xylose test, jejunal culture, serum PMe1 A03 H01 J01 AHJ carotene, faecal fat determination) or an empiric trial of therapy (e.g. antibiotics, prokinetics, octreotide) should be offered within 3 months BECAUSE malabsorption can lead to malnutrition and can be treated. Khanna et al. 119 IF a patient has systemic sclerosis-associated interstitial lung disease and documented a >10% decline in FVC during the past 12 months, THEN immunosuppressive treatment (e.g. 1879 2011 USA cyclophosphamide, methotrexate, azathioprine, cyclosporine, PMe1 L04 L mycophenolate mofetil) should be offered within 3 months BECAUSE this therapy improves lung function and quality of life associated with scleroderma lung disease. Khanna et al. 119 IF a patient with systemic sclerosis presents with scleroderma renal crisis (defined as accelerated arterial hypertension [at least SBP ≥140 and a rise of SBP ≥30mmHg from baseline] or 1880 2011 USA PMe15 C09 C rapidly progressive renal failure), THEN s/he should be prescribed an ACEI within 72 hours BECAUSE ACEIs Khanna et al. 119 improve survival. IF a patient with systemic sclerosis has digital tip ulcer(s), THEN treatment (e.g. calcium channel blockers, prostacyclin 1881 2011 USA therapy, topical nitrate therapy, PDE-5 inhibitor) should be PMe1 B01 C08 G04 BCG prescribed within 3 months of diagnosis BECAUSE treatment improves healing of digital ulcers and hand function. Khanna et al. 119 IF a patient is undergoing total hip or knee replacement, THEN a history of present illness should be documented prior to the operation including the following: a onset and duration of symptoms 1882 2011 USA P Ge 7 N/A N/A b location of pain c severity of pain d activity limitations SooHoo et al. 120 e prior treatments and medication IF a patient is undergoing total hip or knee replacement, THEN the following medical history should be documented in the medical record prior to the operation: 1883 2011 USA a Past Medical History P Ge 7 N/A N/A b Past Surgical History c Medications (names and dosing regimen) SooHoo et al. 120 d Allergies IF a patient is undergoing total hip or knee replacement, THEN intravenous antibiotic prophylaxis should follow the recommendations of the National Surgical Infection Prevention Project and the AAOS advisory statement including: a Antibiotic prophylaxis should be started within one hour before the skin incision. 1884 2011 USA PMe145J01 J b Antibiotic prophylaxis should be discontinued within 24 hours after surgery. c If a proximal tourniquet is used, the antimicrobial should be completely infused before inflation. d The preferred antimicrobials are cefazolin or . e If the patient has a B-lactam allergy, vancomycin or clindamycin should be used. SooHoo et al. 120 IF a patient is undergoing total hip or knee replacement, THEN they should be placed on a clinical care pathway that includes the following: a Consultations (Physical therapy, internal medicine) b Procedures and tests (Hb/Hct, electrolytes on postoperative day #1) c Treatments (Incentive spirometry or deep breathing 1885 2011 USA exercises) P Ge 9 N/A N/A d Activities e Medications f Safety (Positioning instructions) g Nutrition (Diet) h Elimination (Urinary catheterization, bowel protocols) i Patient Education SooHoo et al. 120 j Discharge Planning Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF a patient undergoes total hip or knee arthroplasty, THEN the patient should receive written discharge instructions, including the following: a Plan for follow-up 1886 2011 USA PMe6 B01 B b Activity restrictions c Plan for anticoagulation d Need for dental prophylaxis according to AAOS/ADA SooHoo et al. 120 guidelines IF a patient is undergoing total knee replacement, THEN despite the findings of the Seventh ACCP Conference on Antithrombotic Therapy, the risk of bleeding complications justifies the selective use of the following for deep venous thrombosis prophylaxis 1887 2011 USA a Intermittent pneumatic compression hose and aspirin in PMe1 B01 B patients undergoing TKR b Intermittent pneumatic compression hose and aspirin in patients undergoing THR c Low-dose coumadin in patients undergoing total hip SooHoo et al. 120 replacement (Indicator added during panel meeting) IF a patient undergoes total hip or knee replacement, THEN 1888 2011 USA deep venous thrombosis prophylaxis should be provided for a PMe14 B01 B minimum of 2 weeks after hospital discharge. SooHoo et al. 120 IF a patient is undergoing total hip or knee replacement, AND a registry is available, THEN the following operative data should be recorded in a registry format (Indicator modified during panel meeting) 1889 2011 USA a Procedure PMe9 J01 J b Approach c Implants used and bearing surfaces d Surgical time SooHoo et al. 120 e Antibiotic prophylaxis Children with SCD should complete PCV7 vaccinations per 1890 121 2011 USA PMe1 J07 J Wang et al. CDC guidelines Children and adolescents with SCD should complete PPV23 1891 121 2011 USA PMe1 J07 J Wang et al. vaccinations per CDC guidelines Children with SCD should have an annual influenza 1892 121 2011 USA PMe1 J07 J Wang et al. immunization according to CDC guidelines All children with FS on initial newborn screen should receive 1893 2011 USA PMe1 J01 J antibiotic (eg, penicillin) prophylaxis by 2 mo of age Wang et al. 121 Children with sickle cell anemia who are younger than 5 y 1894 2011 USA should receive antibiotic (eg, penicillin) prophylaxis for PMe1 J01 J Wang et al. 121 pneumococcal disease All children with SCD and acute chest syndrome should be 1895 2011 USA treated with broad-spectrum antibiotics, including 1 from the PMe1 J01 J Wang et al. 121 macrolide class All children with SCD hospitalized for acute pain requiring 1896 2011 USA opioids should have documented incentive spirometry with 10 PMe7 N02 N maximal inspirations≥2 h, a minimum of 6 times per day Wang et al. 121 Children with SCD who have a fever of ≥38.5°C should be 1897 2011 USA given parenteral broad spectrum antibiotic treatment within 60 PMe15 J01 J Wang et al. 121 min of triage Children with SCD who present with an acute pain episode 1898 2011 USA should receive a parenteral analgesic within 60 min of PMe15 N02 N Wang et al. 121 registration or 30 min of triage Initial pain assessment should be documented using an age- 1899 2011 USA appropriate pain scale, and the assessment should be PMe7 N02 N Wang et al. 121 repeated within 30 min of the first dose of analgesic Children with SCD with blood pressure values above the 95th 1900 2011 USA percentile for age should be evaluated and treated with PMe17 C02C03C07C08C09 C Wang et al. 121 antihypertensives Hydroxyurea should be recommended for children 5 or older 1901 2011 USA with recurrent painful episodes or acute chest syndrome, and PMe5 L01 L the recommendation should be documented Wang et al. 121 Children with SCD receiving a chronic transfusion program 1902 2011 USA should receive to maintain ferritin<1500 or PMe1 V03 V Wang et al. 121 liver iron<7 mg/g dry weight by biopsy or MRI Anticholinergic therapy should not be offered as a treatment to 1903 2013 USA a woman who presents with new or worsening bothersome PMe1 A03N04R03S01 ANRS Anger et al. 122 SUI without symptoms of OAB. A woman with UUI/OAB who is prescribed anticholinergic 1904 2013 USA medications should also be counseled about behavioral PMe5 A03N04R03S01 ANRS Anger et al. 122 therapy. A woman age 65 or older with UUI/OAB who elects to 1905 2013 USA undergo treatment with anticholinergic medication should be PMe5 A03N04R03S01 ANRS Anger et al. 122 counseled regarding the risks of cognitive impairment. A woman with UUI/OAB who has persistent bothersome 1906 2013 USA UUI/OAB symptoms after pharmacologic therapy or is not a PMe9G04 G candidate for pharmacologic therapy should be offered SNM. Anger et al. 122 A woman whose UUI/OAB symptoms are refractory to conservative therapy, and who is not a candidate or chooses 1907 2013 USA PMe1 M03 M not to pursue SNM, should be offered intravesical injection of Anger et al. 122 BTX. A woman who elects to undergo BTX injections should be counseled about the risks of urinary retention (that may 1908 2013 USA PMe5 M03 M require a catheter) and an associated increase in the risk of Anger et al. 122 urinary tract infection. A woman with UUI/OAB who is treated with BTX injections 1909 2013 USA should be followed up for efficacy and retention within to PMe7 M03 M Anger et al. 122 weeks. Patients referred to medical oncologist who then received 5- 1910 2013 USA Colon cancer patients [stage III] FU based therapy (intravenous or oral []) or PMe1 L01 L Jackson et al. 123 documented reason why not. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Patients referred to medical oncologist who then received 5- FU based therapy (intravenous or oral [capecitabine]) with 1911 2013 USA Colon cancer patients [stage III] therapy started within 8 weeks of first positive biopsy or 8 PMe5 L01 L weeks of surgery or documented reason for not receiving such therapy (for completed 2006 or later). Jackson et al. 123 Patients referred to medical oncologist who then received 5- FU based therapy (intravenous or oral [capecitabine]) for at 1912 2013 USA Colon cancer patients [stage III] PMe4 L01 L least 6 months or documented reason for not receiving such Jackson et al. 123 therapy. Rectal cancer patients who had curative intent surgery [stages Patients referred for neo-adjuvant chemo and/or radiation or 1913 2013 USA PMe1 L01 L Jackson et al. 123 II–III] documented reason for not being referred. Patients received 5-FU based therapy (intravenous or oral Rectal cancer patients who had curative intent resection 1914 2013 USA [capecitabine]) adjuvant chemotherapy or documented reason PMe1 L01 L [stages II–III] Jackson et al. 123 for not receiving therapy. Elapsed days between collection of a pathologic specimen which is diagnostic for colorectal cancer and the first 1915 2013 USA treatment date. The first treatment date could be the date of PMe5 L01 L surgery, starting date of chemotherapy, or starting date of Jackson et al. 123 radiation therapy – whichever occurs first. Elapsed days between the end of a patient’s treatment and the follow-up . The end of a patient’s treatment 1916 2013 USA could be the date of surgery, ending date of chemotherapy PMe7 L01 L (neoadjuvant or adjuvant), or ending date of radiation therapy Jackson et al. 123 – whichever occurs last. Elapsed days between the ending date of neoadjuvant 1917 2013 USA PMe9 L01 L Jackson et al. 123 chemotherapy treatment and the date of surgery. Elapsed days between the ending the date of surgery and the 1918 2013 USA PMe5 L01 L Jackson et al. 123 beginning date of adjuvant chemotherapy treatment. Elapsed days between the beginning and the ending date of 1919 2013 USA PMe4 L01 L Jackson et al. 123 adjuvant chemotherapy treatment. Elapsed days between the end of a patient’s treatment and the date of death. The end of a patient’s treatment could be 1920 2013 USA the date of surgery, ending date of chemotherapy PMe9 L01 L (neoadjuvant or adjuvant), or ending date of radiation therapy Jackson et al. 123 – whichever occurs last. IF a patient with IBD is initiating therapy with anti-TNF, THEN 1921 2013 USA PMe7 L04 L risk assessment for hepatitis B virus should be documented Melmed et al. 124 IF a patient with IBD requires at least 10 mg prednisone (or equivalent) for 16 weeks or longer, THEN an appropriately 1922 2013 USA PMe3 A07 A dosed steroid-sparing agent or operation should be Melmed et al. 124 recommended IF a hospitalized patient with severe colitis is not improving on intravenous steroids within 3 days, THEN sigmoidoscopy with 1923 2013 USA PMe7 H02 H biopsy should be performed to exclude cytomegalovirus, AND surgical consultation should be obtained Melmed et al. 124 IF a patient with IBD is initiating 6-MP/AZA, THEN TPMT 1924 2013 USA PMe7 L01 L04 L Melmed et al. 124 testing should be performed before starting therapy IF a patient with IBD is on immunosuppressive therapy, THEN patients should be educated about appropriate vaccinations, 1925 2013 USA including (1) annual inactivated influenza, (2) pneumococcal PMe5 J07 L04 JL vaccination with a 5-year booster, and (3) general avoidance Melmed et al. 124 of live virus vaccines (Inflammatory Bowel Disease)Proportion of patients with 1926 2013 USA OMe9 H02 H Melmed et al. 124 steroid-free clinical remission for 12 month period (Inflammatory Bowel Disease) Proportion of patients currently 1927 2013 USA taking prednisone (excluding those diagnosed within the last OMe9 H02 H Melmed et al. 124 112 days) (Inflammatory Bowel Disease) Proportion of patients currently 1928 2013 USA OMe9 N02 N Melmed et al. 124 taking narcotic analgesics (infantile spasms) ACTH should be selected as one of the first- 1929 125 2013 USA PMe1 H01 H Wang et al. line treatments for infantile spasms. (infantile spasms) Potentially serious adverse events associated with exposure to ACTH should be monitored at 1930 2013 USA PMe7 H01 H regular intervals after initiation of treatment: Weekly blood Wang et al. 125 pressure measurement. (infantile spasms) ACTH monitoring continued: Clinical evaluation by a healthcare provider should be performed 1931 2013 USA PMe7 H01 H within 1 week of documenting hypertension (>99 percentile for Wang et al. 125 age). (infantile spasms) ACTH monitoring continued: Prescriber 1932 2013 USA should monitor and document evidence of infection during PMe7 H01 H Wang et al. 125 every visit. (infantile spasms) ACTH monitoring continued: Electrolytes 1933 2013 USA should be checked pretreatment and within the first week of PMe7 H01 H Wang et al. 125 initiating ACTH treatment. (infantile spasms) There must be documentation that a 1934 2013 USA qualified healthcare provider reviewed the FDA checklist for PMe7 H01 H Wang et al. 125 side effects of ACTH with the child’s caregiver. (infantile spasms) Vigabatrin should be selected as one of the 1935 125 2013 USA PMe1 N03 N Wang et al. first-line treatments for Infantile Spasms. (infantile spasms) Vigabatrin should be used as a first-line 1936 125 2013 USA PMe1 N03 N Wang et al. therapy for patients with Infantile Spasms and TSC. (infantile spasms) If there is not a complete response (no 1937 2013 USA spasms and no hypsarrhythmia) to a first-line treatment after 2- PMe13 H01 N03 HN 3 weeks, then treatment (dose or drug) should be changed. Wang et al. 125 (infantile spasms) In patients who fail one first-line drug, 1938 125 2013 USA PMe1 H01 N03 HN Wang et al. another first-line drug should be considered. IF a patient has typical GERD, THEN an initial trial of empiric

1939 Yadlapati et 2015 USA PPI therapy, H2 Receptor Antagonist, or is PMe1 A02 A al. 126 appropriate. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka IF PPI therapy is initiated, THEN it should be at once a day 1940 Yadlapati et 2015 USA dosing before the first meal of the day (or before an evening PMe3 A02 A meal for patients with predominant night time symptoms). al. 126

IF a patient with GERD is prescribed chronic PPI or H2 1941 2015 USA PMe A02 A Yadlapati et Receptor Antagonists, THEN the patient should receive an 7 assessment of their GERD symptoms within 12 months. al. 126 IF a patient with GERD is prescribed an initial empiric trial of 1942 Yadlapati et 2015 USA PPI, THEN the patient should have scheduled follow-up within PMe7 A02 A al. 126 4 to 12 weeks. IF a patient has refractory typical GERD symptoms despite twice daily PPI and adherence to PPI, THEN an upper 1943 2015 USA PMe7 A02 A Yadlapati et endoscopy should be performed to exclude non- al. 126 GERD etiologies. IF a patient has LA grade B or greater erosive , 1944 Yadlapati et 2015 USA THEN at least an 8-week course of PPI is the therapy of PMe14 A02 A al. 126 choice for symptom relief and healing. IF a patient has a peptic stricture, THEN maintenance PPI 1945 Yadlapati et 2015 USA therapy is recommended following stricture dilation to reduce PMe1 A02 A al. 126 the need for repeated dilations. IF a patient with non-erosive GERD experiences heartburn

1946 Yadlapati et 2015 USA relief with H2RA therapy, THEN an H2RA can be used as a PMe1 A02 A al. 126 maintenance option. Yadlapati et IF PPIs have proven clinically effective for patients with 1947 2015 USA PMe1 A02 A al. 126 GERD, THEN PPIs should be used long-term. IF a patient has refractory GERD symptoms despite standard 1948 Yadlapati et 2015 USA PPI therapy, THEN the first step in management is PMe3 A02 A al. 126 optimization of PPI therapy. IF a patient with suspected troublesome GERD has not responded to empirical trial of PPI therapy, has normal 1949 2015 USA findings on endoscopy, and has no major abnormalities on PMe7 A02 A Yadlapati et manometry, THEN ambulatory reflux monitoring off of PPI al. 126 therapy for 7 days should be performed. IF a patient has suspected GERD with disease refractory to PPI therapy and no findings of erosive disease on endoscopy, 1950 2015 USA THEN ambulatory esophageal reflux monitoring off of PPI PMe7 A02 A Yadlapati et therapy for 7 days is indicated before consideration of al. 126 endoscopic or surgical therapy. IF planning to perform reflux monitoring off of anti-reflux 1951 Yadlapati et 2015 USA medication, THEN either pH or impedance-pH monitoring are PMe7 A02 A al. 126 sufficient to establish a GERD diagnosis. IF planning to perform reflux monitoring on anti-reflux medication, THEN impedance-pH monitoring should be 1952 2015 USA PMe7 A02 A Yadlapati et performed to enable measurement of persistent acid or al. 126 nonacid reflux. IF anti-reflux surgery and PPI therapy are judged to offer similar efficacy in a patient with an esophageal GERD 1953 2015 USA syndrome, THEN PPI therapy should be recommended as PMe1 A02 A Yadlapati et initial therapy because of superior safety and long-term al. 126 efficacy. All children identified with FS on initial newborn screening 1954 2016 USA should have prophylactic antibiotics initiated by 3 months of PMe1 J01 J Faro et al. 127 screen Children with FS who are younger than 5 years should receive 1955 2016 USA antibiotic (e.g., penicillin) prophylaxis against pneumococcal PMe1 J01 J Faro et al. 127 disease (Preoperative vaccinations) Patients undergoing cochlear Patients undergoing cochlear implant who have received both 1956 128 2016 USA PMe1 J05 J Vila et al . implant vaccinations prior to the implantation date Patients requiring inpatient admission for intravenous (Postoperative infection rate) Patients undergoing cochlear 1957 2016 USA antibiotics due to a surgical site or wound infection after OMe9 J01 J implant Vila et al .128 cochlear implant Patient age 18 years and older with a diagnosis of rheumatoid 1958 2016 USA arthritis seen for two or more face-to-face encounters for RA Patient received a DMARD PMe1 L04 L with the same clinician during the measurement period Yazdany et al. 129 Number of moderate or deep sedated transthoracic Number of moderate/deep sedated transthoracic echo Proportion of sedated echocardiograms associated with 1959 Chowdhury et al. 2017 USA echocardiograms performed for children < 3 years of age procedures associated with minor, moderate, or severe OMe8 N05 N adverse events 130 during the measurement period. adverse events. Number of patients, < 5 years old, with diagnosis of heterotaxy Number of patients with at least one documented Recommendation for Antibiotic Prophylaxis in Patients with 1960 Chowdhury et al. 2017 USA and asplenia who had an outpatient visit to the pediatric recommendation for antibiotic prophylaxis within a note in the PMe5 J01 J Heterotaxy and Asplenia 130 cardiology clinic during the measurement period. medical record. Number of health care personnel working in patient care Number of health care personnel who received an influenza Proportion of health care personnel in a pediatric cardiology 1961 Chowdhury et al. 2017 USA areas at least one working day during the measurement PMe1 J07 J vaccination during the current flu season practice who receive timely influenza vaccination. 130 period Number of patients, ≤ 21 years old, with a known prior Number of patients with a documented recommendation, or a Proportion of patients with documented recommendation for 1962 Chowdhury et al. 2017 USA diagnosis of rheumatic fever and an outpatient clinic visit specific prescription, for the prevention of secondary PMe1 J01 J antibiotics for secondary prevention of rheumatic fever. 130 during the measurement period. rheumatic fever. Number of patients, ≤ 18 years old, who had an inpatient Proportion of Kawasaki Disease patients with a Number of patients who were prescribed (upon discharge) 1963 Chowdhury et al. 2017 USA discharge within the measurement period for acute Kawasaki recommendation for aspirin during the first 6 weeks after PMe134B01 B daily low dose aspirin (<10 mg/kg/day) for 6 weeks or more. 130 Disease. onset of disease. IF patient has a newly identified diagnosis of alcohol 1964 2017 USA dependence, THEN patient should receive pharmacotherapy PMe1 N07 N for alcohol dependence within 90 days following identification Hepner et al. 131 IF patient started on new medication for alcohol dependence, 1965 2017 USA THEN patient should have at least one alcohol-related follow- PMe7 N07 N up encounter within 30 days of the index visit. Hepner et al. 131 IF patient receives medication assisted detox, THEN patient 1966 2017 USA should receive alcohol-related outpatient follow-up within 7 PMe7 N07 N Hepner et al. 131 days. If a patient has undergone an emergency general surgery procedure, then the discharge or transfer summary should 1967 2017 USA indicate a complete list of all medications and dosages to PGe6N/A N/A Ingraham et continue on discharge, including the purpose and side effects al. 132 of new medications Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka If a hospital provides emergency general surgery care, then a protocol should be in place for the preoperative hematologic 1968 2017 USA SMe1 B01 B Ingraham et preparation of patients taking common anticoagulants prior to al. 132 emergency surgery. If a hospital provides emergency general surgery care, then 1969 Ingraham et 2017 USA the hospital should have a protocol in place regarding the SMe1 B05 B al. 132 availability of blood products. (Asthma) All children presenting to the ED with an acute exacerbation of asthma should receive a history that includes at a minimum: a. Time of onset or duration of current symptoms b. Causes (triggers) of exacerbations or documentation that they are not known c. Current asthma medications d. For children currently on SABA medication quantity of in last month (canisters per month) 1970 2017 USA PMe7 R03 R e. Estimate of previous unscheduled doctor, ED visits or hospitalizations for asthma in the past year or documentation that there were none f. Presence or absence of any previous episodes of respiratory insufficiency due to asthma (loss of consciousness or intubation and mechanical ventilation) g. Presence or absence of potentially complicating illnesses Mangione-Smith (eg, other pulmonary or cardiac disease or immunodeficiency et al. 133 diseases) (Asthma) Children who present to the ED with an acute exacerbation of asthma who are experiencing severe symptoms should have their vital signs (including respiratory 1971 2017 USA PMe7 R03 R rate, heart rate, and pulse oximetry or asthma respiratory Mangione-Smith score) and lung sounds reassessed and recorded within 15 et al. 133 min of each SABA treatment. (Asthma) Children who present to the ED with an acute exacerbation of asthma who are experiencing mild or moderate symptoms should have their vital signs (including 1972 2017 USA PMe7 R03 R respiratory rate, heart rate, and pulse oximetry or asthma Mangione-Smith respiratory score) and lung sounds reassessed and recorded within 15 min of receiving 3 back-to-back SABA treatments. et al. 133 (Asthma) For all children experiencing an acute exacerbation 1973 Mangione-Smith 2017 USA of asthma in the ED, oxygen should be administered for an PMe1 V03 V et al. 133 SaO2≦ 90%. (Asthma) Children who present to the ED with an acute exacerbation of asthma should receive 3 back-to-back inhaled 1974 2017 USA PMe15 R03 R Mangione-Smith SABA treatments in the first hour after admission to the ED et al. 133 (approximately 20 min/treatment). (Asthma) Children in the ED experiencing a severe asthma 1975 Mangione-Smith 2017 USA exacerbation or impending/actual respiratory failure should PMe1 R03 R receive inhaled ipratropium bromide in addition to SABA. et al. 133 (Asthma) Children with moderate to severe asthma exacerbation who do not respond immediately to the initial 3 1976 2017 USA PMe1 H02 R03 HR Mangione-Smith SABA treatments in the ED should receive systemic et al. 133 corticosteroids while in the ED. (Asthma) Children admitted to the ED with an acute 1977 Mangione-Smith 2017 USA PMe1 R03 R exacerbation of asthma should not receive methylxanthines. et al. 133 (Asthma) Children admitted to the ED for an acute exacerbation of asthma should be given antibiotics only if they 1978 2017 USA PMe1 J01 J Mangione-Smith are also diagnosed with a bacterial infection (eg, pneumonia et al. 133 or sinusitis). Mangione-Smith (Asthma) Children admitted to the ED for acute exacerbation 1979 2017 USA PMe1 R05 R et al. 133 of asthma should not receive mucolytics. (Asthma) Children admitted to the ED for acute exacerbation 1980 Mangione-Smith 2017 USA of asthma should not receive sedatives unless part of a rapid PMe1 N05 N et al. 133 sequence intubation. (Asthma) Children in the ED with moderate asthma exacerbation symptoms and/or an FEV1 or PEF 40% to 69% 1981 2017 USA of predicted during their first reassessment after receiving 3 PMe15 R03 R Mangione-Smith back-to-back SABA treatments in the ED, should be given additional inhaled SABA every 60 min for the next 2 h. et al. 133 (Asthma) Children in the ED who have severe exacerbation symptoms or FEV1 or PEF <40% of predicted or no improvement from initial 3 SABA treatments should be given 1982 2017 USA PMe15 R03 R hourly or continuous nebulized SABA until improvement of Mangione-Smith symptoms is documented or FEV1 or PEF improves to >70% et al. 133 of predicted. (Asthma) Children evaluated in the ED for acute exacerbation of asthma should be discharged to home after 1 observation 1983 2017 USA PMe7 R03 R Mangione-Smith with no more than mild symptoms at least 60 min after SABA et al. 133 treatment. (Asthma) When ready for discharge, all children evaluated and treated for an acute exacerbation of asthma in the ED should be given prescriptions for new medications or needed 1984 2017 USA refills and instructions for how to use (eg, albuterol MDI PMe15 R03 R prescription, AeroChamber prescription, albuterol nebulization Mangione-Smith solution prescription) to continue treatment with inhaled SABA et al. 133 at home. (Asthma) All children evaluated and treated for an acute exacerbation of asthma in the ED who were given systemic 1985 2017 USA corticosteroid treatment should be discharged with a PMe1 H02 H Mangione-Smith prescription to continue oral systemic corticosteroids to et al. 133 complete at least a 2-d course. (Asthma) All children evaluated and treated for an acute exacerbation of asthma in the ED already taking inhaled 1986 2017 USA PMe5 R03 R Mangione-Smith corticosteroid therapy should be instructed to continue their et al. 133 inhaled corticosteroid therapy after discharge. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Asthma) During flu season (November to March) all children older than 6 mo admitted to the ED for acute exacerbation of 1987 2017 USA PMe7 J07 J Mangione-Smith asthma should have their influenza vaccination status et al. 133 documented. (Asthma) During flu season (November to March) all children older than 6 mo admitted to the ED for acute exacerbation of asthma who have not yet received an influenza vaccination 1988 2017 USA PMe1 J07 J and lack documented contraindications, should be vaccinated Mangione-Smith before discharge or refusal by parent/child should be et al. 133 documented. (Asthma) All children evaluated and treated for an acute exacerbation of asthma in the ED should have documentation 1989 2017 USA PMe5 R03 R Mangione-Smith that they received a review and/or initiation of an asthma et al. 133 action plan. (Asthma) Children hospitalized with an acute exacerbation of asthma should be treated with oxygen therapy if they have an 1990 2017 USA PMe1 V03 V Mangione-Smith SaO2 recorded on 2 consecutive occasions ≧20 min apart et al. 133 that is ≦90%. (Asthma) Children hospitalized with an acute exacerbation of 1991 Mangione-Smith 2017 USA PMe1 H02 H asthma should be given systemic corticosteroids. et al. 133 (Asthma) Children admitted to the hospital with acute 1992 Mangione-Smith 2017 USA exacerbation of asthma should not receive ipratropium PMe1 R03 R et al. 133 bromide after 24 h of hospitalization. (Asthma) Children hospitalized for an acute exacerbation of asthma can be discharged to home when they meet the following criteria: 1993 2017 USA • Tolerating at least every 4 h SABA treatments PMe7 R03 R • Room air SaO2 ≧ 92% for at least 4 h Mangione-Smith • FEV1 or PEF ≧70% of predicted (if child is able to perform et al. 133 and if test is done). (Asthma) Before discharge home, all children hospitalized for an acute exacerbation of asthma should be given prescriptions for new medications or needed refills and 1994 2017 USA instructions for how to use (eg, albuterol MDI prescription, PMe15 R03 R AeroChamber prescription, albuterol nebulization solution Mangione-Smith prescription) to continue treatment with inhaled SABA at et al. 133 home. (Asthma) All children hospitalized with an acute exacerbation of asthma who were given systemic corticosteroid treatment 1995 2017 USA should be discharged from the hospital with a prescription to PMe1 H02 H Mangione-Smith continue oral systemic corticosteroids to complete at least a 3- et al. 133 d course. (Asthma) At the time of discharge, all children hospitalized for an acute exacerbation of asthma who were already taking 1996 2017 USA inhaled corticosteroid therapy before hospitalization should be PMe5 R03 R Mangione-Smith instructed to continue their inhaled corticosteroid therapy after et al. 133 discharge. (Asthma) During flu season (November to March) all children older than 6 mo admitted to the hospital for acute 1997 2017 USA PMe7 J07 J Mangione-Smith exacerbation of asthma should have their influenza et al. 133 vaccination status documented. (Asthma) During flu season (November to March) all children older than 6 mo admitted to the hospital for acute exacerbation of asthma who have not yet received an 1998 2017 USA PMe1 J07 J influenza vaccination and lack documented contraindications, Mangione-Smith should be vaccinated before discharge or refusal by et al. 133 parent/child should be documented. (Bronchiolitis) A child admitted to the hospital with a diagnosis of bronchiolitis should not be treated with antibiotic 1999 2017 USA PMe1 J01 J Mangione-Smith medications unless the child is also diagnosed with a possible et al. 133 bacterial infection. (Bronchiolitis) A child admitted to the hospital with a diagnosis 2000 Mangione-Smith 2017 USA PMe1 H02 H of bronchiolitis should not be treated with corticosteroids. et al. 133 (Bronchiolitis) A child admitted to the hospital with a diagnosis of bronchiolitis who has difficulty feeding safely because of respiratory distress (respiratory rate exceeds 70 breaths per 2001 2017 USA minute, nasal secretions are copious) should receive PMe1 V06 V supplemental fluids (intravenous, nasogastric, oral-gastric Mangione-Smith tube administration of fluid, or subcutaneous fluid et al. 133 administration). (Bronchiolitis) A child admitted to the hospital with a diagnosis 2002 Mangione-Smith 2017 USA of bronchiolitis should not be treated with antihistamines, oral PMe1 R01 R06 R decongestants, or nasal vasoconstrictors. et al. 133

(CAP) Children hospitalized with a diagnosis of pneumonia should have the following history items documented: a. Presence or absence of history of previous hospitalizations 2003 2017 USA b. Immunization status PMe7 J01 J07 J c. Presence or absence of recent exposure to TB d. Presence or absence of recent travel Mangione-Smith e. Presence or absence of recent antibiotic use et al. 133 (CAP) Infants between 21 and 60 d of age admitted to the hospital with a diagnosis of pneumonia and treated with antibiotics should have all of the following tests performed: 2004 2017 USA a. Blood culture PMe7 J01 J b. Urine culture Mangione-Smith c. A with differential et al. 133 d. A chest radiograph Mangione-Smith (Croup) All children diagnosed with croup should receive a 2005 2017 USA PMe1 H02 H et al. 133 dose of dexamethasone. (Croup) Children experiencing mild croup symptoms should 2006 Mangione-Smith 2017 USA be discharged from the hospital after a single dose of PMe1 H02 H et al. 133 dexamethasone. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (Croup) Children experiencing moderate croup symptoms 2007 Mangione-Smith 2017 USA should be observed in the ED or observation unit for at least 2 PMe7 H02 H et al. 133 h after treatment with dexamethasone. (Croup) Children with severe croup should be given a dose of nebulized racemic epinephrine or L- epinephrine within 30 min 2008 2017 USA PMe15 R03 R Mangione-Smith of arriving at the ED (or within 30 min of developing severe et al. 133 croup symptoms). (Croup) Children with severe croup need to be observed for a minimum of 2 h after both treatments (dexamethasone and 2009 2017 USA PMe17 H02 R03 HR Mangione-Smith racemic epinephrine) are administered to make sure severe et al. 133 symptoms do not return. (Croup) Children with moderate croup should be admitted to the hospital if they continue to have moderate respiratory 2010 2017 USA distress (defined as stridor and chest wall retractions at rest PMe9 H02 H Mangione-Smith without agitation) 4 h after receiving an initial dose of et al. 133 dexamethasone. (Croup) If the child with severe croup continues to have moderate to severe croup symptoms 30 min after receiving an 2011 2017 USA initial dose of racemic epinephrine, a repeat dose should be PMe1 R03 R Mangione-Smith given and the child should be admitted to the hospital for et al. 133 further treatment and observation. (Croup) If a child with croup requiring hospitalization continues to experience severe respiratory distress after admission, 2 2012 2017 USA PMe1 R03 R Mangione-Smith back-to-back doses of nebulized racemic epinephrine or L- et al. 133 epinephrine should be administered. (Protocol for sepsis syndrome in the ED) The proportion of 2013 2017 USA hospitals with a specific written protocol to identify and treat S Me 9 J01 J Odetola et al. 134 children with sepsis syndrome in the ED (Timely antibiotics for children with severe sepsis or septic shock) The proportion of hospitalized children with severe 2014 2017 USA sepsis or septic shock who received parenteral antibiotics PMe15 J01 J within 60 minutes of meeting diagnostic criteria for severe Odetola et al. 134 sepsis or septic shock (Timely fluid bolus for children with severe sepsis or septic shock) The proportion of hospitalized children with severe 2015 2017 USA sepsis or septic shock who received a fluid bolus within 60 PMe15 B05 B minutes of meeting diagnostic criteria for severe sepsis or Odetola et al. 134 septic shock Number of female patients older than 18 years diagnosed with Disease-specific antibiotic prescribing: percentage of female Number of female patients older than 18 years with 2016 2018 USA cystitis/other urinary infection prescribed antibacterials for patients older than 18 years with cystitis/other urinary infection PMe1 J01 J cystitis/other urinary infection systemic use prescribed antibacterials for systemic use. NQMC 135 Number of patients older than 1 year diagnosed with acute Disease-specific antibiotic prescribing: percentage of patients Number of patients older than 1 year diagnosed with acute 2017 2018 USA upper respiratory infection prescribed antibacterials for older than 1 year with acute upper respiratory infection PMe1 J01 J upper respiratory infection NQMC 135 systemic use prescribed antibacterials for systemic use. Number of patients older than 2 years diagnosed with acute Disease-specific antibiotic prescribing: percentage of patients Number of patients older than 2 years diagnosed with acute 2018 2018 USA otitis media/myringitis prescribed antibacterials for systemic older than 2 years with acute otitis media/myringitis prescribed PMe1 J01 J otitis media/myringitis prescribed quinolones use antibacterials for systemic use receiving quinolones. NQMC 135 Disease-specific antibiotic prescribing: percentage of patients Number of patients aged between 18 and 75 years diagnosed Number of patients aged between 18 and 75 years diagnosed aged between 18 and 75 years with acute 2019 2018 USA with acute bronchitis/bronchiolitis prescribed antibacterials for PMe1 J01 J with acute bronchitis/bronchiolitis prescribed quinolones bronchitis/bronchiolitis prescribed antibacterials for systemic systemic use NQMC 135 use receiving quinolones. Disease-specific antibiotic prescribing: percentage of patients Number of patients older than 1 year diagnosed with acute Number of patients older than 1 year diagnosed with acute 2020 2018 USA older than 1 year with acute tonsillitis prescribed antibacterials PMe1 J01 J tonsillitis tonsillitis prescribed antibacterials for systemic use NQMC 135 for systemic use. Disease-specific antibiotic prescribing: percentage of patients Number of patients aged between 18 and 65 years diagnosed Number of patients aged between 18 and 65 years diagnosed 2021 2018 USA aged between 18 and 65 years with pneumonia prescribed PMe1 J01 J with pneumonia prescribed antibacterials for systemic use with pneumonia prescribed quinolones antibacterials for systemic use receiving quinolones. NQMC 135 Number of patients older than 2 years diagnosed with acute Disease-specific antibiotic prescribing: percentage of patients Number of patients older than 2 years diagnosed with acute 2022 2018 USA otitis media/myringitis prescribed antibacterials for systemic older than 2 years with acute otitis media/myringitis prescribed PMe1 J01 J otitis media/myringitis use antibacterials for systemic use. NQMC 135 Disease-specific antibiotic prescribing: percentage of patients Number of patients aged between 18 and 65 years diagnosed Number of patients aged between 18 and 65 years diagnosed 2023 2018 USA aged between 18 and 65 years with pneumonia prescribed PMe1 J01 J with pneumonia with pneumonia prescribed antibacterials for systemic use NQMC 135 antibacterials for systemic use. Number of patients older than 18 years diagnosed with Disease-specific antibiotic prescribing: percentage of patients Number of patients older than 18 years diagnosed with 2024 2018 USA acute/chronic sinusitis prescribed antibacterials for systemic older than 18 years with acute/chronic sinusitis prescribed PMe1 J01 J acute/chronic sinusitis NQMC 135 use antibacterials for systemic use. Disease-specific antibiotic prescribing: percentage of patients Number of patients aged between 18 and 75 years diagnosed Number of patients aged between 18 and 75 years diagnosed aged between 18 and 75 years with acute 2025 2018 USA with acute bronchitis/bronchiolitis prescribed antibacterials for with acute bronchitis/bronchiolitis prescribed with PMe1 J01 J bronchitis/bronchiolitis prescribed antibacterials for systemic systemic use extended spectrum or tetracyclines NQMC 135 use receiving the recommended antibacterials. Number of female patients older than 18 years diagnosed with Disease-specific antibiotic prescribing: percentage of female Number of female patients older than 18 years diagnosed with cystitis/other urinary infection prescribed nitrofuran patients older than 18 years with cystitis/other urinary infection 2026 2018 USA cystitis/other urinary infection prescribed antibacterials for PMe1 J01 J derivatives, trimethoprim and derivatives, or other prescribed antibacterials for systemic use receiving the systemic use NQMC 135 antibacterials recommended antibacterials. Disease-specific antibiotic prescribing: percentage of patients Number of patients older than 1 year diagnosed with acute Number of patients older than 1 year diagnosed with acute older than 1 year with acute upper respiratory infection 2027 2018 USA upper respiratory infection prescribed antibacterials for upper respiratory infection prescribed beta-lactamase PMe1 J01 J prescribed antibacterials for systemic use receiving the systemic use sensitive penicillins NQMC 135 recommended antibacterials. Disease-specific antibiotic prescribing: percentage of patients Number of patients aged between 18 and 65 years diagnosed Number of patients aged between 18 and 65 years diagnosed aged between 18 and 65 years with pneumonia prescribed 2028 2018 USA with pneumonia prescribed penicillins with extended spectrum PMe1 J01 J with pneumonia prescribed antibacterials for systemic use antibacterials for systemic use receiving the recommended or tetracyclines NQMC 135 antibacterials. Disease-specific antibiotic prescribing: percentage of patients Number of patients older than 1 year diagnosed with acute Number of patients older than 1 year diagnosed with acute 2029 2018 USA older than 1 year with acute tonsillitis prescribed antibacterials PMe1 J01 J tonsillitis prescribed antibacterials for systemic use tonsillitis prescribed beta-lactamase sensitive penicillins for systemic use receiving the recommended antibacterials. NQMC 135 Disease-specific antibiotic prescribing: percentage of patients Number of patients older than 18 years diagnosed with Number of patients older than 18 years diagnosed with older than 18 years with acute/chronic sinusitis prescribed 2030 2018 USA acute/chronic sinusitis prescribed antibacterials for systemic acute/chronic sinusitis prescribed penicillins with extended PMe1 J01 J antibacterials for systemic use receiving the recommended use spectrum or beta-lactamase sensitive penicillins NQMC 135 antibacterials. Disease-specific antibiotic prescribing: percentage of patients Number of patients older than 2 years diagnosed with acute Number of patients older than 2 years diagnosed with acute older than 2 years with acute otitis media/myringitis prescribed 2031 2018 USA otitis media/myringitis prescribed antibacterials for systemic otitis media/myringitis prescribed penicillins with extended PMe1 J01 J antibacterials for systemic use receiving the recommended use spectrum or beta-lactamase sensitive penicillins NQMC 135 antibacterials. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Disease-specific antibiotic prescribing: percentage of patients Number of patients older than 1 year diagnosed with acute Number of patients older than 1 year diagnosed with acute 2032 2018 USA older than 1 year with acute tonsillitis prescribed antibacterials PMe1 J01 J tonsillitis prescribed antibacterials for systemic use tonsillitis prescribed quinolones NQMC 135 for systemic use receiving quinolones. Disease-specific antibiotic prescribing: percentage of patients Number of patients aged between 18 and 75 years diagnosed Number of patients aged between 18 and 75 years diagnosed aged between 18 and 75 years with acute 2033 2018 USA with acute bronchitis/bronchiolitis prescribed antibacterials for PMe1 J01 J with acute bronchitis/bronchiolitis prescribed quinolones bronchitis/bronchiolitis prescribed antibacterials for systemic systemic use NQMC 135 use receiving quinolones. Disease-specific antibiotic prescribing: percentage of female Number of female patients older than 18 years diagnosed with Number of female patients older than 18 years diagnosed with patients older than 18 years with cystitis/other urinary infection 2034 2018 USA cystitis/other urinary infection prescribed antibacterials for PMe1 J01 J cystitis/other urinary infection prescribed quinolones prescribed antibacterials for systemic use receiving systemic use NQMC 135 quinolones. All patients age 18 years and older admitted to hospital with Adult trauma care: percentage of patients age 18 years and All patients age 18 years and older admitted to hospital with an injury diagnosis AND DVT prophylaxis (pharmacological 2035 2018 USA older admitted to hospital with an injury diagnosis and DVT PMe15 B01 B an injury diagnosis OR mechanical) prescribed within 24 hours of hospital prophylaxis prescribed within 24 hours of hospital admission. NQMC 135 admission All patients age 18 years and older admitted to hospital with a Adult trauma care: percentage of patients age 18 years and All patients age 18 years and older admitted to hospital with a diagnosis of an open fracture AND administered guideline older admitted to hospital with a diagnosis of an open fracture 2036 2018 USA PMe15 J01 J diagnosis of an open fracture recommended intravenous antimicrobial agent within 1 hour of and administered guideline recommended intravenous hospital arrival antimicrobial agent within 1 hour of hospital arrival. NQMC 135 All patients age 18 years and older with an injury diagnosis Adult trauma care: percentage of patients age 18 years and AND prescribed a massive transfusion who receive attempted All patients age 18 years and older with an injury diagnosis older with an injury diagnosis and prescribed a massive 2037 2018 USA definitive bleeding control (laparotomy, thoracotomy, PMe9 B05 B AND prescribed a massive transfusion transfusion who receive attempted definitive bleeding control percutaneous therapy) within 30 minutes of the massive within 30 minutes of the massive transfusion prescription. NQMC 135 transfusion prescription Patients age 30 years and older who were seen at hospital outpatient clinics with the following primary diagnoses for COPD according to the Danish version of the International Classification of Diseases, Tenth Revision (ICD-10): COPD: proportion of outpatients with COPD receiving Outpatients with COPD receiving inhalation therapy who have 2038 2018 USA J44.X inhalation therapy who have their inhaler technique checked PMe5 R03 R their inhaler technique checked at least once a year OR at least once a year. J96.X in combination with J44.X as a secondary diagnosis AND Who are receiving inhalation therapy NQMC 135

Patients age 30 years and older who were seen at hospital outpatient clinics with the following primary diagnoses for COPD according to the Danish version of the ICD-10: ・J44.X Outpatients with COPD and a Medical Research Council level COPD: proportion of outpatients with a Medical Research OR of 2 or more who receive long-acting bronchodilator inhaled Council level of 2 or more who receive long-acting 2039 2018 USA ・J96.X in combination with J44.X as a secondary diagnosis PMe1 R03 R therapy – either long-acting or long- bronchodilator inhaled therapy – either long-acting muscarinic AND acting beta2 agonist antagonist or long-acting beta2 agonist. ・At least one procedure code ZZ0150CD and an attached value code VPH0002, VPH0003, VPH0004 or VPH0005 within the last 12 months of the last day of the monitored calendar period NQMC 135

Patients age 30 years and older who were seen at hospital outpatient clinics with the following primary diagnoses for COPD according to the Danish version of the ICD-10: ・J44.X OR ・J96.X in combination with J44.X as a secondary diagnosis AND all of the following within the last 12 months of the last day of the monitored calendar period: Outpatients with COPD and a Medical Research Council level COPD: proportion of outpatients with a Medical Research ・At least one procedure code ZZ0150CD with an attached of 2 or more, long-acting bronchodilator inhaled therapy and a Council level of 2 or more, long-acting bronchodilator inhaled 2040 2018 USA value code VPH0002, VPH0003, VPH0004 or VPH0005 PMe1 R03 R forced expiratory volume within the FEV1 equal to or below therapy and a FEV1 equal to or below 60% of predicted value ・At least one procedure code ZZ4139 and value code 60% of predicted value who are treated with inhaled steroids who are treated with inhaled steroids. VPH0000 through VPH0059 ・At least one Anatomical Therapeutic Chemical code for one or more of the following long-acting beta2 agonists or long- acting muscarinic antagonists: salmeterol (R03AC12), formoterol (R03AC13), indacaterol (R03AC18), salmeterol + (R03AK06), formoterol + or beclomethasone (R03AK07) or at least one of the following LAMAs: tiotropium (R03BB04)

NQMC 135 Number of patients with a diagnosis of estrogen receptor Breast cancer: the proportion of patients with estrogen Number of patients with a diagnosis of estrogen receptor 2041 2018 USA negative (Tumour > 1 cm or Node+) invasive carcinoma who receptor negative (T > 1 cm or Node+) invasive carcinoma PMe1 L01 L negative (Tumour > 1 cm or Node+) invasive carcinoma NQMC 135 received adjuvant chemotherapy who received adjuvant chemotherapy. Number of patients with a diagnosis of N+ or N- T > 1 cm Number of patients with a diagnosis of N+ or N- T > 1 cm Breast cancer: the proportion of patients with N+ or N- T > 1 2042 2018 USA HER2+ (IHC 3+ or FISH+) invasive carcinoma treated with HER2+ (IHC 3+ or FISH+) invasive carcinoma treated with cm HER2+ (IHC 3+ or FISH+) invasive carcinoma treated with PMe1 L01 L chemotherapy chemotherapy and who had adjuvant trastuzumab chemotherapy and who had adjuvant trastuzumab. NQMC 135 Number of patients with a diagnosis of endocrine sensitive Number of patients with a diagnosis of endocrine sensitive Breast cancer: the proportion of patients with endocrine 2043 2018 USA PMe1 L02 L invasive carcinoma invasive carcinoma who received hormonotherapy sensitive invasive carcinoma who received hormonotherapy. NQMC 135 Standardized methods for labeling, packaging and storing Total number of possible failures assessed in three medications: percentage of failures in labeling, conservation 2044 2018 USA dispensaries (operating room, medical ward and emergency Number of failures detected x 100 P Ge 6 N/A N/A and storage of medications in wards, emergency department department) selected at random NQMC 135 and operating room dispensaries. Standardized methods for labeling, packaging and storing Total number of possible labeling failures assessed in the 2045 2018 USA Number of failures detected x 100 medications: percentage of failures in labeling of medications P Ge 6 N/A N/A evaluated labels NQMC 135 prepared in hospital pharmacy service. Standardized methods for labeling, packaging and storing Total number of errors possible failures assessed in a 2046 2018 USA Number of failures detected x 100 medications: percentage of failures in maintenance of P Ge 6 N/A N/A selected at random cardiac arrest cart medication and equipment available on cardiac arrest carts. NQMC 135 Number of prescriptions validated in the last year x 100. The Validation of medication orders: percentage of prescriptions 2047 2018 USA Total number of prescriptions issued in last year description of the main features of the validation process by P Ge 9 N/A N/A validated by pharmacy service before dispensation. NQMC 135 type of medication is also requested. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Total number of healthcare professionals responding to the following item in the "Safety Culture" survey: Communication of changes in patient care: percentage of "Before a new prescription is ordered, the list of medication healthcare professionals who affirm that in their unit or area 2048 2018 USA Respondents indicating "always" x 100 P Ge 6 N/A N/A being taken by the patient is revised." new prescriptions are always ordered revising all the Possible replies: never / almost never / sometimes / almost medication being taken by the patient. NQMC 135 always / always Prevention of surgical wound infection: percentage of surgical Patients receiving correct prophylactic treatment in all aspects 2049 2018 USA Patients undergoing surgery in which prophylaxis is indicated procedures that meet recommendations on antibiotic PMe1 J01 J x 100 NQMC 135 prophylaxis. Total number of healthcare workers responding to the following item in the "Safety Culture" survey: Influenza vaccination for all hospital workers: percentage of 2050 2018 USA Respondents indicating "Yes" x 100 PMe1 J07 J "Have you been vaccinated against influenza in the last year?" healthcare workers vaccinated against influenza. Possible answer: No / Yes NQMC 135 Prevention of surgical wound infection: percentage of errors Number of surgical procedures reviewed x possible errors 2051 2018 USA Errors in compliance with protocol for antibiotic prophylaxis (quality defects) in antibiotic prophylaxis for surgical PMe1 J01 J assessed NQMC 135 procedures. Total number of possible failures assessed Note: The aspects assessed in a selected list of medications are: use-by date; separation of concentrates; safekeeping Standardized methods for labeling, packaging and storing under lock and key; refrigeration and protection from light. In 2052 2018 USA Number of failures detected x 100 medications: percentage of failures in conservation and P Ge 6 N/A N/A the case of the following will also be assessed: (a) in storage of medications in the hospital pharmacy. general: the existence of a list of available antidotes, location separated from other drugs; and (b) in a selected list of them: use-by dates, adequate stock, and easy (rapid) location. NQMC 135 Medication errors: percentage of medical prescriptions free of 2053 2018 USA Number of prescriptions assessed Number of prescriptions (first and last) without errors x 100 non-recommended abbreviations, symbols or dose P Ge 6 N/A N/A NQMC 135 designations. Number of patients treated with heparin whose weight and, Management of anticoagulants: percentage of patients 2054 2018 USA Total number of patients receiving heparin where appropriate, renal function (creatinine) is in their assessed for weight and renal function before starting PMe7 B01 B NQMC 135 medical records before heparin prescription x 100 anticoagulant therapy with heparin. Medication errors: average number of non-recommended Total number of prescriptions (first prescription and discharge Number of non-recommended expressions in prescriptions 2055 2018 USA abbreviations, symbols or dose designations used in medical P Ge 6 N/A N/A report prescription) x number of patients studied (first prescription and discharge report prescription) NQMC 135 prescription. Total number of healthcare providers replying to the following Communication of changes in patient care: percentage of item in the "Safety Culture" survey: healthcare providers who affirm that in their unit or area "All changes in medications are communicated clearly and 2056 2018 USA Replies indicating "always" x 100 changes in patients medications are always communicated P Ge 5 N/A N/A rapidly to all professionals involved in patient care." clearly and rapidly to all professionals involved in the care of Possible replies: never / almost never / sometimes / almost those patients. NQMC 135 always / always Number of patients with ischemic strokes undergoing Neurointensive care and traumatology: percentage of patients 2057 2018 USA Number of patients with ischemic strokes PMe1 B01 B intravenous fibrinolysis with ischemic stroke undergoing intravenous fibrinolysis. NQMC 135 Number of patients receiving prophylaxis against deep vein Acute respiratory failure: percentage of patients receiving 2058 135 2018 USA Number of patients admitted PMe1 B01 B NQMC thromboembolism prophylaxis against deep vein thromboembolism. Number of patients with ACS administered beta-blockers Cardiac care: percentage of patients with ACS administered 2059 135 2018 USA Number of patients with ACS discharged from the ICU) PMe1 C07 C NQMC during the ICU stay beta-blockers during the ICU stay. Number of patients with infections administered inappropriate Infectious diseases: percentage of patients with infections 2060 135 2018 USA Number of patients with infections PMe1 J01 J NQMC empirical antibiotic treatment administered inappropriate empirical antibiotic treatment. Neurointensive care and traumatology: percentage of patients 2061 135 2018 USA Total number of patients with SAH admitted to critical care Number of patients with SAH treated with nimodipine PMe1 C08 C NQMC with SAH treated with nimodipine. Sedation and analgesia: percentage of patients without Number of patients without sedation who might need 2062 2018 USA Number of patients monitored according to the protocol sedation who might need analgesia who are monitored PMe7 N02 N analgesia NQMC 135 according to the protocol. Number of patients with severe sepsis administered Infectious diseases: percentage of patients with severe sepsis 2063 135 2018 USA Number of patients with severe sepsis PMe15 J01 J NQMC antibiotics early administered antibiotics early. Total number of patients treated with vasoactive drugs Nephrologic care: percentage of patients treated with renal 2064 135 2018 USA Number of patients treated with renal doses of dopamine PMe1 C01 C NQMC discharged from the critical care department doses of dopamine. 2065 NQMC 135 2018 USA Total number of administrations of medication Total number of errors in medication reported Nursing care: percentage of errors in medication reported. P Ge 6 N/A N/A Number of mechanical ventilation patients with cognitive Number of mechanical ventilation patients administered Sedation and analgesia: percentage of mechanical ventilation 2066 2018 USA PMe1 N02 N deterioration analgesics patients with cognitive deterioration administered analgesics. NQMC 135 Number of mechanical ventilation patients with sedation in the Number of mechanical ventilation patients with appropriate Sedation and analgesia: percentage of mechanical ventilation 2067 135 2018 USA PMe1 N05 N NQMC ICU sedation patients with appropriate sedation. Cardiac care: percentage of patients with ST-segment Number of patients with ST-segment elevation acute coronary Number of patients with ST-segment elevation acute coronary elevation acute coronary syndrome and indications for 2068 2018 USA syndrome and indications for fibrinolytic treatment and door- PMe5 B01 B syndrome and indications for fibrinolytic treatment fibrinolytic treatment and door-needle time less than or equal needle time less than or equal to 30 minutes NQMC 135 to 30 minutes. Number of patients with enteral nutrition and early initiation of Metabolism and nutrition: percentage of patients with early 2069 135 2018 USA Numbers of patients with enteral nutrition PMe5 B05 B NQMC enteral nutrition initiation of enteral nutrition. Number of nonbleeding patients without thrombocytopenia Blood components: percentage of nonbleeding patients 2070 2018 USA Number of patients transfused with platelet-rich plasma and/or platelet dysfunction transfused with platelet-rich without thrombocytopenia and/or platelet dysfunction PMe1 B05 B NQMC 135 plasma transfused with platelet-rich plasma. Number of children diagnosed with epilepsy as defined who Number of patients diagnosed with epilepsy as defined who Epilepsy: percentage of children with epilepsy who were 2071 2018 USA were commenced on antiepileptic drugs at any time during were commenced on antiepileptic drugs who had input from or commenced on antiepileptic drugs referred for input by an PMe9 N03 N NQMC 135 first year referral to an epilepsy specialist nurse epilepsy specialist nurse by 1 year. Number of patients diagnosed with epilepsy as defined who Number of children with diagnosed epilepsy as defined who Epilepsy: percentage of children with epilepsy who were were commenced on antiepileptic drugs who had input/referral 2072 2018 USA were commenced on antiepileptic drugs at any time during commenced on antiepileptic drugs, with input by a consultant PMe5 N03 N from a paediatrician with expertise in epilepsy or a paediatric first year paediatrician with expertise in epilepsies by 1 year. NQMC 135 neurologist Female children 12 years and more who were commenced on Epilepsy: percentage of females over 12 years given Female children 12 years and more who were commenced on 2073 2018 USA antiepileptic drugs who had evidence of discussion regarding antiepileptic drugs, who had documented evidence of PMe5 N03 N antiepileptic drugs NQMC 135 pregnancy and/or contraception discussion of pregnancy or contraception. Number of children commenced on carbamazepine who do not have the contraindications for carbamazepine (NOT Epilepsy: percentage of children given carbamazepine, in 2074 2018 USA Number of children commenced on carbamazepine idiopathic generalised epilepsy or juvenile myoclonic epilepsy PMe1 N03 N whom there were no defined contraindications. or juvenile absence epilepsy or childhood absence epilepsy or symptomatic and generalised or Lennox–Gastaut syndrome ) NQMC 135 The number of patients in the denominator with severe Schizophrenia: percent of patients with severe symptoms or 2075 2018 USA The number of patients with schizophrenia in the sample symptoms or side effects and no recent medication treatment side effects and no recent medication treatment change to PMe1 N05 N NQMC 135 change to address these problems address these problems. The number of adult patients with advanced CKD for at least The number of patients from denominator who have a blood Advanced CKD: percent of patients with blood pressure less 2076 2018 USA three months, not currently receiving renal replacement pressure less than 130/80 mmHg and are receiving than 130/80 mmHg and are receiving erythropoietin or OMe9 B03 B therapy who are receiving an erythropoietin or analogue erythropoietin or analogue analogue. NQMC 135 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka HIV ambulatory care satisfaction: percentage of HIV positive HIV positive adolescents and adults 13 years of age and older The number of patients who indicated "Yes," "No," or "Not adolescent and adult patients who reported whether their 2077 2018 USA who had at least 2 HIV primary care visits in the last 12 Sure" to the item, "My providers explained the side effects of OMe5 J05 J providers explained the side effects of their HIV medications months and completed the survey my HIV medications in a way I could understand." NQMC 135 in a way they could understand. HIV ambulatory care satisfaction: percentage of HIV positive HIV positive adult patients 18 years of age and older engaged The number of patients who indicated "Yes," "No," or "Does adult patients who reported whether, if they relapsed, their 2078 2018 USA in a substance use treatment program who completed the Not Apply" to the item, "If I relapsed, my substance use OMe5 J05 J substance use counselors explained ways to reduce the harm survey counselors explained ways to reduce the harm of drug use." NQMC 135 of drug use. The number of patients who indicated "Strongly Disagree," HIV ambulatory care satisfaction: percentage of HIV positive HIV positive adult patients 18 years of age and older who "Disagree," "Agree," "Strongly Agree," or "Does Not Apply" to adult patients who reported whether they needed more 2079 2018 USA received one or more mental health services in the last 12 OMe5 N05 N the item, "I needed more information about the purpose of my information about the purpose of their psychiatric medications months and completed the survey psychiatric medications and their side effects." and their side effects. NQMC 135 The number of patients who indicated "Strongly Disagree," HIV ambulatory care satisfaction: percentage of HIV positive "Disagree," "Agree," "Strongly Agree," or "Does Not Apply" to HIV positive adult patients 18 years of age and older engaged adult patients who reported whether their substance use the item, "My substance use counselors explained to me in a 2080 2018 USA in a substance use treatment program who completed the counselors explained to them in a way they could understand OMe5 J05 N07 JN way I could understand how my substance use treatment (for survey how their substance use treatment (for example, ) example, methadone) and my HIV medications might and their HIV medications might interact. NQMC 135 interact." HIV ambulatory care satisfaction: percentage of HIV positive HIV positive adolescents and adults 13 years of age and older The number of patients who indicated "Yes," "No," or "Not adolescent and adult patients who reported whether their 2081 2018 USA who had at least 2 HIV primary care visits in the last 12 Sure" to the item, "My providers suggested ways to help me OMe5 J05 J providers suggested ways to help them remember to take months and completed the survey remember to take my HIV medications." NQMC 135 their HIV medications. The number of patients who indicated "Strongly Disagree," HIV ambulatory care satisfaction: percentage of HIV positive HIV positive adult patients 18 years of age and older engaged "Disagree," "Agree," "Strongly Agree," or "I did not have a adult patients who reported whether their substance use 2082 2018 USA in a substance use treatment program who completed the treatment plan" to the item, "My substance use counselors OMe5 N07 N counselors helped them to achieve their substance use survey helped me to achieve my substance use treatment plan treatment plan goals. NQMC 135 goals." The number of patients who indicated "Yes," "No," or "Does HIV ambulatory care satisfaction: percentage of HIV positive HIV positive adult patients 18 years of age and older engaged Not Apply" to the item, "If I needed, my substance use adult patients who reported whether their substance use 2083 2018 USA in a substance use treatment program who completed the OMe5 N07 N counselors helped me to get into a residential drug treatment counselors helped them get into a residential drug treatment survey NQMC 135 program." program if needed. The number of patients who indicated "Strongly Disagree," HIV ambulatory care satisfaction: percentage of HIV positive HIV positive adult patients 18 years of age and older who "Disagree," "Agree," "Strongly Agree," or "Does Not Apply" to adult patients who reported whether their providers explained 2084 2018 USA received one or more mental health services in the last 12 the item, "My providers explained to me in a way I could OMe5 J05 N05 JN to them in a way they could understand how their psychiatric months and completed the survey understand how my psychiatric medications interact with my medications interact with their HIV medications. NQMC 135 HIV medications." The number of patients who indicated "All of the time," "Most HIV ambulatory care satisfaction: percentage of HIV positive HIV positive adolescents and adults 13 years of age and older times," "Sometimes," "Rarely," "Never," or "Does not apply" to adolescent and adult patients who reported how often it was 2085 2018 USA who had at least 2 HIV primary care visits in the last 12 OMe6 J05 J the item, "It was hard for me to get my HIV medication hard for them to get their HIV medication prescriptions filled months and completed the survey NQMC 135 prescriptions filled when I needed them." when they needed them. HIV positive adult patients 18 years of age and older engaged The number of patients who indicated "All of the time," "Most HIV ambulatory care satisfaction: percentage of HIV positive 2086 2018 USA in a methadone maintenance program who completed the times," "Sometimes," "Rarely," "Never," or "Does not apply" to adult patients in a methadone maintenance program who O Ge 9 N/A N/A survey the item, "The dispensing line was too slow." reported how often the dispensing line was too slow. NQMC 135 The number of patients who indicated "Yes," "No," "Nor Sure", HIV ambulatory care satisfaction: percentage of HIV positive HIV positive adult patients 18 years of age and older engaged or "Does Not Apply" to the item, "My substance use adult patients who reported whether their substance use 2087 2018 USA in a substance use treatment program who completed the OMe5 N07 N counselors understood where I was with my recovery and counselors understood where they were with their recovery survey helped me to reduce or eliminate my drug use." and helped them to reduce or eliminate their drug use. NQMC 135 The number of adult patients with advanced CKD for at least three months, not currently receiving renal replacement The number of patients from the denominator treated with an Advanced CKD: percent of patients treated with an 2088 2018 USA PMe1 B03 B therapy who were anemic, had an anemia work-up, and are erythropoietin or analogue erythropoietin or analogue. on iron therapy for three months or are iron replete NQMC 135 The number of adult patients with advanced CKD, not The number of patients from the denominator prescribed Advanced CKD: percent of patients prescribed elemental 2089 2018 USA currently receiving renal replacement therapy, with corrected PMe1 A12 A elemental calcium calcium. calcium less than 8.5 mg/dL and normal phosphorus levels NQMC 135 The number of adult patients with advanced CKD, not currently receiving renal replacement therapy, with blood The number of patients from the denominator with Advanced CKD: percent of patients with antihypertensive 2090 2018 USA PMe3 C02C03C07C08C09 C pressure greater than 130/80 mmHg, and on antihypertensive antihypertensive therapy intensified therapy intensified. NQMC 135 medications The number of adult patients with advanced CKD, not currently receiving renal replacement therapy, with The number of patients from the denominator prescribed Advanced CKD: percent of patients prescribed with calcitriol, 2091 2018 USA immunoreactive greater than 100 pg/mL PMe1 A11 H05 AH calcitriol, alfacalcidol, or vitamin D analogues alfacalcidol, or vitamin D analogues. (or 1.5 times the upper limit of normal) and has remained so after 3 months (90 days) of recommended intervention NQMC 135 The number of adult patients with advanced CKD, not The number of patients from the denominator on lipid lowering Advanced CKD: percent of patients on lipid lowering 2092 2018 USA currently receiving renal replacement therapy, and LDL PMe1 C10 C treatment treatment. NQMC 135 greater than or equal to 100 mg/dL The number of adult patients with advanced CKD, not currently receiving renal replacement therapy, with blood The number of patients from the denominator on ACEIs or 2093 2018 USA Advanced CKD: percent of patients on ACEIs or ARBs. P Me 1 C09 C pressure greater than 130/80 mmHg with or without ARBs NQMC 135 antihypertensive treatment The number of adult patients with advanced CKD for at least The number of patients from the denominator who are on iron Advanced CKD: percent of patients who are anemic, iron 2094 2018 USA three months, not currently receiving renal replacement PMe1 B03 B therapy deficient and on iron therapy. therapy who are anemic and are iron deficient NQMC 135 The number of adult patients with advanced CKD, not currently receiving renal replacement therapy, with The number of patients from the denominator prescribed 2095 2018 USA immunoreactive parathyroid hormone greater than 100 pg/mL Advanced CKD: percent of patients prescribed vitamin D2. P Me 1 A11 A vitamin D2 (or greater than 1.5 times the upper limit of normal for each assay used) and vitamin D level less than 30 ng/mL NQMC 135 Total number of patients with an underlying National Heart, The number of patients from the denominator who are on anti- Asthma: percent of patients with persistent asthma at last 2096 2018 USA Lung, and Blood Institute classification of persistent asthma at PMe1 R03 R inflammatory medication contact who are on an anti-inflammatory medication. NQMC 135 last contact in the registry Health plan members age 18 years and older, enrolled in a managed care organization or managed behavioral health organization for the previous 12 months with no more than The number of health plan members from the denominator Behavioral health care patients' experiences: percentage of one break in enrollment of up to 45 days during the enrollment 2097 2018 USA who indicated "Yes" or "No" regarding whether they were told adult patients who reported whether they were told about O Ge 5 N/A N/A period, who received behavioral health care services and who of medication side effects medication side effects. answered the "Being Told About Medication Aide Effects" question on the Experience of Care and Health Outcomes NQMC 135 Survey Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Health plan members age 18 years and older, enrolled in a managed care organization or managed behavioral health organization for the previous 12 months with no more than The number of health plan members from the denominator Behavioral health care patients' experiences: percentage of one break in enrollment of up to 45 days during the enrollment 2098 2018 USA who indicated "Yes" or "No" regarding whether they felt they adult patients who reported whether they felt they could refuse O Ge 5 N/A N/A period, who received behavioral health care services and who could refuse a specific type of medication or treatment a specific type of medicine or treatment. answered the "Whether the Patient Feels that He or She Can Refuse Treatment" question on the Experience of Care and NQMC 135 Health Outcomes Survey Depression: percent of patients with a diagnosis of major All patients with a diagnosis of major depression or dysthymia 2099 2018 USA All patients with a diagnosis of major depression or dysthymia depression or dysthymia who, as of their last visit, are taking PMe1 N06 N taking an antidepressant at the time of the last visit NQMC 135 an antidepressant. Depression: percent of patients with diagnosis of major All patients with a diagnosis of major depression or dysthymia All patients with a diagnosis of major depression or dysthymia 2100 2018 USA depression or dysthymia who have been on antidepressants PMe14 N06 N for at least 6 months who have been on antidepressants for at least 6 months NQMC 135 for at least 6 months. All clinically significant depression patients with a New Depression: percent of clinically significant depression All clinically significant depression patients having a New Episode Patient Health Questionnaire in the last 12 months patients who, within one month of last New Episode Patient 2101 2018 USA PMe1 N06 N Episode Patient Health Questionnaire in the last 12 months who were on an antidepressant or in psychotherapy within one Health Questionnaire, are on an antidepressant and/or in month of last New Episode Patient Health Questionnaire psychotherapy. NQMC 135 All patients with a diagnosis of minor depression, depression Depression: percent of patients with a diagnosis of minor All patients with a diagnosis of minor depression, depression not otherwise specified, or adjustment disorder (last New depression, depression not otherwise specified, or adjustment 2102 2018 USA not otherwise specified, or adjustment disorder (last New PMe1 N06 N Episode Patient Health Questionnaire less than 10) NOT on disorder (New Episode Patient Health Questionnaire less than Episode Patient Health Questionnaire less than 10) an antidepressant 10) who are NOT on an antidepressant. NQMC 135 The number of "Extremely Dissatisfied," "Very Dissatisfied," "Dissatisfied," "Somewhat Satisfied," "Satisfied," "Very "Convenience" scale of the Treatment Satisfaction Satisfied," and "Extremely Satisfied" responses for the Patients who completed the "Convenience" items on the Questionnaire for Medication: the mean scale score for the 2103 2018 USA "Convenience" items on the Treatment Satisfaction O Ge 9 N/A N/A Treatment Satisfaction Questionnaire for Medication "Convenience" items on the Treatment Satisfaction Questionnaire for Medication. From the responses, a scale Questionnaire for Medication (version II). score is calculated with a higher score indicating greater NQMC 135 satisfaction. The number of "Extremely Dissatisfied," "Very Dissatisfied," "Dissatisfied," "Somewhat Satisfied," "Satisfied," "Very "Effectiveness" scale of the Treatment Satisfaction Satisfied," and "Extremely Satisfied" responses for the Patients who completed the "Effectiveness" items on the Questionnaire for Medication: the mean scale score for the 2104 2018 USA "Effectiveness" items on the Treatment Satisfaction O Ge 9 N/A N/A Treatment Satisfaction Questionnaire for Medication "Effectiveness" items on the Treatment Satisfaction Questionnaire for Medication. From the responses, a scale Questionnaire for Medication (version II). score is calculated with a higher score indicating greater NQMC 135 satisfaction. The number of "Extremely Dissatisfied," "Very Dissatisfied," "Dissatisfied," "Somewhat Satisfied," "Satisfied," "Very "Global Satisfaction" scale of the Treatment Satisfaction Satisfied," and "Extremely Satisfied" responses for the "Global Patients who completed the "Global Satisfaction" items on the Questionnaire for Medication: the mean scale score for the 2105 2018 USA Satisfaction" items on the Treatment Satisfaction O Ge 9 N/A N/A Treatment Satisfaction Questionnaire for Medication "Global Satisfaction" items on the Treatment Satisfaction Questionnaire for Medication. From the responses, a scale Questionnaire for Medication (version II). score is calculated with a higher score indicating greater NQMC 135 satisfaction. Total number of diabetic patients older than 40 years in the The number of patients from the denominator who have a Diabetes mellitus: percent of patients 40 years and older who 2106 135 2018 USA PMe1 C10 C NQMC clinical information system current prescription for statins have a current prescription for statins. Total number of diabetic patients in the clinical information The number of patients from the denominator who are not Diabetes mellitus: percent of patients 12 to 70 years of age 2107 2018 USA system 12 years and older but less than 70 years of age who already on ACEIs or an ARB and have had a who are not already on ACEI or ARB and have had a PMe7 C09 C NQMC 135 are not already on ACEIs or an ARB microalbuminuria screening test in the last 12 months microalbuminuria screening test in the last 12 months. Total number of diabetic patients 55 years and older in the The number of patients from the denominator who have a Diabetes mellitus: percent of patients 55 years and older who 2108 2018 USA PMe1 C09 C clinical information system current prescription for ACEIs or ARB medication have a current prescription for ACEIs or ARB medication. NQMC 135 Total number of diabetic patients in the clinical information The number of patients from the denominator who obtained Diabetes mellitus: percent of patients who obtained an 2109 135 2018 USA PMe1 J07 J NQMC system an influenza vaccination in the last 12 months influenza vaccination in the last 12 months. Total number of diabetic patients in the clinical information The number of patients from the denominator who have had Diabetes mellitus: percent of patients who have had one 2110 135 2018 USA PMe1 J07 J NQMC system one pneumococcal vaccination at any time pneumococcal vaccination at any time. Diabetes mellitus: percent of patients 40 years and older who Total number of diabetic patients 40 years and older in the The number of patients from the denominator who have a 2111 2018 USA have a current prescription for aspirin or other antithrombotic PMe1 B01 B clinical information system current prescription for aspirin or other antithrombotic agent NQMC 135 agent. Patients whose level of functioning was evaluated during the Bipolar disorder: the percentage of patients diagnosed and 2112 2018 USA Patients diagnosed and treated for bipolar disorder initial assessment and again within 12 weeks of initiating treated for bipolar disorder who are monitored for change in PMe7 N05 N treatment their level-of-functioning in response to treatment. NQMC 135 Bipolar disorder: percentage of patients with Bipolar I Disorder Patients with evidence of use of a mood stabilizing or Patients with Bipolar I Disorder with symptoms or episodes with depressive symptoms and behaviors who have evidence 2113 2018 USA antimanic agent during the first 12 weeks of pharmacotherapy PMe1 N05 N that involve depression of use of a mood stabilizing or antimanic agent during the first treatment 12 weeks of pharmacotherapy treatment. NQMC 135 Bipolar disorder: the percentage of patients diagnosed and Patients who receive education/information about bipolar treated for bipolar disorder who are provided with education 2114 2018 USA Patients diagnosed and treated for bipolar disorder PMe5 N05 N disorder within 12 weeks of initiating treatment and information about their illness and treatment within 12 NQMC 135 weeks of initiating treatment. Continuous variable statement: Median time, in hours, from Patients, 16 years of age and older, with a diagnosis of severe severe sepsis/septic shock identification to the initiation of Sepsis: median time to initiation of Vancomycin (or Linezolid) 2115 2018 USA PMe5 J01 J sepsis/septic shock Vancomycin (or Linezolid) for patients with severe following severe sepsis/septic shock identification. NQMC 135 sepsis/septic shock Depression: the percentage of patients presenting with Patients who receive an assessment, prior to treatment for depression who were assessed, prior to the initiation of 2116 2018 USA Patients diagnosed and treated for unipolar depression unipolar depression, that includes consideration of current PMe7 N06 N treatment, for the presence of prior or current symptoms and/or prior manic or hypomanic symptoms or behaviors NQMC 135 and/or behaviors associated with mania or hypomania. Bipolar disorder: the percentage of patients diagnosed with Patients who are screened for evidence of hyperglycemia Patients diagnosed with bipolar disorder and treated with an bipolar disorder and treated with an atypical antipsychotic 2117 2018 USA within 16 weeks after initiating treatment with an atypical PMe7 N05 N atypical antipsychotic agent agent who receive at least one screening for hyperglycemia antipsychotic agent NQMC 135 within the initial 16 weeks of treatment. Bipolar disorder: the percentage of patients diagnosed with Patients diagnosed with bipolar disorder and treated with an Patients who are assessed for hyperlipidemia within 16 weeks bipolar disorder and treated with an atypical antipsychotic 2118 2018 USA PMe7 N05 N atypical antipsychotic agent after initiating treatment with an atypical antipsychotic agent agent who received at least one assessment for hyperlipidemia within the initial 16 week period of treatment. NQMC 135 Sepsis: percent of patients with severe sepsis/septic shock Total number of patients, 16 years of age and older, with a Number of patients who had Vancomycin (or Linezolid) AND an organism other than MRSA or MRSE who had 2119 2018 USA diagnosis of severe sepsis/septic shock AND an organism discontinued within 24 hours prior to and 72 hours following PMe4 J01 J Vancomycin (or Linezolid) discontinued within 72 hours other than MRSA or MRSE severe sepsis/septic shock identification NQMC 135 following severe sepsis/septic shock identification. Total number of patients, 16 years of age and older, with a Number of patients who received steroids within 24 hours Sepsis: percent of patients with septic shock who received 2120 2018 USA PMe15 H02 H diagnosis of septic shock prior to and 24 hours following septic shock identification steroids within 24 hours following septic shock identification. NQMC 135 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Bipolar disorder: the percentage of patients with bipolar Patients with a recommendation for psychosocial intervention disorder who receive a recommendation for an adjunctive 2121 2018 USA Patients diagnosed and treated for bipolar disorder PMe9 N05 N within 12 weeks of initiating treatment psychosocial intervention, including evidence-based NQMC 135 therapies, within 12 weeks of initiating treatment. Sepsis: percent of patients with severe sepsis/septic shock Number of patients who received a recommended broad- Total number of patients, 16 years of age and older, with a who received a recommended broad-spectrum antibiotic 2122 2018 USA spectrum antibiotic within 24 hours prior to and 24 hours PMe15 J01 J diagnosis of severe sepsis/septic shock within 24 hours following severe sepsis/septic shock following severe sepsis/septic shock identification NQMC 135 identification. Bipolar disorder: the percentage of patients with Bipolar I Patients with Bipolar I Disorder episodes with Disorder with mania/hypomania, mixed or cycling symptoms ・Manic/hypomanic symptoms or behaviors Patients with evidence of use of an antimanic agent during the 2123 2018 USA and behaviors who have evidence of use of pharmacotherapy PMe1 N05 N ・Mixed symptoms or behaviors first 12 weeks of pharmacotherapy treatment agent with antimanic properties during the first 12 weeks of ・Cycling symptoms or behaviors NQMC 135 treatment. Bipolar disorder: the percentage of patients diagnosed with Patients diagnosed and treated for bipolar disorder with an Patients assessed for extrapyramidal symptoms twice during bipolar disorder and treated with an antipsychotic agent who 2124 2018 USA PMe7 N05 N antipsychotic agent initial 24 weeks of treatment were assessed for the presence of extrapyramidal symptoms twice within the first 24 weeks of treatment. NQMC 135 Number of patients who received Vancomycin (or Linezolid) Sepsis: percent of patients with severe sepsis/septic shock Total number of patients, 16 years of age and older, with a 2125 2018 USA within 24 hours prior to and 24 hours following severe who received Vancomycin (or Linezolid) within 24 hours PMe15 J01 J diagnosis of severe sepsis/septic shock NQMC 135 sepsis/septic shock identification following severe sepsis/septic shock identification. Bipolar disorder: the percentage of patients diagnosed with Patients diagnosed and treated for bipolar disorder with a Patients with a serum medication level within 12 weeks of bipolar disorder and treated with lithium who have evidence of 2126 2018 USA PMe7 N05 N lithium agent beginning treatment with lithium a lithium serum medication level with 12 weeks of beginning NQMC 135 treatment. Substance use disorders: percentage of patients aged 18 Patients who were counseled regarding psychosocial AND years and older with a diagnosis of current opioid addiction All patients aged 18 years and older with a diagnosis of 2127 2018 USA pharmacologic treatment options for opioid addiction within who were counseled regarding psychosocial AND PMe5 N07 N current opioid addiction the 12 month reporting period pharmacologic treatment options for opioid addiction within NQMC 135 the 12 month reporting period. Substance use disorders: percentage of patients aged 18 Patients who were counseled regarding psychosocial AND years and older with a diagnosis of current alcohol All patients aged 18 years and older with a diagnosis of 2128 2018 USA pharmacologic treatment options for alcohol dependence dependence who were counseled regarding psychosocial PMe5 N07 N current alcohol dependence within the 12 month reporting period AND pharmacologic treatment options for alcohol NQMC 135 dependence within the 12 month reporting period. Number of patients with pancreatic cancer undergoing cancer- Pancreatic cancer: percentage of patients undergoing cancer- Number of patients with pancreatic cancer undergoing cancer- directed resection for whom adjuvant chemotherapy with or directed resection for whom adjuvant chemotherapy with or 2129 2018 USA PMe1 L01 L directed resection without radiation is considered or administered, or a valid without radiation is considered or administered, or a valid reason is documented for not receiving adjuvant therapy reason is documented for not receiving adjuvant therapy. NQMC 135 Parkinson's disease: percentage of patients with a diagnosis Patients (or caregiver[s], as appropriate) who had the of Parkinson's disease (or caregiver[s], as appropriate) who Parkinson's disease treatment options (e.g., non- 2130 2018 USA All patients with a diagnosis of Parkinson's disease had the Parkinson's disease treatment options (e.g., non- PMe7 N04 N pharmacological treatment, pharmacological treatment, or pharmacological treatment, pharmacological treatment, or surgical treatment) reviewed at least once annually surgical treatment) reviewed at least once annually. NQMC 135 Parkinson's disease: percentage of patients with a diagnosis Patients (or caregiver[s], as appropriate) who were counseled of Parkinson's disease (or caregiver[s], as appropriate) who about context-specific safety issues appropriate to the were counseled about context-specific safety issues 2131 2018 USA All patients with a diagnosis of Parkinson's disease PMe5 N04 N patient's stage of disease (e.g., injury prevention, medication appropriate to the patient's stage of disease (e.g., injury management, or driving) at least annually prevention, medication management, or driving) at least NQMC 135 annually. Number of patients age 18 years and older and diagnosed VTE diagnosis and treatment: percentage of patients with Number of patients age 18 years and older and diagnosed with VTE who receive ongoing warfarin therapy with VTE who receive ongoing warfarin therapy with 2132 2018 USA PMe7 B01 B with VTE who receive ongoing warfarin therapy documentation in the medical record indicating a current INR documentation in the medical record indicating a current INR is available and is used to monitor and adjust therapy is available and is used to monitor and adjust therapy. NQMC 135 Melanoma: percentage of patients who have a resected Number of patients who have a resected primary melanoma Number of patients who have a resected primary melanoma primary melanoma metastatic to regional lymph nodes or 2133 2018 USA metastatic to regional lymph nodes or distant sites for whom PMe5 L01 L metastatic to regional lymph nodes or distant sites distant sites for whom there is a documented discussion there is a documented discussion regarding adjuvant therapy NQMC 135 regarding adjuvant therapy. Patients who had their Parkinson's disease diagnosis Parkinson's disease: percentage of patients with a diagnosis reviewed, including a review of current medications (e.g., of Parkinson's disease who had their Parkinson's disease medications that can produce Parkinson-like signs or diagnosis reviewed, including a review of current medication symptoms) and a review for the presence of atypical features and a review for the presence of atypical features (e.g., falls at 2134 2018 USA All patients with a diagnosis of Parkinson's disease PMe7 N04 N (e.g., falls at presentation and early in the disease course, presentation and early in the disease course, poor response poor response to levodopa, symmetry at onset, rapid to levodopa, symmetry at onset, rapid progression [to Hoehn progression [to Hoehn and Yahr stage 3 in 3 years], lack of and Yahr stage 3 in 3 years], lack of tremor, or ) tremor, or dysautonomia) at least annually at least annually. NQMC 135 Parkinson's disease: percentage of visits for patients with a Patient visits with patient (or caregiver[s], as appropriate) diagnosis of Parkinson's disease where patients (or 2135 2018 USA All visits for patients with a diagnosis of Parkinson's disease queried about Parkinson's disease medication-related motor caregiver[s], as appropriate) were queried about Parkinson's PMe7 N04 N complications (e.g., wearing-off, dyskinesia, or off-time) disease medication-related motor complications (e.g., wearing- NQMC 135 off, dyskinesia, or off-time). Number of HIV-infected oral health patients with a Phase 1 Number of HIV-infected oral health patients that completed HIV oral health services: percentage of HIV-infected oral 2136 2018 USA treatment plan established in the year prior to the Phase 1 treatment within 12 months of establishing a health patients with a Phase 1 treatment plan that is PMe6 J05 J NQMC 135 measurement year treatment plan completed within 12 months. Number of patients undergoing adjuvant therapy for Pancreatic cancer: percentage of patients undergoing Number of patients undergoing adjuvant therapy for 2137 2018 USA pancreatic cancer for whom the timing relative to resection adjuvant therapy for whom the timing relative to resection PMe9 L01 L pancreatic cancer NQMC 135 (before, after, both) is recorded (before, after, both) is recorded. AOE: percentage of patients aged 2 years and older with a 2138 2018 USA All patients aged 2 years and older with a diagnosis of AOE Patients who were prescribed topical preparations PMe1 S02 S diagnosis of AOE who were prescribed topical preparations. NQMC 135 Stroke and stroke rehabilitation: percentage of patients aged All patients aged 18 years and older with the diagnosis of 2139 2018 USA Patients who were prescribed antiplatelet therapy at discharge 18 years and older with the diagnosis of ischemic stroke or PMe1 B01 B ischemic stroke OR TIA TIA who were prescribed antiplatelet therapy at discharge. NQMC 135 Stroke and stroke rehabilitation: percentage of patients aged All patients aged 18 years and older with the diagnosis of 18 years and older with the diagnosis of ischemic stroke or Patients who underwent a dysphagia screening process 2140 2018 USA ischemic stroke or intracranial hemorrhage who receive any intracranial hemorrhage who underwent a dysphagia P Ge 5 N/A N/A before taking any foods, fluids or medication by mouth foods, fluids or medication by mouth screening process before taking any foods, fluids or NQMC 135 medication by mouth. Cancer - nausea and vomiting: percentage of patients Number of patients undergoing chemotherapy treatment with undergoing chemotherapy treatment with a high acute emetic a high acute emetic risk for whom a 3-drug regimen including Number of cancer therapy patients undergoing chemotherapy risk for whom a 3-drug regimen including single doses of a 5- 2141 2018 USA single doses of a 5-HT3 receptor antagonist, dexamethasone, PMe1 A01 A04 L01 AL treatment with a high acute emetic risk HT3 receptor antagonist, dexamethasone, and selective and selective neurokinin-1 receptor blocker was given neurokinin-1 receptor blocker was given immediately prior to immediately prior to chemotherapy NQMC 135 chemotherapy. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Number of hospitalized patients with cancer over the age of Cancer - delirium: percentage of hospitalized patients with 65 or with advanced cancer with delirium for whom there was cancer over the age of 65 or with advanced cancer with Number of hospitalized patients with cancer over the age of an assessment for the presence or absence of at least one of delirium for whom there was an assessment for the presence 2142 2018 USA P Ge 7 N/A N/A 65 or with advanced cancer with delirium the following potential causes and their association with or absence of at least one of the following potential causes delirium: medication effects, central disease, and their association with delirium: medication effects, central infection, or metabolic processes nervous system disease, infection, or metabolic processes. NQMC 135 Number of patients with cancer who underwent chemotherapy Cancer - information and care planning: percentage of and, prior to chemotherapy, were informed about the risks and patients who underwent chemotherapy and, prior to 2143 2018 USA Number of patients with cancer who underwent chemotherapy benefits of treatment, including likely symptoms and side chemotherapy, were informed about the risks and benefits of PMe5 L01 L effects, and whether the treatment intent is curative or treatment, including likely symptoms and side effects, and NQMC 135 palliative whether the treatment intent is curative or palliative. OME: percentage of patients aged 2 months through 12 years All patients aged 2 months through 12 years with a diagnosis 2144 2018 USA Patients who were not prescribed systemic antimicrobials with a diagnosis of OME who were not prescribed systemic PMe1 J01 J of OME NQMC 135 antimicrobials. OME: percentage of patients aged 2 months through 12 years All patients aged 2 months through 12 years with a diagnosis 2145 2018 USA Patients who were not prescribed systemic corticosteroids with a diagnosis of OME who were not prescribed systemic PMe1 H02 H of OME NQMC 135 corticosteroids. Number of HIV-infected pediatric patients greater than equal Number of HIV-infected pediatric patients who had at least MMR vaccine: percentage of pediatric patients with HIV to 2 years and less than 3 years of age who had a medical 2146 2018 USA one dose of MMR administered between 12 to 24 months of infection who have had at least one dose of MMR vaccine PMe1 J07 J visit with a provider with prescribing privileges at least once in age administered between 12 to 24 months of age. NQMC 135 the measurement year Stroke and stroke rehabilitation: percentage of patients aged All patients aged 18 years and older with the diagnosis of 18 years and older with the diagnosis of ischemic stroke or 2147 2018 USA ischemic stroke or TIA with documented permanent, Patients who were prescribed an anticoagulant at discharge TIA with documented permanent, persistent, or paroxysmal PMe1 B01 B persistent, or paroxysmal atrial fibrillation atrial fibrillation who were prescribed an anticoagulant at NQMC 135 discharge. Number of patients with cancer treated with agents that block Cancer - skin rash: percentage of patients treated with agents Number of patients with cancer treated with agents that block epidermal growth factor receptors for whom the presence and that block epidermal growth factor receptors for whom the 2148 2018 USA PMe7 L01 L epidermal growth factor receptors severity of skin rash was evaluated within one month after presence and severity of skin rash was evaluated within one starting the treatments and at each visit month after starting the treatments and at each visit. NQMC 135 Number of patients undergoing chemotherapy who have Cancer - diarrhea: percentage of patients undergoing diarrhea for whom all of the following were assessed: history chemotherapy who have diarrhea for whom all of the following of onset and duration, number of stools and stool composition, were assessed: history of onset and duration, number of Number of cancer patients undergoing chemotherapy who and at least one of the associated symptoms (fever, dizziness, stools and stool composition, and at least one of the 2149 2018 USA PMe7 L01 L have diarrhea abdominal pain/cramping, nausea/vomiting, decreased associated symptoms (fever, dizziness, abdominal performance status, sepsis, fever, bleeding, or dehydration), pain/cramping, nausea/vomiting, decreased performance in order to classify the diarrhea as complicated or status, sepsis, fever, bleeding, or dehydration), in order to NQMC 135 uncomplicated classify the diarrhea as complicated or uncomplicated. Number of outpatients not receiving chemotherapy or Cancer - nausea and vomiting: percentage of outpatients not Number of cancer outpatients not receiving chemotherapy or radiation who were treated for nausea or vomiting with an receiving chemotherapy or radiation who were treated for 2150 2018 USA radiation who were treated for nausea or vomiting with an antiemetic medication for whom the effectiveness of treatment nausea or vomiting with an antiemetic medication for whom PMe7 A04 L01 AL antiemetic medication was evaluated before or on the next visit to the same the effectiveness of treatment was evaluated before or on the NQMC 135 outpatient site next visit to the same outpatient site. Number of infants who: Neonatal zidovudine prophylaxis: percentage of infants born ・Were born to HIV-infected women during the measurement Number of infants born to HIV-infected women who were to HIV-infected women who were prescribed zidovudine 2151 2018 USA year; and prescribed zidovudine prophylaxis within 12 hours of birth PMe1 J05 J prophylaxis for HIV within 12 hours of birth during the ・Had a visit with a provider with prescribing privileges in an during the measurement year measurement year. NQMC 135 HIV setting during the measurement year Cancer - nausea and vomiting: percentage of patients Number of patients undergoing chemotherapy treatment with undergoing chemotherapy treatment with a moderate acute Number of cancer patients undergoing chemotherapy a moderate acute emetic risk for whom a 2-drug regimen 2152 2018 USA emetic risk for whom a 2-drug regimen including a 5-HT3 PMe1 A01 A04 L01 AL treatment with a moderate acute emetic risk including a 5-HT3 receptor antagonist and dexamethasone receptor antagonist and dexamethasone were given were given immediately prior to chemotherapy NQMC 135 immediately prior to chemotherapy. Stroke and stroke rehabilitation: percentage of patients aged All patients aged 18 years and older with the diagnosis of Patients from the denominator who were considered for t-PA 18 years and older with the diagnosis of ischemic stroke 2153 2018 USA ischemic stroke whose time from symptom onset to arrival is administration (given t-PA or documented reasons for patient PMe1 B01 B whose time from symptom onset to arrival is less than 3 hours less than 3 hours not being a candidate for therapy) NQMC 135 who were considered for t-PA administration. Number of patients undergoing chemotherapy with a high-risk Cancer - diarrhea: percentage of patients undergoing Number of cancer patients undergoing chemotherapy with a (greater than 10%) of chemotherapy-induced diarrhea for chemotherapy with a high-risk (greater than 10%) of 2154 2018 USA high-risk (greater than 10%) of chemotherapy-induced PMe1 A07 L01 AL whom an antidiarrheal agent was prescribed on or before chemotherapy-induced diarrhea for whom an antidiarrheal diarrhea NQMC 135 treatment was initiated agent was prescribed on or before treatment was initiated. Acute otitis externa: percentage of patients aged 2 years and Patients who were not prescribed systemic antimicrobial 2155 2018 USA All patients aged 2 years and older with a diagnosis of AOE older with a diagnosis of AOE who were not prescribed PMe1 J01 J therapy NQMC 135 systemic antimicrobial therapy. Cancer - nausea and vomiting: percentage of patients Number of patients with cancer undergoing moderately or Number of patients with cancer undergoing moderately or undergoing moderately or highly emetic chemotherapy or with highly emetic chemotherapy or with cancer affecting the highly emetic chemotherapy or with cancer affecting the cancer affecting the gastrointestinal tract or abdomen seen for 2156 2018 USA gastrointestinal tract or abdomen seen for a visit in a cancer- PMe7 L01 L gastrointestinal tract or abdomen seen for a visit in a cancer- a visit in a cancer-related outpatient setting for whom the related outpatient setting for whom the presence or absence related outpatient setting presence or absence of nausea or vomiting was assessed at of nausea or vomiting was assessed at every visit NQMC 135 every visit. Number of patients started on a long-acting opioid formulation Cancer - pain: percentage of patients with cancer pain started Number of cancer patients with cancer pain who were started 2157 2018 USA for whom a short-acting opioid formulation for breakthrough on a long-acting opioid formulation for whom a short-acting PMe1 N02 N on a long-acting opioid formulation pain was also provided opioid formulation for breakthrough pain was also provided. NQMC 135 Number of patients started on chronic opioid treatment who Cancer - pain: percentage of patients with cancer pain started Number of cancer patients with cancer pain started on chronic were offered either a prescription or nonprescription bowel on chronic opioid treatment who were offered either a 2158 2018 USA PMe1 A06 N02 AN opioid treatment regimen within 24 hours or had documented contraindication prescription or nonprescription bowel regimen within 24 hours to a bowel regimen or had documented contraindication to a bowel regimen. NQMC 135 Number of patients with new neurologic symptoms or findings Cancer - pain: percentage of patients with new neurologic Number of cancer patients with new neurologic symptoms or on physical examination consistent with spinal cord symptoms or findings on physical examination consistent with 2159 2018 USA findings on physical examination consistent with spinal cord compression who were treated with steroids as soon as spinal cord compression who were treated with steroids as PMe15 H02 H compression possible, but within 24 hours or had a contraindication to soon as possible, but within 24 hours or had a NQMC 135 steroids documented contraindication to steroids documented. Otitis media with effusion: percentage of patients aged 2 All patients aged 2 months through 12 years with a diagnosis Patients who were not prescribed or recommended to receive months through 12 years with a diagnosis of OME who were 2160 2018 USA PMe1 R01 R06 R of OME either antihistamines or decongestants not prescribed or recommended to receive either NQMC 135 antihistamines or decongestants. Mean therapeutic international normalized ratio (INR) range Percent time in therapeutic INR range (TTR): mean TTR All patients, 18 years and older, who received prescriptions for 2161 2018 USA (TTR) achieved among patients who received prescriptions achieved among patients who received prescriptions for OMe3 B01 B warfarin and had sufficient INR values to calculate TTR for warfarin and had sufficient INR values to calculate TTR warfarin and had sufficient INR values to calculate TTR. NQMC 135 Patients' experiences: percentage of patients who reported All patients who answered the "Shared Decisionmaking" items The number of "Yes, definitely," "Yes, somewhat," or "No" 2162 2018 USA whether their provider included them in decisions about their O Ge 5 N/A N/A on the CAHPS American Indian Survey responses on the "Shared Decisionmaking" items NQMC 135 treatment or health care. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Androgen deficiency: percentage of male patients aged 18 Patients who have a baseline gonadotropin (LH or FSH) years and older with androgen deficiency who are receiving All male patients aged 18 years and older with androgen 2163 2018 USA measurement performed within six months prior to initiating testosterone therapy, who have a baseline gonadotropin (LH PMe7 G03 G deficiency who are receiving testosterone therapy testosterone therapy or FSH) measurement performed within six months prior to NQMC 135 initiating testosterone therapy. Diagnosis and treatment of ischemic stroke: percentage of Number of patients presenting with acute symptoms of Number of patients who have hypertension managed in the tPA non-recipients who have hypertension appropriately 2164 2018 USA PMe1 B01 C02 C03 C07 C08 C09 BC ischemic stroke who are non-tPA recipients first 48 hours of hospitalization or until neurologically stable managed in the first 48 hours of hospitalization or until NQMC 135 neurologically stable. Infection control after hematopoietic cell transplantation: The number of patients in your selection having hematopoietic The number of patients in your selection having hematopoietic percentage of patients who had hematopoietic cell cell transplantation AND herpes simplex virus seropositive 2165 2018 USA cell transplantation AND herpes simplex virus seropositive transplantation and were herpes simplex virus seropositive PMe1 J05 J AND/OR varicella-zoster virus seropositive AND prophylaxis AND/OR varicella-zoster virus seropositive and/or varicella-zoster virus seropositive and prophylaxis was was prescribed NQMC 135 prescribed. Number of adult patients hospitalized for a medical condition Venous thromboembolism prophylaxis: percentage of adult Number of adult patients who are hospitalized for a medical or surgery and on heparin or low-molecular-weight heparin hospitalized patients on prescribed heparin or low-molecular- 2166 2018 USA condition or surgery who are prescribed heparin or low- PMe7 B01 B who have appropriate ongoing laboratory tests drawn and weight heparin who have appropriate ongoing laboratory tests molecular-weight heparin NQMC 135 used to adjust therapy drawn and used to adjust therapy. Number of adult patients hospitalized for a medical condition VTE prophylaxis: percentage of hospitalized patients who Number of adult patients who are hospitalized for a medical 2167 2018 USA or surgery and on warfarin who have a baseline international have a baseline international normalized ratio when initially PMe7 B01 B condition or surgery and prescribed warfarin NQMC 135 normalized ratio prescribed warfarin. Diagnosis and treatment of chest pain and ACS: percentage Number of patients with AMI for whom statin treatment is Number of patients with AMI receiving statin agent within 24 of AMI patients who receive a statin agent within 24 hours of 2168 2018 USA PMe5 C10 C appropriate hours of arrival and on discharge from hospital arrival and at discharge from hospital for whom treatment is NQMC 135 appropriate. Number of patients presenting with acute symptoms of Diagnosis and treatment of ischemic stroke: percentage of 2169 135 2018 USA Number of patients who receive intravenous fluids PMe1 B05 B NQMC ischemic stroke and dehydration patients with dehydration who receive IV fluids. Adult acute and subacute low back pain: percentage of Number of patients who were advised on maintenance or patients who were advised on maintenance or resumption of resumption of activities, against bed rest, use of heat, activities, against bed rest, use of heat, education on Number of patients with diagnosis of acute low back pain or education on importance of active lifestyle and exercise, and 2170 2018 USA importance of active lifestyle and exercise, and PMe5 M01 M02 M radiculopathy recommendation to take anti-inflammatory or analgesic recommendation to take anti-inflammatory or analgesic medication in the first six weeks of pain onset in the absence medication in the first six weeks of pain onset in the absence of "red flags" NQMC 135 of "red flags." Infection control after HCT: percentage of patients who were The number of patients in your selection having HCT AND The number of patients in your selection having HCT AND expected to be neutropenic for 7 or more days during HCT 2171 2018 USA expected to be neutropenic for 7 or more days AND were PMe1 J01 J expected to be neutropenic for 7 or more days and were prescribed antibacterial prophylaxis with a prescribed fluoroquinolone NQMC 135 fluoroquinolone. Diagnosis and treatment of ischemic stroke: percentage of Number of patients who have appropriate prevention for VTE Number of patients presenting with acute symptoms of patients with ischemic stroke with paralysis or other reason for 2172 2018 USA such as subcutaneous heparin or pneumatic compression PMe1 B01 B ischemic stroke and paralysis or other reason for immobility immobility receiving appropriate prevention for VTE device (subcutaneous heparin or pneumatic compression device). NQMC 135 ALS: percentage of visits for patients with a diagnosis of ALS Patient visits with patient offered treatment for pseudobulbar 2173 2018 USA All visits for patients with a diagnosis of ALS with patients offered treatment for pseudobulbar affect, PMe1 M01 M03 N02 N06 N07 MN affect, sialorrhea, or ALS related symptoms, if present NQMC 135 sialorrhea, and ALS related symptoms. The number of patients in your selection having HCT AND Infection control after HCT: percentage of patients who had 2174 2018 USA The number of patients in your selection having HCT annual influenza vaccination with trivalent inactivated vaccine HCT and receiving recommendation for annual seasonal PMe1 J07 J was recommended influenza vaccination with trivalent inactivated vaccine. NQMC 135 Diagnosis and treatment of ischemic stroke: percentage of 2175 135 2018 USA Number of patients eligible for tPA treatment Number of patients who were treated with tPA PMe1 B01 B NQMC eligible patients with ischemic stroke treated with tPA. Number of patients who are up-to-date with the following Immunizations: percentage of patients who by age 13 years immunizations: were up-to-date with the following recommended adolescent ・One HPV – human papillomavirus vaccine (for females) Number of patients who reach their 13th birthday during the immunizations: one human papillomavirus vaccine (for 2176 2018 USA ・One MCV4 – meningococcal PMe1 J07 J specified measurement period females), one meningococcal, one tetanus, diphtheria toxoids ・One Tdap – tetanus, diphtheria toxoids and acellular and acellular pertussis vaccine, and one influenza within the pertussis vaccine last year. NQMC 135 ・One influenza within the last year The number of patients in your selection diagnosed with The number of patients in your selection diagnosed with cGVHD: percentage of patients with moderate or severe 2177 2018 USA cGVHD AND condition is considered moderate or severe AND PMe1 L04 L cGVHD AND condition is considered moderate or severe cGVHD with systemic immunosuppressive therapy prescribed. NQMC 135 receiving systemic immunosuppression therapy Androgen deficiency: percentage of male patients aged 18 years and older with androgen deficiency who are receiving All male patients aged 18 years and older with androgen Patients who have a hematocrit or hemoglobin test performed 2178 2018 USA testosterone therapy, who have a hematocrit or hemoglobin PMe7 G03 G deficiency who are receiving testosterone therapy within two to six months after initiation of testosterone therapy test performed within two to six months after initiation of NQMC 135 testosterone therapy. Diagnosis and treatment of ischemic stroke: percentage of Number of patients eligible for tPA treatment and treated with Number of patients who were treated with tPA with a "door to patients with stroke symptoms who are candidates for tPA 2179 2018 USA PMe5 B01 B tPA drug" time of less than 60 minutes with a "door to drug" time (time of arrival to time of drug NQMC 135 administration) of less than 60 minutes. Number of adult patients hospitalized for a medical condition VTE prophylaxis: percentage of adult hospitalized patients Number of adult patients who are hospitalized for a medical or surgery and on heparin therapy for venous receiving heparin therapy for VTE prophylaxis who have a 2180 2018 USA condition or surgery and receiving heparin therapy for venous thromboembolism prophylaxis who have a baseline platelet PMe7 B01 B baseline platelet count before starting heparin and then a thromboembolism prophylaxis count before starting heparin and then a platelet count every platelet count every other day over the course of 14 days. NQMC 135 other day over the course of 14 days Diagnosis and management of asthma: percentage of patients Number of asthma patients who are uncontrolled or have a Number of asthma patients who are seen by a clinician within whose asthma is not controlled or have change in medication 2181 2018 USA PMe7 R03 R change in medication or clinical status two to six weeks of change in medication or clinical status or clinical status, who are seen by a health care clinician NQMC 135 within two to six weeks. Adult acute and subacute low back pain: percentage of Number of patients with diagnosis of acute or subacute low 2182 2018 USA Number of patients who were prescribed opioids patients with low back pain diagnosis who are prescribed PMe1 N02 N back pain or radiculopathy NQMC 135 opioids. Number of adult patients hospitalized for a medical condition Number of adult patients hospitalized for a medical condition VTE prophylaxis: percentage of hospitalized patients on 2183 2018 USA or surgery who are on warfarin and have current international or surgery and on warfarin for whom current international warfarin for whom current international normalized ratio is PMe3 B01 B normalized ratio normalized ratio is used to monitor and adjust therapy used to monitor and adjust therapy. NQMC 135 Diagnosis and management of ADHD in primary care for Number of patients diagnosed with ADHD and prescribed school-age children and adolescents: percentage of patients psychostimulant medication for the first time whose medical treated with psychostimulant medication for the diagnosis of Number of patients newly diagnosed with ADHD and record contains documentation of a follow-up visit within 30 2184 2018 USA ADHD for the first time whose medical record contains PMe5 N06 N prescribed psychostimulant medication days of medication initiation and the following components documentation of a follow-up visit within 30 days of medication were discussed at the visit: height, weight, medication, school initiation that includes height, weight, a discussion of progress and a care plan medication, a discussion of school progress and a care plan. NQMC 135 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka

Number of patients, 19 years and older, who are up-to-date Immunizations: percentage of adult patients, 19 years and with the following immunizations: older, who are up-to-date with the following immunizations: ・One tetanus, diphtheria toxoids vaccine in the last 10 years one tetanus, diphtheria toxoids vaccine in the last 10 years, Number of patients, 19 years and older, during the specified ・Varicella - two doses or history of disease up to year 1995 2185 2018 USA two doses of varicella or history of disease up to year 1995, PMe1 J07 J measurement period ・Pneumococcal polysaccharide vaccine (PPSV23) for pneumococcal polysaccharide vaccine (PPSV23) for patients patients 65 years and older 65 years and older, one influenza within the last year, and ・One influenza within the last year herpes zoster/shingles for patients 60 years and older. ・Herpes zoster/shingles (patients 60 years and older) NQMC 135 Diagnosis and treatment of ischemic stroke: percentage of Number of patients who were treated with aspirin within 24 patients who are not candidates for tPA treatment who receive 2186 2018 USA Number of patients not eligible for tPA treatment hours of hospitalization, after a negative head CT, unless PMe15 B01 B aspirin within 24 hours of hospitalization, after a negative contraindicated NQMC 135 head CT, unless contraindicated. Androgen deficiency: percentage of male patients aged 18 years and older with androgen deficiency who are receiving All male patients aged 18 years and older with androgen Patients who have a testosterone measurement performed 2187 2018 USA testosterone therapy, who have a testosterone measurement PMe7 G03 G deficiency who are receiving testosterone therapy within six months prior to initiating testosterone therapy performed within six months prior to initiating testosterone NQMC 135 therapy. Number of adult patients hospitalized for a medical condition VTE prophylaxis: percentage of hospitalized patients at risk or surgery at risk for VTE who have VTE education within 24 for VTE who have VTE education within 24 hours of Number of adult patients who are hospitalized for a medical 2188 2018 USA hours of admission that includes 1) VTE risk, 2) signs and admission that includes 1) VTE risk, 2) signs and symptoms, PMe5 B01 B condition or surgery at risk for venous thromboembolism symptoms, 3) early and frequent mobilization, and 4) clinically 3) early and frequent mobilization, and 4) clinically appropriate appropriate treatment/prophylaxis methods treatment/prophylaxis methods. NQMC 135 ALS: percentage of patients with a diagnosis of ALS with Patients with whom the clinician discussed disease-modifying whom the clinician discussed disease modifying 2189 2018 USA All patients with a diagnosis of ALS pharmacotherapy (riluzole) to slow ALS disease progression PMe5 N07 N pharmacotherapy (riluzole) to slow ALS disease progression at least once annually NQMC 135 at least once annually. Infection control after hematopoietic cell transplantation: The number of patients in your selection having hematopoietic The number of patients in your selection having hematopoietic percentage of patients who had HCT and family 2190 2018 USA cell transplantation AND influenza vaccinations for family PMe1 J07 J cell transplantation members/household contacts receiving recommendations for members were recommended NQMC 135 annual seasonal influenza vaccinations. Immunizations: percentage of patients or parents (if patient Number of patients or parents (if patient younger than 18 Number of patients, any age, who were eligible for younger than 18 years) who receive education regarding the 2191 2018 USA years) who receive education regarding the importance of PMe5 J07 J immunizations importance of immunizations and recommended immunization immunizations and recommended immunization schedules NQMC 135 schedules. Number of patients eligible for tPA treatment and treated with Number of patients who were treated with tPA according to Diagnosis and treatment of ischemic stroke: percentage of 2192 135 2018 USA PMe1 B01 B NQMC tPA guideline eligible patients receiving tPA according to guideline. VTE prophylaxis: percentage of adult hospitalized patients Number of adult patients who are hospitalized for a medical Number of adult patients hospitalized for a medical condition with creatinine clearance less than 30 mL/min in the medical 2193 2018 USA condition or surgery with creatinine clearance less than 30 or surgery and with creatinine clearance less than 30 mL/min PMe3 B01 B record who receive a reduced dose of anticoagulation mL/min who receive a reduced dose of anticoagulation therapy NQMC 135 therapy. Diagnosis and treatment of ischemic stroke: percentage of Number of patients who were screened for dysphagia before Number of all patients presenting with symptoms of acute ischemic stroke patients who are assessed with a swallow 2194 2018 USA taking any food, fluids or medication (including aspirin) by PMe5 B01 B ischemic stroke screening test before receiving food, fluids or medications by mouth NQMC 135 mouth. Diagnosis and management of asthma: percentage of Number of asthma patients who are discharged on an inhaled 2195 2018 USA Number of asthma patients who were hospitalized hospitalized patients with asthma who are discharged on an PMe1 R03 R anti-inflammatory medication NQMC 135 inhaled anti-inflammatory medication. Home health care patients' experiences: percentage of adult Home health care patients age 18 years and older who The number of "Yes" and "No" responses on the "Specific home health care patients who reported whether their home 2196 2018 USA answered the "Specific Care Issues" questions on the Home O Ge 9 N/A N/A Care Issues" questions health care providers addressed specific care issues related Health Care CAHPS Survey NQMC 135 to pain, medication, and home safety. Eligible patients whose parent or guardian answered the Patient-centered medical home patients' experiences: The number of "Yes" and "No" responses on the question, "In question, "In the last 12 months, did you and anyone in this percentage of parents or guardians who reported whether the last 12 months, did you and anyone in this provider's office 2197 2018 USA provider's office talk at each visit about all the prescription anyone in their child's provider's office talked with them at O Ge 5 N/A N/A talk at each visit about all the prescription medicines your child medicines your child was taking?," on the CAHPS Patient- each visit about all the prescription medicines their child was was taking?" Centered Medical Home Survey, Child Version taking. NQMC 135 Eligible patients who answered the question, "In the last 12 The number of "Yes" and "No" responses on the question, "In Patient-centered medical home patients' experiences: months, did you and anyone in this provider's office talk at the last 12 months, did you and anyone in this provider's office percentage of patients who reported whether anyone in their 2198 2018 USA each visit about all the prescription medicines you were O Ge 5 N/A N/A talk at each visit about all the prescription medicines you were provider's office talked with them at each visit about all the taking?," on the CAHPS Patient-Centered Medical Home taking?" prescription medicines they were taking. NQMC 135 Survey, Adult Version Patients diagnosed with lower extremity VTE as identified by VTE diagnosis and treatment: percentage of patients Patients treated with LMWH (listed with Generic Code the following International Classification of Diseases, Ninth diagnosed with lower extremity VTE who meet the criteria for 2199 2018 USA Number code 7542) for whom shared decision-making was PMe5 B01 B Revision (ICD-9) codes: 451.11, 451.19, 451.2, 453.8, who LMWH and for whom shared decision-making was used prior used prior to therapy selection NQMC 135 meet the criteria for LMWH to implementing therapy. Number of patients as described in the population definition Management of labor: percentage of patients with protracted 2200 135 2018 USA Number of patients who were given PMe1 H01 H NQMC who are in protracted labor labor who are administered oxytocin. Assessment and management of chronic pain: percentage of Number of patients who are prescribed an opioid who have an Number of patients age 18 years and older diagnosed with patients diagnosed with chronic pain who are prescribed an 2201 2018 USA opioid agreement form and urine toxicology screen PMe7 N02 N chronic pain and prescribed opioids opioid who have an opioid agreement form and urine documented in the medical record toxicology screen documented in the medical record. NQMC 135 Diagnosis and treatment of respiratory illness in children and Patients diagnosed with seasonal allergic rhinitis being treated 2202 2018 USA Patients diagnosed with seasonal allergic rhinitis adults: percentage of patients diagnosed with seasonal PMe1 H02 H with injectable corticosteroids allergic rhinitis being treated with injectable corticosteroids. NQMC 135 Lipid management in adults: percentage of patients with Patients with (a) established atherosclerotic cardiovascular established atherosclerotic cardiovascular disease, or 10-year Patients who have a fasting lipid panel within 24 months of 2203 2018 USA disease, (b) 10-year coronary heart disease (CHD) risk CHD risk greater than or equal to 10%, or diabetes and on PMe7 C10 C prescription for lipid-lowering medication greater than or equal to 10%, or (c) diabetes lipid-lowering medication who have a fasting lipid panel within NQMC 135 24 months of medication prescription. Breast cancer: percentage of cycles where patients who are Number of cycles for which breast cancer patients received a Number of cycles for which patients were prescribed colony- prescribed a potentially myelosuppressive chemotherapy 2204 2018 USA PMe1 L01 L04 L potentially myelosuppressive chemotherapy regimen stimulating factor regimen receive a prescription for colony-stimulating factor to begin within 24 to 72 hours after chemotherapy administration. NQMC 135 Number of patients who are up-to-date with following Preventive services for children and adolescents: percentage immunizations: of patients who by age 13 years were up-to-date with ・One HPV – human papillomavirus vaccine (for females) recommended adolescent immunizations: 1) one HPV – Number of patients who reach their 13th birthday during the 2205 2018 USA ・One MCV4 – meningococcal human papillomavirus vaccine by age 13, 2) one MCV4 – PMe1 J07 J specified measurement period ・One Tdap – tetanus, diphtheria toxoids and acellular meningococcal, 3) one Tdap – tetanus, diphtheria toxoids and pertussis vaccine acellular pertussis vaccine, and 4) one influenza vaccine NQMC 135 ・One influenza vaccine within the last year within the last year. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Number of patients age 18 years and older and diagnosed VTE diagnosis and treatment: percentage of patients with Number of patients age 18 years and older and diagnosed with VTE who are initially prescribed warfarin therapy with VTE who are initially prescribed warfarin therapy with 2206 2018 USA PMe7 B01 B with VTE and initially prescribed warfarin documentation in the medical record indicating a baseline INR documentation in the medical record indicating a baseline INR NQMC 135 was obtained was obtained. Management of labor: percentage of patients whose oxytocin 2207 135 2018 USA Number of patients who present in labor Number of patients whose oxytocin is discontinued PMe1 H01 H NQMC is discontinued.

Healthcare personnel in the denominator population, who during the time from when the vaccine became available (e.g., August or September) through March 31 of the following year: Received an influenza vaccination administered at the healthcare facility; or Reported in writing (paper or electronic) or provided documentation that influenza vaccination was received Healthcare personnel who are physically present in the elsewhere; or Influenza vaccination: percentage of healthcare personnel 2208 2018 USA healthcare facility for at least 1 working day between October PMe1 J07 J Were determined to have a medical contraindication/condition who receive the influenza vaccination. 1 and March 31 of the following year of severe allergic reaction to eggs or to other component(s) of the vaccine, or history of Guillain-Barré syndrome within 6 weeks after a previous influenza vaccination; or Were offered but declined influenza vaccination; or Had an unknown vaccination status or did not otherwise meet any of the definitions of the above-mentioned numerator categories. NQMC 135 Stable coronary artery disease: percentage of patients with Number of patients with cardiovascular disease who received 2209 2018 USA Number of stable coronary artery disease patients cardiovascular disease who received an annual influenza PMe1 J07 J an annual influenza vaccination NQMC 135 vaccination. Stable coronary artery disease: percentage of patients with Number of stable coronary artery disease patients who are 2210 2018 USA Number of stable coronary artery disease patients stable coronary artery disease who are prescribed aspirin and PMe1 B01 C10 BC prescribed aspirin and anti-atherosclerotic medications NQMC 135 anti-atherosclerotic medications. VTE diagnosis and treatment: percentage of patients with Number of patients age 18 years and older and diagnosed VTE who are prescribed UFH and LMWH who have Number of patients age 18 years and older and diagnosed with VTE who are prescribed UFH and LMWH who have 2211 2018 USA appropriate laboratory tests (platelets, partial thromboplastin PMe7 B01 B with VTE who are prescribed UFH and LMWH appropriate laboratory tests (platelets; partial thromboplastin time for those on UFH) available to monitor and adjust time for those on UFH) available to monitor and adjust therapy NQMC 135 therapy. MDD: percentage of patients aged 18 years and older with a Patients with documentation of the patient's response to new diagnosis or recurrent episode of MDD with All patients aged 18 years and older with a new diagnosis or treatment three times in the first 90 days following diagnosis, documentation of the patient's response to treatment three 2212 2018 USA PMe7 N06 N recurrent episode of MDD and, if patient has not improved, documentation of treatment times in the first 90 days following diagnosis, and, if patient plan review or alteration has not improved, documentation of treatment plan review or NQMC 135 alteration. Diagnosis and treatment of respiratory illness in children and Patients with a diagnosis of strep pharyngitis and prescribed Patients diagnosed with strep pharyngitis with education on 24- adults: percentage of patients with strep pharyngitis 2213 2018 USA PMe5 J01 J antibiotics hour treatment prior to returning to work, school or day care prescribed antibiotics with documentation of education on 24- hour treatment prior to returning to work, school or day care. NQMC 135 Stable coronary artery disease: percentage of patients with a Number of stable coronary artery disease patients and chronic Number of stable coronary artery disease patients who had a 2214 2018 USA diagnosis of stable coronary artery disease and chronic PMe1 C09 C kidney disease prescription for an ACEI or ARB kidney disease who are prescribed an ACEI or ARB. NQMC 135 Number of patients age 18 years and older who have a high VTE diagnosis and treatment: percentage of VTE patients Number of VTE patients age 18 years and older who have a clinical pretest probability for pulmonary embolism (score who have a high clinical pretest probability (score greater than 2215 2018 USA high clinical pretest probability for pulmonary embolism (score PMe1 B01 B greater than 6) who receive anticoagulation prior to diagnostic 6) for PE who received anticoagulation prior to diagnostic greater than 6) NQMC 135 evaluation evaluation. Diagnosis and treatment of respiratory illness in children and Patients with viral upper-respiratory infection alone who do not 2216 2018 USA Patients with viral upper-respiratory infection diagnosis alone adults: percentage of patients diagnosed with a viral upper- PMe1 J01 J receive an antibiotic respiratory infection who do not receive an antibiotic. NQMC 135 Stable coronary artery disease: percentage of patients with a Number of stable coronary artery disease patients and Number of patients who had a prescription for an ACEI or 2217 2018 USA diagnosis of stable coronary artery disease and hypertension PMe1 C09 C hypertension ARB NQMC 135 who are prescribed an ACEI or ARB. Management of labor: percentage of patients who have an IV 2218 135 2018 USA Number of patients who present in labor Number of patients who have an IV fluid bolus administered PMe1 B05 B NQMC fluid bolus administered. Geriatrics: percentage of patients aged 65 years and older All patients aged 18 years and older discharged from any discharged from any inpatient facility (e.g., hospital, skilled inpatient facility (e.g., hospital, skilled nursing facility, or Patients who had a reconciliation of the discharge nursing facility, or rehabilitation facility) and seen within 30 rehabilitation facility) and seen within 30 days following 2219 2018 USA medications with the current medication list in the outpatient days of discharge in the office by the physician, prescribing P Ge 6 N/A N/A discharge in the office by the physician, prescribing medical record documented practitioner, registered nurse, or clinical pharmacist who had practitioner, registered nurse, or clinical pharmacist providing reconciliation of the discharge medications with the current on-going care medication list in the outpatient medical record documented. NQMC 135 Assessment and management of chronic pain: percentage of Number of patients age 18 years and older diagnosed with Number of patients with a diagnosis and prescribed a sedative patients diagnosed with chronic pain with a diagnosis of 2220 2018 USA neuropathic pain and prescribed a sedative analgesic OR PMe1 N02 N03 N analgesic OR anticonvulsant prior to use of opioids neuropathic pain who are prescribed a sedative analgesic OR anticonvulsant or opioids anticonvulsant prior to use of opioids. NQMC 135 MDD: percentage of patients aged 18 years and older with a Adult patients who have a depression severity classification diagnosis of MDD who have a depression severity and who receive, at a minimum, treatment appropriate to their 2221 2018 USA All patients aged 18 years and older with a diagnosis of MDD classification and who receive, at a minimum, treatment PMe1 N06 N depression severity classification at the most recent visit appropriate to their depression severity classification at the during the measurement period NQMC 135 most recent visit during the measurement period. Assessment and management of chronic pain: percentage of Number of patients diagnosed with chronic pain who are Number of patients age 18 years and older diagnosed with patients diagnosed with chronic pain who are screened for 2222 2018 USA screened for chemical dependency before being prescribed PMe7 N02 N chronic pain and prescribed opioids chemical dependency before being prescribed opioid opioid medication NQMC 135 medication. Diagnosis and treatment of respiratory illness in children and Patients diagnosed with strep pharyngitis who were adults: percentage of patients diagnosed with strep 2223 2018 USA Patients with a diagnosis of strep pharyngitis PMe1 J01 J prescribed first-line medications for strep pharyngitis pharyngitis prescribed first-line medications for strep NQMC 135 pharyngitis. Lipid management in adults: percentage of patients with Patients with (a) established ASCVD, or (b) 10-year CHD risk established ASCVD, or a 10-year CHD risk greater than or greater than or equal to 10%, or (c) diabetes and most recent Patients with LDL greater than 100 who are prescribed a equal to 10%, or diabetes on lipid-lowering medication and 2224 2018 USA PMe13 C10 C LDL greater than 100 mg/dL and are prescribed lipid-lowering maximal recommended dose of a potent statin most recent LDL greater than 100 mg/dL, who are prescribed medication a maximal recommended dose of a potent statin (such as simvastatin, pitavastatin, rosuvastatin or atorvastatin). NQMC 135 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Assessment and management of chronic pain: percentage of Number of patients with documentation of receiving education patients diagnosed with chronic pain with documentation of Number of patients age 18 years and older diagnosed with regarding their diagnosis of chronic pain, medications, 2225 2018 USA receiving education regarding their diagnosis of chronic pain, PMe5 M01 M02 N02 MN chronic pain importance of physical activity, and/or any interventional medications, importance of physical activity and/or any procedures in the medical record interventional procedures in the medical record. NQMC 135 VTE diagnosis and treatment: percentage of patients with any Number of patients age 18 years and older and diagnosed of these diagnosis – VTE, PE, DVT – indicating a complete list Number of patients age 18 years and older and diagnosed with VTE, DVT, or PE for which a complete list of medications of medications was communicated to the next clinician of 2226 2018 USA PMe56 B01 B with any of the following diagnoses: VTE, DVT, or PE was communicated to the next clinician of service when the service when the patient is referred or transferred to another patient was referred or transferred to another care setting setting, service, practitioner or level of care within or outside NQMC 135 the organization. Diagnosis and treatment of respiratory illness in children and Patients diagnosed with strep pharyngitis and prescribed Patients with a diagnosis of strep pharyngitis and prescribed adults: percentage of patients diagnosed with strep 2227 2018 USA antibiotics with education on taking the complete course of PMe5 J01 J antibiotics pharyngitis prescribed antibiotics with documentation of being antibiotics NQMC 135 educated on taking the complete course. Number of patients age 12 years and older with migraine Diagnosis and treatment of : percentage of patients Number of patients age 12 years and older with migraine 2228 2018 USA headache diagnosis and treatment plan who report adherence with migraine headache with a treatment plan who report PMe5 N02 N headache diagnosis and treatment plan NQMC 135 to their treatment plan adherence to their treatment plan. Number of patients age 18 years and older and with VTE VTE diagnosis and treatment: percentage of patients with Number of patients age 18 years and older and with VTE treated with UFH who receive heparin treatment for at least VTE treated with UFH who receive heparin treatment for at 2229 2018 USA PMe4 B01 B treated with UFH five days after the initiation of warfarin therapy and until INR is least five days after the initiation of warfarin therapy and until greater than or equal to 2.0 for two consecutive days INR is greater than or equal to 2.0 for two consecutive days. NQMC 135 Number of patients age 18 years and older diagnosed with VTE who are prescribed UFH and/or LMWH who have VTE diagnosis and treatment: percentage of patients with Number of patients age 18 years and older diagnosed with 2230 2018 USA baseline laboratory tests documented in the medical record: VTE who are prescribed UFH and/or LMWH who have PMe7 B01 B VTE who are prescribed UFH and/or LMWH INR, blood count including platelets, creatinine, weight and baseline laboratory tests documented in their medical record. NQMC 135 baseline partial thromboplastin time Diagnosis and treatment of respiratory illness in children and Patients with a diagnosis of strep pharyngitis and prescribed Patients diagnosed with strep pharyngitis and prescribed adults: percentage of patients diagnosed with strep 2231 2018 USA PMe7 J01 J antibiotics antibiotics who have a negative laboratory strep test pharyngitis, and prescribed antibiotics, who had a negative culture or no rapid group A strep test or strep culture. NQMC 135 Stable coronary artery disease: percentage of patients with Number of stable coronary artery disease patients who had 2232 2018 USA Number of stable coronary artery disease patients documentation in the medical record of receiving a pneumonia PMe1 J07 J documented pneumonia vaccination vaccination according to the CDC recommendations. NQMC 135 Stable coronary artery disease: percentage of patients with Number of patients who had prognostic assessment documentation in the medical record of prognostic 2233 2018 USA Number of stable coronary artery disease patients PMe7 B01 B preceding or following a course of pharmacologic therapy assessment preceding or following a course of pharmacologic NQMC 135 therapy. Number of patients in preterm labor who received antenatal Management of labor: percentage of patients with preterm 2234 2018 USA Number of patients in preterm labor PMe1 H02 H corticosteroids prior to delivery labor who received antenatal corticosteroids prior to delivery. NQMC 135 Number of patients age 12 years and older and with migraine Diagnosis and treatment of headache: percentage of patients Number of patients age 12 years and older with migraine 2235 2018 USA headache diagnosis who are prescribed opiates or with migraine headache with a prescription for opiates or PMe1 N02 N05 N headache diagnosis NQMC 135 barbiturates for the treatment of migraine barbiturates for the treatment of migraine. ・Patients with at least one documented assessment during Breast cancer: percentage of patients with at least one the 12-month period after completing the final component of documented assessment during the 12-month period after the treatment plan for each of the following: fatigue, pain, completing the final component of the treatment plan for each Breast cancer patients stage 0 to III who have completed the 2236 2018 USA psychosocial distress, and sleep of the following: fatigue, pain, psychosocial distress, sleep; PMe7 L01 L02 L final component of the treatment plan ・Assessment for bone health risk, lymphedema, menopausal assessment for bone health risk, lymphedema, menopausal symptoms, or neuropathy as applicable to the patient based symptoms, or neuropathy as applicable to the patient based NQMC 135 on the types of treatments received on the types of treatments received. Stable coronary artery disease: percentage of patients with Number of stable coronary artery disease patients with Number of patients who had a prescription for an ACEI or diagnosis of stable coronary artery disease with systolic CHF 2237 2018 USA PMe1 C09 C systolic CHF (ejection fraction less than or equal to 40%) ARB (ejection fraction less than or equal to 40%) who are NQMC 135 prescribed an ACEI or ARB. Number of patients age 18 years and older and diagnosed VTE diagnosis and treatment: percentage of hospitalized Number of patients age 18 years and older and diagnosed 2238 2018 USA with VTE and hospitalized who receive warfarin on day one of patients with VTE who receive warfarin on day one of heparin PMe15 B01 B with VTE and hospitalized NQMC 135 heparin therapy therapy. Heart failure in adults: percentage of patients with heart failure Number of patients 18 years and older with a diagnosis of diagnosis and LVSD who at the last clinic visit met the Number of patients age 18 years and older with a diagnosis of 2239 2018 USA heart failure and LVSD who were prescribed or were taking following (if eligible): prescribed or were on ACEI/ARB, PMe1 C07 C09 C heart failure and LVSD ACEI/ARB, beta-blocker therapy and a non-smoker prescribed or were on beta-blocker therapy, and a non- NQMC 135 smoker. Breast cancer: percentage of patients with a documented Breast cancer patients prior to the second moderately or Patients who received documented assessment for assessment for chemotherapy-induced nausea and vomiting 2240 2018 USA PMe7 L01 L highly emetogenic chemotherapy treatment at this facility chemotherapy-induced nausea and vomiting prior to the second round of moderately or highly emetogenic NQMC 135 chemotherapy treatment. Number of patients age 18 years and older and with VTE VTE diagnosis and treatment: percentage of patients with Number of patients age 18 years and older and with VTE treated with LMWH who receive heparin treatment for at least VTE treated with LMWH who receive heparin treatment for at 2241 2018 USA PMe4 B01 B treated with LMWH five days after the initiation of warfarin therapy and until INR is least five days after the initiation of warfarin therapy and until greater than or equal to 2.0 for two consecutive days INR is greater than or equal to 2.0 for two consecutive days. NQMC 135 Patients that have documented instruction on hand washing Breast cancer: percentage of patients with documented Breast cancer patients who received intravenous 2242 2018 USA and to contact his or her health care provider in the event of education on neutropenia precautions prior to or at the time of PMe5 L01 L chemotherapy the development of a practice-defined specific level of fever the first chemotherapy administration. NQMC 135 Breast cancer: percentage of patients who received a Patients with an exercise program recommended prior to the 2243 2018 USA Breast cancer patients who have begun chemotherapy recommendation for an exercise program prior to the first PMe5 L01 L first chemotherapy treatment NQMC 135 chemotherapy treatment. Assessment and management of chronic pain: percentage of Number of patients age 18 years and older diagnosed with Number of patients who are referred to diagnostic and/or chronic pain patients who are referred to diagnostic and/or 2244 2018 USA chronic pain and whose pain control and functional status therapeutic procedures if the goals for pain control or PMe7 H02 N02 HN therapeutic procedures if the goals for pain control or goals have not been met functional status have not been met NQMC 135 functional status have not been met. Lipid management in adults: percentage of patients with Patients with (a) established ASCVD, (b) 10-year CHD risk established ASCVD, or 10-year CHD risk greater than or Patients who remain on pharmacotherapy 12 months after 2245 2018 USA greater than or equal to 10%, or (c) diabetes and are equal to 10%, or diabetes and on lipid-lowering therapy who PMe4 C10 C therapy was prescribed prescribed lipid-lowering medication remain on lipid-lowering pharmacotherapy 12 months after NQMC 135 therapy was prescribed. Assessment and management of chronic pain: percentage of Number of patients who are receiving opioids who have patients diagnosed with chronic pain who are receiving documentation of the four A's assessment: 1) the degree of Number of patients age 18 years and older diagnosed with opioids who have documentation of the four A's assessment: 2246 2018 USA analgesia, 2) current opioid-related side effects, 3) current PMe7 N02 N chronic pain and prescribed opioids 1) the degree of analgesia, 2) current opioid-related side functional status and 4) existence of aberrant drug-related effects, 3) current functional status and 4) existence of behaviors documented at each visit aberrant drug-related behaviors documented at each visit. NQMC 135 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Lipid management in adults: percentage of patients with Patients with (a) established ASCVD, (b) 10-year risk for CHD Patients who are on a statin therapy OR have LDL less than established ASCVD, or a 10-year risk for CHD greater than or 2247 2018 USA PMe1 C10 C greater than or equal to 10%, or (c) diabetes 100 mg/dL equal to 10%, or diabetes, who are on a statin or have LDL NQMC 135 less than 100 ml/dL within a 12-month period. Number of patients diagnosed with chronic pain who are Assessment and management of chronic pain: percentage of Number of patients age 18 years and older diagnosed with 2248 2018 USA prescribed an opioid at a dose less than 100 mg per day of patients diagnosed with chronic pain who are prescribed an PMe3 N02 N chronic pain and prescribed an opioid morphine opioid at a dose less than 100 mg per day of morphine. NQMC 135 Number of patients age 12 years and older with primary Diagnosis and treatment of headache: percentage of patients Number of patients age 12 years and older with primary 2249 2018 USA headache syndrome who are prescribed prophylactic with primary headache syndrome who are prescribed PMe1 N02 N headache syndrome NQMC 135 treatment when appropriate prophylactic treatment when appropriate. Number of all patients aged greater than or equal to 65 years Number of patients with severe opioid-related constipation or Pain management: percentage of patients with severe opioid- 2250 135 2018 USA OMe8 N02 N NQMC receiving opioid treatment for pain fecal impaction related constipation or fecal impaction. Number of all patients aged greater than or equal to 65 years Number of all patients with controlled ADRs to pain Pain management: percentage of patients with controlled 2251 135 2018 USA OMe8 M01 M02 N02 MN NQMC receiving pain medication who had an ADR medications ADRs to pain medications. Antidepressant medication management (effective Patients age 18 years and older as of April 30 of the continuation phase treatment): percentage of patients 18 At least 180 days (6 months) of continuous treatment with measurement year, with a Negative Medication History, with a years of age and older who were diagnosed with a new 2252 2018 USA antidepressant medication during the 231-day period following PMe4 N06 N diagnosis of major depression, and who were treated with episode of major depression, treated with antidepressant the Index Prescription Start Date (inclusive) antidepressant medication during the Intake Period medication, and who remained on an antidepressant NQMC 135 medication for at least 180 days (6 months). Antidepressant medication management (effective acute Patients age 18 years and older as of April 30 of the phase treatment): percentage of patients 18 years of age and At least 84 days (12 weeks) of continuous treatment with measurement year, with a Negative Medication History, with a older who were diagnosed with a new episode of major 2253 2018 USA antidepressant medication during the 114-day period following PMe4 N06 N diagnosis of major depression, and who were treated with depression, treated with antidepressant medication, and who the Index Prescription Start Date antidepressant medication during the Intake Period remained on an antidepressant medication for at least 84 NQMC 135 days (12 weeks). Number of all patients receiving pain medication aged greater Number of patients with adverse drug reactions related to pain Pain management: percentage of patients with adverse drug 2254 135 2018 USA OMe8 M01 M02 N02 MN NQMC than or equal to 65 years medications reactions related to pain medications. Adolescent assessment of preparation for transition to adult- For survey items within each composite score, the For survey items within each composite score, the numerator focused health care: composite score for the "Counseling on 2255 2018 USA denominator is the number of respondents for whom the item is the number of respondents with a positive response (item O Ge 5 N/A N/A Prescription Medication" domain on the Adolescent is scored as 0 or 1. score of 1). Assessment of Preparation for Transition Survey. NQMC 135 Hospital inpatients with an admission during the reporting The number of "Never," "Sometimes," "Usually," or "Always" Hospital inpatients' experiences: percentage of adult 2256 2018 USA period who answered the "Communication about Medicines" responses on the "Communication about Medicines" inpatients who reported how often the hospital staff O Ge 5 N/A N/A NQMC 135 questions on the CAHPS Hospital Survey questions communicated well about new medications. Hospital inpatients with an admission during the reporting The number of "Yes, definitely" responses on the Hospital inpatients' experiences: percentage of parents who period whose parent answered the "Communication About 2257 2018 USA "Communication About Your Child's Medicines" items on the reported whether providers communicated about their child's O Ge 5 N/A N/A Your Child's Medicines" items on the Child Hospital CAHPS Child Hospital CAHPS Survey medicines. NQMC 135 Survey Children age 2 years as of July 1 of the year prior to the measurement year to 18 years of age as of June 30 of the Appropriate testing for children with pharyngitis: percentage of measurement year, with a 30-day Negative Medication A group A streptococcus test in the seven-day period from children 2 to 18 years of age who were diagnosed with 2258 2018 USA History, who had an outpatient or ED visit during the Intake three days prior to the IESD through three days after the IESD PMe7 J01 J pharyngitis, dispensed an antibiotic medication, and received Period with only a diagnosis of pharyngitis and who were (see the related "Numerator Inclusions/Exclusions" field) a group A streptococcus test for the episode. dispensed or prescribed an antibiotic medication on or three NQMC 135 days after the Episode Date Number of patients having preoperative recommendations Perioperative protocol: percentage of patients with documented/communicated to the patient and/or surgical comorbidities undergoing elective non-high-risk surgery who facility for all of the following applicable comorbidities: have preoperative recommendations ・Antithrombotic therapy Number of patients age two years and older with comorbidities documented/communicated to the patient and/or surgical 2259 2018 USA ・Recent coronary stent/antiplatelet therapy PMe5 B01 C07 BC undergoing elective non-high-risk surgery facility for all of the following applicable comorbidities: ・Beta-blocker therapy antithrombotic therapy, recent coronary stent/antiplatelet ・Diabetes mellitus therapy, beta-blocker therapy, diabetes mellitus, sleep apnea, ・Sleep apnea and cessation. NQMC 135 ・Nicotine cessation

・Rate 1: Drug-disease interactions—history of falls and ・Rate 1: Drug-disease interactions—history of falls and anticonvulsants, nonbenzodiazepine hypnotics, SSRIs, anticonvulsants, nonbenzodiazepine hypnotics, SSRIs, , antipsychotics, benzodiazepines or tricyclic antiemetics, antipsychotics, benzodiazepines or tricyclic antidepressants: Patients age 67 years and older as of antidepressants: Dispensed an ambulatory prescription for an December 31 of the measurement year who had an anticonvulsant, nonbenzodiazepine hypnotic, SSRI or accidental fall or hip fracture on or between January 1 of the antiemetic, antipsychotic, benzodiazepine or tricyclic year prior to the measurement year and December 1 of the antidepressant on or between the IESD and December 31 of measurement year the measurement year ・Rate 2: Drug-disease interactions—dementia and ・Rate 2: Drug-disease interactions—dementia and Potentially harmful drug-disease interactions in the elderly: antiemetics, antipsychotics, benzodiazepines, tricyclic antiemetics, antipsychotics, benzodiazepines, tricyclic percentage of Medicare patients 65 years of age and older antidepressants, H2 receptor antagonists, nonbenzodiazepine antidepressants, H2 receptor antagonists, nonbenzodiazepine who have evidence of an underlying disease, condition or 2260 2018 USA hypnotics or anticholinergic agents: Patients age 67 years and hypnotics or anticholinergic agents: Dispensed an ambulatory PMe1 A02 A03 A04 M01 M02 N03 N04 N05 N06 R03 S01 A M N R S health concern and who were dispensed an ambulatory older as of December 31 of the measurement year with a prescription for an antiemetic, antipsychotic, benzodiazepine prescription for a potentially harmful medication, concurrent diagnosis of dementia or a dispensed dementia medication on or tricyclic antidepressant or H2 receptor antagonist, with or after the diagnosis. or between January 1 of the year prior to the measurement nonbenzodiazepine hypnotic or anticholinergic agent on or year and December 1 of the measurement year between the IESD and December 31 of the measurement ・Rate 3: Drug-disease interactions—Cox-2 selective NSAIDs year or nonasprin NSAIDs: Patients age 67 years and older as of ・Rate 3: Drug-disease interactions—Cox-2 selective NSAIDs December 31 of the measurement year with chronic kidney or nonasprin NSAIDs: Evidence of an NSAID or Cox-2 disease as identified by a diagnosis of end-stage renal selective NSAID on or between the IESD and December 31 of disease, stage 4 chronic kidney disease or kidney transplant the measurement year on or between January 1 of the year prior to the measurement (Total rate (the sum of the three numerators divided by the year and December 1 of the measurement year sum of the three denominators)) NQMC 135 Statin therapy for patients with diabetes: percentage of Members age 40 to 75 years as of December 31 of the members 40 to 75 years of age during the measurement year measurement year with diabetes who do not have ASCVD The number of members who achieved a PDC of at least 80% 2261 2018 USA with diabetes who do not have ASCVD who remained on a PMe5 C10 C who had at least one dispensing event for a statin medication during the treatment period statin medication of any intensity for at least 80% of the of any intensity during the measurement year NQMC 135 treatment period. All visits for patients with a diagnosis of epilepsy actively Epilepsy: percentage of all patients with a diagnosis of Patients with anti-seizure therapy side effects for whom an 2262 2018 USA receiving anti-seizure therapy with a side effect noted at time epilepsy with active anti-seizure therapy side effects for whom PMe5 N03 N intervention was discussed NQMC 135 of visit an intervention was discussed. Immunizations for adolescents: percentage of adolescents 13 Adolescents who received one dose of meningococcal years of age who had one dose of meningococcal vaccine Adolescents who turn 13 years of age during the vaccine and one tetanus, diphtheria toxoids and acellular 2263 2018 USA and one tetanus, diphtheria toxoids and acellular pertussis PMe1 J07 J measurement year pertussis vaccine or one tetanus, diphtheria toxoids vaccine vaccine or one tetanus, diphtheria toxoids vaccine by their by their 13th birthday NQMC 135 13th birthday. Diagnosis and management of T2DM in adults: percentage of Number of patients ages 40 to 75 years old who have T2DM 2264 2018 USA Number of patients who are prescribed statin therapy patients ages 40 to 75 years old with untreated LDL greater PMe1 C10 C and untreated LDL greater than 70 mg/dL than 70 mg/dL who are prescribed statin therapy. NQMC 135 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Appropriate testing or treatment for osteoporosis after the fracture defined by any one of the following criteria:

Women age 67 to 85 years as of December 31 of the A BMD test on the IESD or in the 180-day (6-month) period Osteoporosis management in women who had a fracture: measurement year, with a Negative Diagnosis History, who after the IESD percentage of women 67 to 85 years of age who suffered a 2265 2018 USA had an outpatient visit, an observation visit, an ED visit, a A BMD test during the inpatient stay for the fracture (applies PMe1 G03 H05 M05 GHM fracture and who had either a BMD test or prescription for a nonacute inpatient encounter or an acute inpatient encounter only to fractures requiring hospitalization) drug to treat osteoporosis in the six months after the fracture. for a fracture during the Intake Period Osteoporosis therapy on the IESD or in the 180-day (6-month) period after the IESD A dispensed prescription to treat osteoporosis on the IESD or NQMC 135 in the 180-day (6-month) period after the IESD Use of high-risk medications in the elderly: percentage of Patients age 66 years and older as of December 31 of the Patients who received at least one high-risk medication during 2266 2018 USA patients 66 years of age and older who received at least one PMe1 A03 B01 C01 C02 C04 G03 M01 M02 M03 N01 N04 N05 N06 R06 A B C G M N R measurement year the measurement year NQMC 135 high-risk medication. The eligible population for the numerator is the number of Sepsis: proportion of hospitalized children younger than 19 The eligible population for the denominator is the number of hospitalized children younger than 19 years of age with years of age with severe sepsis or septic shock who received 2267 2018 USA hospitalized children younger than 19 years of age with severe sepsis or septic shock who received parenteral PMe15 J01 J parenteral antibiotics within 60 minutes of meeting diagnostic severe sepsis or septic shock antibiotics within 60 minutes of meeting diagnostic criteria for criteria for either condition. NQMC 135 these conditions The eligible population for the numerator is the number of Sepsis: proportion of hospitalized children younger than 19 The eligible population for the denominator is the number of hospitalized children younger than 19 years of age with years of age with severe sepsis or septic shock whose heart hospitalized children younger than 19 years of age with severe sepsis or septic shock whose heart rate was rate was documented at least every 15 minutes for the first 2268 2018 USA PMe7 B05 B severe sepsis or septic shock who received intravenous or documented at least every 15 minutes for the first hour of hour of intravenous or intraosseous fluid resuscitation and intraosseous fluid resuscitation intravenous or intraosseous fluid resuscitation and then hourly then hourly thereafter until resolution of their condition, or for thereafter until resolution of their condition or for 24 readings 24 readings. NQMC 135 Epilepsy: all female patients of childbearing potential (12 to 44 Female patients or caregivers counseled at least once a year All females of childbearing potential (12 to 44 years old) with a years old) diagnosed with epilepsy who were counseled or 2269 2018 USA about how epilepsy and its treatment may affect contraception PMe5 N03 N diagnosis of epilepsy referred for counseling for how epilepsy and its treatment may OR pregnancy affect contraception OR pregnancy at least once a year. NQMC 135 Use of high-risk medications in the elderly: percentage of Patients age 66 years and older as of December 31 of the Patients who received at least two different high-risk 2270 2018 USA patients 66 years of age and older who received at least two PMe1 A03 B01 C01 C02 C04 G03 M01 M02 M03 N01 N04 N05 N06 R06 A B C G M N R measurement year medications during the measurement year NQMC 135 different high-risk medications. Follow-up care for children prescribed ADHD medication Identify all patients who meet the following criteria: Patients age 6 years as of March 1 of the year prior to the (continuation and maintenance phase): percentage of patients ・An outpatient, intensive outpatient or partial hospitalization measurement year to 12 years as of February 28 of the 6 to 12 years of age as of the index prescription start date with follow-up visit with a practitioner with prescribing authority measurement year, with a Negative Medication History, who an outpatient ADHD medication who remained on the 2271 2018 USA within 30 days after the IPSD PMe7 N06 N were dispensed an ADHD medication during the 12-month medication for at least 210 days and who, in addition to the and Intake Period who remained on the medication for at least 210 visit in the initiation phase, had at least two follow-up visits ・Had at least two follow-up visits from 31 to 300 days (9 days with a practitioner within 270 days (9 months) after the months) after the IPSD with any practitioner NQMC 135 initiation phase ended. Number of male patients ages 45 to 79 years at risk for Preventive services for adults: percentage of male patients Number of male patients ages 45 to 79 years at risk for 2272 2018 USA myocardial infarctions who receive aspirin chemoprophylaxis ages 45 to 79 years at risk for myocardial infarctions who PMe5 B01 B myocardial infarctions NQMC 135 counseling receive aspirin chemoprophylaxis counseling. Number of all patients aged greater than or equal to 65 years Number of patients who are being monitored for side effects UI: percentage of patients who are being monitored for side 2273 2018 USA PMe7 G04 G receiving medication for UI of medication prescribed for the treatment of UI effects of medications prescribed for the treatment of UI. NQMC 135 The eligible population for the numerator is the number of SCD: percentage of children younger than 18 years of age The eligible population for the denominator is the number of children younger than 18 years of age with SCD who identified as having SCD presenting to an ED with fever who children younger than 18 years of age with SCD who presented to an ED with fever during the measurement year 2274 2018 USA received parenteral broad-spectrum antibiotic treatment within PMe15 J01 J presented to an ED with fever during the measurement year (January 1 to December 31) and received parenteral broad- 60 minutes following initial contact during the measurement (January 1 to December 31) spectrum antibiotic treatment within 60 minutes following initial year. NQMC 135 contact The eligible population for the numerator is the number of The eligible population for the denominator is the number of SCD: percentage of children younger than 18 years of age children younger than 18 years of age with SCD who children younger than 18 years of age with SCD presenting to identified as having SCD presenting to an ED with severe pain 2275 2018 USA presented to an ED with severe pain who had parenteral PMe15 N02 N the ED with severe pain during the measurement year who had a parenteral analgesic within 60 minutes following analgesic within 60 minutes following initial contact during the (January 1 to December 31) initial contact during the measurement year. NQMC 135 measurement year Pain management: percentage of patients on opioid Number of all patients on opioid medications aged greater Number of patients on opioid medications receiving an 2276 2018 USA medications receiving an appropriate constipation prevention PMe1 A06 N02 AN than or equal to 65 years appropriate constipation prevention regime NQMC 135 regime. Diagnosis and management of T2DM in adults: percentage of Number of patients ages 18 to 75 years old who have type 2 Number of patients with established ASCVD with documented 2277 2018 USA patients with established ASCVD with documented aspirin PMe1 B01 B diabetes mellitus aspirin use (unless contraindicated) NQMC 135 use. Prostate cancer: percentage of patients, regardless of age, All patients, regardless of age, with a diagnosis of prostate with a diagnosis of prostate cancer at high or very high risk of Patients who were prescribed adjuvant hormonal therapy 2278 2018 USA cancer at high or very high risk of recurrence receiving recurrence, receiving external beam radiotherapy to the PMe1 L02 L (GnRH agonist or antagonist) external beam radiotherapy to the prostate prostate who were prescribed adjuvant hormonal therapy NQMC 135 (GnRH agonist or antagonist). Number of patients who have failed on nonpharmacologic Urinary incontinence: percentage of patients who have failed Number of patients who have failed on nonpharmacologic 2279 2018 USA interventions and are then evaluated for pharmacologic on nonpharmacologic interventions and are then evaluated for PMe7 G04 G interventions aged greater than or equal to 65 years NQMC 135 treatment pharmacologic treatment. Use of appropriate medications for people with asthma: Patients age 5 to 64 years by December 31 of the percentage of patients 5 to 64 years of age during the Evidence of at least one asthma medication for a preferred 2280 2018 USA measurement year who were identified as having persistent measurement year who were identified as having persistent PMe1 R03 R therapy during the measurement year asthma asthma and who were appropriately dispensed medication NQMC 135 during the measurement year. ・Rate 1: Annual monitoring for patients on ACEIs or ARBs: ・Rate 1: Annual monitoring for patients on ACEIs or ARBs: Patients age 18 years and older as of December 31 of the At least one serum potassium and a serum creatinine measurement year who received at least 180 treatment days therapeutic monitoring test in the measurement year Annual monitoring for patients on persistent medications: of ACEIs or ARBs during the measurement year ・Rate 2: Annual monitoring for patients on digoxin: At least percentage of patients 18 years of age and older who ・Rate 2: Annual monitoring for patients on digoxin: Patients one serum potassium, at least one serum creatinine, and at received at least 180 treatment days of ambulatory medication age 18 years and older as of December 31 of the least one serum digoxin therapeutic monitoring test in the 2281 2018 USA therapy for a select therapeutic agent during the PMe7 C01 C03 C09 C measurement year who received at least 180 treatment days measurement year measurement year and had at least one therapeutic of digoxin during the measurement year ・Rate 3: Annual monitoring for patients on diuretics: At least monitoring event for the therapeutic agent in the ・Rate 3: Annual monitoring for patients on diuretics: Patients one serum potassium and a serum creatinine therapeutic measurement year. age 18 years and older as of December 31 of the monitoring test in the measurement year measurement year who received at least 180 treatment days (Total rate (the sum of the three numerators divided by the of a diuretic during the measurement year sum of the three denominators)) NQMC 135 Number of patients having appropriate management of comorbidities prior to surgery, including: Perioperative protocol: percentage of patients with ・Antithrombotic therapy comorbidities undergoing elective non-high-risk surgery who Number of patients age two years and older with comorbidities ・Recent coronary stent/antiplatelet therapy have appropriate management of comorbidities prior to 2282 2018 USA PMe1 B01 C07 J01 N07 BCJN undergoing elective non-high-risk surgery ・Beta-blocker therapy surgery, including antithrombotic therapy, recent coronary ・Diabetes mellitus stent/antiplatelet therapy, beta-blocker therapy, diabetes ・Sleep apnea mellitus, sleep apnea, and nicotine cessation. NQMC 135 ・Nicotine cessation Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Number of female patients ages 55 to 79 years at risk for Preventive services for adults: percentage of female patients Number of female patients ages 55 to 79 years at risk for 2283 2018 USA ischemic stroke who receive aspirin chemoprophylaxis ages 55 to 79 years at risk for ischemic stroke who receive PMe5 B01 B ischemic stroke NQMC 135 counseling aspirin chemoprophylaxis counseling. Children age 3 months as of July 1 of the year prior to the measurement year to 18 years as of June 30 of the Appropriate treatment for children with upper respiratory measurement year, with a Negative Medication History and a Evidence of antibiotic medication dispensed or prescribed on infection: percentage of children 3 months to 18 years of age 2284 2018 USA PMe1 J01 J Negative Competing Diagnosis, who had an outpatient or ED or three days after the IESD who were given a diagnosis of upper respiratory infection and visit with only a diagnosis of upper respiratory infection during were not treated with an antibiotic medication. NQMC 135 the Intake Period The eligible population for the numerator is the number of Sickle cell disease: percentage of children younger than 18 The eligible population for the denominator is the number of children younger than 18 years of age with SCD who years of age identified as having SCD presenting to an ED children younger than 18 years of age with SCD presenting to presented to an ED with severe pain who had a pain 2285 2018 USA with severe pain who had a pain assessment within 30 PMe17 N02 N the ED with severe pain during the measurement year assessment within 30 minutes following analgesic minutes following analgesic administration during the (January 1 to December 31) administration during the measurement year (January 1 to measurement year. NQMC 135 December 31) Medication reconciliation post-discharge: percentage of Discharges for patients age 66 years and older as of Medication reconciliation conducted by a prescribing discharges from January 1 to December 1 of the December 31 of the measurement year who had an acute or 2286 2018 USA practitioner, clinical pharmacist, or registered nurse on or measurement year for patients 66 years of age and older for P Ge 6 N/A N/A nonacute inpatient discharge on or between January 1 and within 30 days of discharge whom medications were reconciled on or within 30 days of December 1 of the measurement year NQMC 135 discharge. Number of patients with UI who have had nonessential Urinary incontinence: percentage of patients with UI who have Number of all patients with UI receiving pharmacologic 2287 2018 USA anticholinergic medications discontinued to reduce the overall had nonessential anticholinergic medications discontinued to PMe1 A03N04R03S01 ANRS therapy aged greater than or equal to 65 years NQMC 135 anticholinergic load reduce the overall anticholinergic load. Children who had four diphtheria, tetanus, and acellular Childhood immunization status: percentage of children 2 pertussis vaccinations; three polio vaccinations; one measles, years of age who had four diphtheria, tetanus, and acellular mumps, and rubella vaccination; three haemophilus influenza pertussis; three polio; one measles, mumps, and rubella; Children who turn two years of age during the measurement type B vaccinations; three hepatitis B vaccinations; one 2288 2018 USA three H influenza type B; three hepatitis B; one chicken pox PMe1 J07 J year chicken pox (VZV) vaccination; four pneumococcal conjugate (VZV); four pneumococcal conjugate; one hepatitis A; two or vaccinations; one hepatitis A vaccination; two or three three rotavirus; and two influenza vaccines by their second rotavirus vaccinations; and two influenza vaccinations by their birthday. NQMC 135 second birthday Patients age 6 years as of March 1 of the year prior to the Follow-up care for children prescribed ADHD medication measurement year to 12 years as of February 28 of the An outpatient, intensive outpatient or partial hospitalization (initiation phase): percentage of patients 6 to 12 years of age 2289 2018 USA measurement year, with a Negative Medication History, who follow-up visit with a practitioner with prescribing authority as of the index prescription start date with an outpatient ADHD PMe7 N06 N were dispensed an ADHD medication during the 12-month within 30 days after the IPSD medication who had one follow-up visit with a practitioner with Intake Period prescribing authority during the 30-day initiation phase. NQMC 135 The eligible population for the numerator is the number of Sickle cell disease: percentage of children younger than 18 The eligible population for the denominator is the number of children younger than 18 years of age with sickle cell anemia years of age identified as having sickle cell anemia who children younger than 18 years of age with sickle cell anemia who received anticipatory guidance regarding the risks and 2290 2018 USA received anticipatory guidance regarding the risks and PMe5 B03 B who received outpatient care during the measurement year benefits of treatment with hydroxyurea as part of outpatient benefits of treatment with hydroxyurea as part of outpatient (January 1 to December 31) care during the measurement year (January 1 to December care during the measurement year. NQMC 135 31) Ischemic stroke patients who develop a symptomatic Stroke: percentage of ischemic stroke patients who develop a Ischemic stroke patients treated with intravenous thrombolytic intracranial hemorrhage less than or equal to 36 hours after symptomatic intracranial hemorrhage within (less than or 2291 2018 USA therapy only or intra-arterial t-PA therapy, or who undergo the onset of treatment with intravenous thrombolytic therapy, equal to) 36 hours after the onset of treatment with IV or IA OMe8 B01 B mechanical endovascular reperfusion therapy or intra-arterial t-PA therapy, or mechanical endovascular thrombolytic therapy, or mechanical endovascular reperfusion NQMC 135 reperfusion therapy procedure. Stroke: percentage of ischemic stroke patients with a post- treatment reperfusion grade of thrombolysis in cerebral Ischemic stroke patients treated with intra-arterial thrombolytic Ischemic stroke patients with a post-treatment reperfusion infarction 2B or higher in the vascular territory beyond the 2292 2018 USA OMe9 B01 B therapy and/or mechanical endovascular reperfusion therapy grade of thrombolysis in cerebral infarction 2B or higher target arterial occlusion at the end of treatment with IA thrombolytic therapy and/or mechanical endovascular NQMC 135 reperfusion therapy. Health plan members' experiences: percentage of adult health Eligible members age 18 years and older who answered the plan members who reported how often they were able to find The number of "Never," "Sometimes," "Usually," and "Always" 2293 2018 USA "Plan Information on Costs" questions on the CAHPS Health out from their health plan how much they would have to pay O Ge 9 N/A N/A responses on the "Plan Information on Costs" questions Plan Survey 5.0H, Adult Version for a healthcare service or equipment and specific prescription NQMC 135 medicines. Eligible members with chronic conditions age 17 years and Health plan members' experiences: percentage of younger whose parent/caretaker answered the "Access to The number of "Never," "Sometimes," "Usually," and "Always" parents/caretakers of health plan members who reported how 2294 2018 USA O Ge 6 N/A N/A Prescription Medicines" question on the CAHPS Health Plan responses on the "Access to Prescription Medicines" question often it was easy to get prescription medicines for their NQMC 135 Survey 5.0H, Child Version children with chronic conditions. Stroke: percent of ischemic and hemorrhagic stroke patients Ischemic or hemorrhagic stroke patients who received VTE who received VTE prophylaxis or who have documentation 2295 2018 USA Ischemic or hemorrhagic stroke patients prophylaxis or have documentation why no VTE prophylaxis PMe1 B01 B why no VTE prophylaxis was given the day of or the day after was given on the day of or the day after hospital admission NQMC 135 hospital admission. Proportion of days covered: percentage of patients who filled Patients 18 years and older who filled at least two The number of patients who met the PDC threshold of 80% at least two prescriptions for a sulfonylurea or sulfonylurea 2296 2018 USA prescriptions for a sulfonylurea or sulfonylurea combination on PMe5 A10 A during the measurement year combination on two unique dates of service who met the PDC two unique dates of service during the measurement period threshold of 80% during the measurement period. NQMC 135 Pharmacotherapy management of COPD exacerbation: Members 40 years of age or older as of January 1 of the percentage of COPD exacerbations for members 40 years of Dispensed prescription for systemic corticosteroid on or 14 measurement year with a COPD exacerbation as indicated by age and older who had an acute inpatient discharge or ED 2297 2018 USA days after the Episode Date. Count systemic corticosteroids PMe1 H02 H an acute inpatient discharge or an ED visit with a principal visit on or between January 1 and November 30 of the that are active on the relevant date. diagnosis of COPD measurement year and who were dispensed a systemic NQMC 135 corticosteroid within 14 days of the event. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka

・Rate 1: Drug-disease interactions—history of falls and ・Rate 1: Drug-disease interactions—history of falls and anticonvulsants, nonbenzodiazepine hypnotics, SSRIs, anticonvulsants, nonbenzodiazepine hypnotics, SSRIs, antiemetics, antipsychotics, benzodiazepines or tricyclic antiemetics, antipsychotics, benzodiazepines or tricyclic antidepressants: Medicare members age 67 years and older antidepressants: Dispensed an ambulatory prescription for an as of December 31 of the measurement year who had an anticonvulsant, nonbenzodiazepine hypnotic, SSRI, or accidental fall or hip fracture on or between January 1 of the antiemetic, antipsychotic, benzodiazepine or tricyclic year prior to the measurement year and December 1 of the antidepressant on or between the IESD and December 31 of measurement year the measurement year ・Rate 2: Drug-disease interactions—dementia and ・Rate 2: Drug-disease interactions—dementia and antiemetics, antipsychotics, benzodiazepines, tricyclic antiemetics, antipsychotics, benzodiazepines, tricyclic Potentially harmful drug-disease interactions in the elderly: antidepressants, H2 receptor antagonists, nonbenzodiazepine antidepressants, H2 receptor antagonists, nonbenzodiazepine percentage of Medicare members 65 years of age and older hypnotics or anticholinergic agents: Medicare members age hypnotics or anticholinergic agents: Dispensed an ambulatory who have evidence of an underlying disease, condition or 2298 2018 USA PMe1 A02 A03 A04 M01 M02 N03 N04 N05 N06 R03 S01 A M N R S 67 years and older as of December 31 of the measurement prescription for an antiemetic, antipsychotic, benzodiazepine health concern and who were dispensed an ambulatory year with a diagnosis of dementia or a dispensed dementia or tricyclic antidepressant or H2 receptor antagonist, prescription for a potentially harmful medication, concurrent medication on or between January 1 of the year prior to the nonbenzodiazepine hypnotic or anticholinergic agent on or with or after the diagnosis. measurement year and December 1 of the measurement year between the IESD and December 31 of the measurement ・Rate 3: Drug-disease interactions—Cox-2 selective year nonsteroidal anti-inflammatory drugs or nonasprin NSAIDs: ・Rate 3: Drug-disease interactions—Cox-2 selective Medicare members age 67 years and older as of December nonsteroidal anti-inflammatory drugs or nonasprin NSAIDs: 31 of the measurement year with chronic kidney disease as Dispensed an ambulatory prescription for an NSAID or Cox-2 identified by a diagnosis of end-stage renal disease, stage 4 selective NSAID on or between the IESD and December 31 of chronic kidney disease or kidney transplant on or between the measurement year January 1 of the year prior to the measurement year and (Total rate (the sum of the three numerators divided by the December 1 of the measurement year sum of the three denominators)) NQMC 135 The number of MDS patients in your selection who are ・Higher-risk (intermediate-2, or high-risk using International The number of MDS patients in your selection who are higher- Prognostic Scoring System [IPSS], very high-risk using IPSS- risk (intermediate-2, or high-risk using IPSS, very high-risk MDS: percentage of higher-risk MDS patients receiving 2299 2018 USA R, and/or with excess blasts, or high- or very high-risk using PMe1 L01 L using IPSS-R, and/or with excess blasts, or high- or very high- or . WPSS) risk using WPSS) AND NQMC 135 ・Receiving azacitidine or decitabine Number of electronic prescribing transactions in the The number of electronic prescriptions for newly initiated drug Primary medication non-adherence: percentage of denominator where there was no pharmacy dispensing event therapy for chronic medications during the measurement prescriptions for chronic medications e-prescribed by a 2300 2018 USA that matched the patient and the prescribed drug or P Ge 6 N/A N/A period and for patients 18 years and older as of the last day of prescriber and not obtained by the patient in the following 30 appropriate alternative drug within 30 days following the e- the measurement period days. NQMC 135 prescribing event Residents meeting any of the following criteria on the selected target assessment: 1. Have an up-to-date pneumococcal vaccine status; or 2. Were offered and declined the vaccine; or Long-stay nursing home care: percent of residents assessed 2301 2018 USA All long-stay residents with a selected target assessment 3. Were ineligible due to medical contraindication(s) (e.g., PMe1 J07 J and appropriately given the pneumococcal vaccine. anaphylactic hypersensitivity to components of the vaccine; bone marrow transplant within the past 12 months; or receiving a course of chemotherapy within the past two NQMC 135 weeks). Adherence to antipsychotic medications for individuals with The number of members who achieved a PDC of at least 80 schizophrenia: percentage of members 19 to 64 years of age Medicaid members 19 to 64 years of age as of December 31 2302 2018 USA percent for their antipsychotic medications during the during the measurement year with schizophrenia who were PMe5 N05 N of the measurement year with schizophrenia measurement year dispensed and remained on an antipsychotic medication for at least 80 percent of their treatment period. NQMC 135 Patients ages 41 to 75 years as of the last day of the The number of patients in the denominator who received a Statin use in persons with diabetes: percentage of patients measurement year who were dispensed two or more 2303 2018 USA prescription fill for a statin or statin combination during the ages 40 to 75 years who were dispensed a medication for PMe1 A10 C10 AC prescription fills for a hypoglycemic agent during the measurement year diabetes that receive a statin medication. NQMC 135 measurement year Antidepressant medication management (effective Members age 18 years and older as of April 30 of the At least 180 days (6 months) of continuous treatment with continuation phase treatment): percentage of members 18 measurement year, with a Negative Medication History, with a antidepressant medication beginning on the Index years of age and older who were treated with antidepressant 2304 2018 USA PMe4 N06 N diagnosis of major depression and were treated with Prescription Start Date through 231 days after the IPSD (232 medication, had a diagnosis of major depression and who antidepressant medication during the Intake Period total days) remained on an antidepressant medication for at least 180 NQMC 135 days (6 months). PDC: percentage of patients who filled at least two Patients 18 years and older who filled at least two The number of patients who met the PDC threshold of 80% prescriptions for the specified diabetes medications on two 2305 2018 USA prescriptions for the specified diabetes medications on two PMe5 A10 A during the measurement year unique dates of service who met the PDC threshold of 80% unique dates of service during the measurement period NQMC 135 during the measurement period. Acute ischemic stroke patients for whom intravenous (IV) Acute ischemic stroke patients whose time of arrival is within 2 Stroke: percent of acute ischemic stroke patients for whom IV thrombolytic therapy was initiated at the hospital within 3 2306 2018 USA hours (less than or equal to 120 minutes) of time last known t-PA was initiated at the hospital within 3 hours (less than or PMe15 B01 B hours (less than or equal to 180 minutes) of time last known well equal to 180 minutes) of time last known well. NQMC 135 well Stroke: percentage of SAH patients for whom nimodipine SAH patients for whom nimodipine treatment was 2307 2018 USA SAH patients treatment was administered within 24 hours of arrival at the PMe15 C08 C administered within 24 hours of arrival at the hospital NQMC 135 hospital. Appropriate testing or treatment for osteoporosis after the fracture defined by any of the following criteria: ・A BMD test, in any setting, on the IESD or in the 180-day (6- month) period after the IESD Medicare-enrolled women age 67 to 85 years as of December Osteoporosis management in women who had a fracture: ・If the IESD was an inpatient stay, a BMD test during the 31 of the measurement year, with a Negative Diagnosis percentage of women 67 to 85 years of age who suffered a inpatient stay 2308 2018 USA History, who had an outpatient visit, an observation visit, an fracture and who had either a BMD test or prescription for a PMe17 G03 H05 M05 GHM ・Osteoporosis therapy on the IESD or in the 180-day (6- ED visit, a nonacute inpatient discharge or an acute inpatient drug to treat or prevent osteoporosis in the six months after month) period after the IESD discharge for a fracture during the Intake Period the fracture. ・If the IESD was an inpatient stay, long-acting osteoporosis therapy during the inpatient stay ・A dispensed prescription to treat osteoporosis on the IESD NQMC 135 or in the 180-day (6-month) period after the IESD Medical assistance with smoking and tobacco use cessation: The number of eligible members who responded to the survey The number of members in the denominator who indicated percentage of members 18 years of age and older who were 2309 2018 USA and indicated that they were current smokers or tobacco that their doctor or health provider recommended or discussed current smokers or tobacco users and who discussed or were PMe5 N07 N users cessation medications recommended cessation medications during the NQMC 135 measurement year. dosing: percentage of patients who were Patients 18 years and older who were dispensed one or more The number of patients who were dispensed a dose of a 2310 2018 USA dispensed a dose higher than the daily recommended dose PMe3 A10 A prescriptions for a biguanide during the measurement year biguanide higher than the daily recommended dose NQMC 135 for biguanides. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Persistence of beta-blocker treatment after a heart attack: Members age 18 years and older as of December 31 of the percentage of members 18 years of age and older during the measurement year who had an acute inpatient discharge with measurement year who were hospitalized and discharged 2311 2018 USA any diagnosis of acute myocardial infarction (AMI) from July 1 A 180-day course of treatment with beta-blockers from July 1 of the year prior to the measurement year to June PMe14 C07 C of the year prior to the measurement year through June 30 of 30 of the measurement year with a diagnosis of AMI and who the measurement year received persistent beta-blocker treatment for six months after NQMC 135 discharge. Medication management for people with asthma: percentage The number of members who achieved a PDC of at least 75% of members 5 to 85 years of age during the measurement Members 5 to 85 years of age by December 31 of the 2312 2018 USA for their asthma controller medications during the year who were identified as having persistent asthma and who PMe5 R03 R measurement year with persistent asthma measurement year were dispensed an asthma controller medication that they remained on for at least 75% of their treatment period. NQMC 135 Adults 18 years of age as of January 1 of the year prior to the measurement year to 64 years of age as of December 31 of Avoidance of antibiotic treatment in adults with acute the measurement year, with a Negative Medication History, a Dispensed prescription for antibiotic medication on or three bronchitis: percentage of adults 18 to 64 years of age with a 2313 2018 USA Negative Comorbid Condition History and a Negative PMe1 J01 J days after the IESD diagnosis of acute bronchitis who were not dispensed an Competing Diagnosis, who had an outpatient visit, an antibiotic prescription. observation visit or an ED visit with any diagnosis of acute NQMC 135 bronchitis during the Intake Period Residents meeting the following criteria on the selected target assessment: Were ineligible due to medical contraindication(s) (e.g., Long-stay nursing home care: percent of residents who did 2314 2018 USA All long-stay residents with a selected target assessment anaphylactic hypersensitivity to components of the vaccine; not receive, due to medical contraindication, the PMe1 J07 J bone marrow transplant within the past 12 months; or pneumococcal vaccine. receiving a course of chemotherapy within the past two NQMC 135 weeks) The number of lymphoma patients in your selection: Male AND less than 60 years old OR The number of lymphoma patients in your selection: Female AND pre-menopausal Non-: percent of lymphoma patients of Male AND less than 60 years old AND childbearing age who received treatment for lymphoma and OR 2315 2018 USA Receiving treatment for lymphoma who were offered fertility counseling prior to starting treatment PMe5 L01 L Female AND pre-menopausal AND OR documentation in the medical record why such counseling AND Received fertility counseling prior to starting treatment was unnecessary. Receiving treatment for lymphoma OR Document in the medical record why such counseling was NQMC 135 unnecessary The number of eligible members with a Flu Vaccinations for Flu vaccinations for adults ages 18 to 64: percentage of The number of members in the denominator who responded Adults Ages 18 to 64 Eligibility Flag of "Eligible" who members 18 to 64 years of age who received an influenza 2316 2018 USA "Yes" to the question "Have you had either a flu shot or flu PMe1 J07 J responded "Yes" or "No" to the question "Have you had either vaccination between July 1 of the measurement year and the spray in the nose since July 1, YYYY?" a flu shot or flu spray in the nose since July 1, YYYY?" date when the CAHPS 5.0H Adult Survey was completed. NQMC 135 Tobacco treatment: percent of patients who received Number of patients who received practical counseling to quit counseling AND medication as well as those who received Number of hospitalized inpatients 18 years of age and older 2317 2018 USA AND received FDA-approved cessation medications during counseling and had reason for not receiving the medication PMe1 N07 N identified as current tobacco users the hospital stay within the first three days after admission during the hospital stay within the first three days after NQMC 135 admission. Drug-drug interactions: percentage of patients who received a The number of patients in the denominator who were prescription for a target medication during the measurement 2318 2018 USA Patients who received a target medication dispensed a concurrent precipitant medication during the P Ge 1 N/A N/A period and who were dispensed a concurrent prescription for measurement period NQMC 135 a precipitant medication. Residents meeting the following criteria on the selected All short-stay residents with a selected influenza vaccination influenza vaccination assessment: Short-stay nursing home care: percent of residents who were 2319 2018 USA PMe5 J07 J assessment, except those with exclusions ・Resident was offered and declined the influenza vaccine offered and declined the seasonal influenza vaccine. NQMC 135 during the most recent influenza season. PDC: percentage of patients who filled at least two Patients 18 years and older who filled at least two The number of patients who met the PDC threshold of 80% prescriptions for a CCB or CCB combination on two unique 2320 2018 USA prescriptions for a CCB or CCB combination on two unique PMe5 C08 C during the measurement year dates of service who met the PDC threshold of 80% during dates of service during the measurement period NQMC 135 the measurement period. Oncology: percentage of patient visits, regardless of patient All patient visits, regardless of age, with a diagnosis of cancer age, with a diagnosis of cancer currently receiving 2321 2018 USA Number of patient visits in which pain intensity is quantified PMe7 L01 L currently receiving chemotherapy or radiation therapy chemotherapy or radiation therapy in which pain intensity is NQMC 135 quantified. Perioperative care: percentage of patients, aged 3 through 17 years of age, who undergo a procedure under general All patients, aged 3 through 17 years of age, who undergo a anesthesia in which an inhalational is used for Patients who receive combination therapy consisting of at procedure under general anesthesia in which an inhalational maintenance AND who have two or more risk factors for 2322 2018 USA least two prophylactic pharmacologic anti-emetic agents of PMe1 A04 N01 AN anesthetic is used for maintenance AND who have two or postoperative vomiting, who receive combination therapy different classes preoperatively or intraoperatively more risk factors for postoperative vomiting consisting of at least two prophylactic pharmacologic anti- emetic agents of different classes preoperatively or NQMC 135 intraoperatively. Patients with documentation that they or their caregivers were VTE: percent of patients diagnosed with confirmed VTE that given written discharge instructions or other educational are discharged to home, home care, court/law enforcement or material about warfarin that addressed all of the following: home on hospice care on warfarin with written discharge 2323 2018 USA Patients with confirmed VTE discharged on warfarin therapy 1. Compliance issues PMe5 B01 B instructions that address all four criteria: compliance issues, 2. Dietary advice dietary advice, follow-up monitoring, and information about the 3. Follow-up monitoring potential for adverse drug reactions/interactions. 4. Potential for adverse drug reactions and interactions NQMC 135 IBD: percentage of patients aged 18 years and older with an Patients who have received dose of corticosteroids greater IBD encounter who were prescribed prednisone equivalents than or equal to 10 mg/day of prednisone equivalents for 60 or greater than or equal to 10 mg/day for 60 or greater greater consecutive days or a single prescription equating to 2324 2018 USA All patients aged 18 years and older with a diagnosis of IBD consecutive days or a single prescription equating to 600 mg PMe17 A07 A 600 mg prednisone or greater for all fills and who were prednisone or greater for all fills and were documented for risk documented for risk of bone loss during the reporting year or of bone loss once during the reporting year or the previous the previous calendar year NQMC 135 calendar year. The number of patients in the denominator who had at least Patients 65 years and older with either a diagnosis of Antipsychotic use in persons with dementia: percentage of one prescription AND greater than 30 days supply for any dementia and/or two or more prescription claims and greater individuals 65 years and older with dementia who are 2325 2018 USA antipsychotic medication during the measurement period and PMe1 N05 N06 N than 60 days supply for a cholinesterase inhibitor or an N- receiving an antipsychotic medication without evidence of a do not have a diagnosis for schizophrenia, bipolar disorder, methyl-D-aspartate receptor antagonist psychotic disorder or related condition. Huntington's disease or Tourette's syndrome NQMC 135 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka ・Rate 1: Annual monitoring for members on ACEIs or ARBs: Members age 18 years and older as of December 31 of the ・Rate 1: Annual monitoring for members on ACEIs or ARBs: measurement year who received at least 180 treatment days At least one serum potassium and a serum creatinine of ACEIs or ARBs during the measurement year therapeutic monitoring test in the measurement year Annual monitoring for patients on persistent medications: ・Rate 2: Annual monitoring for members on digoxin: ・Rate 2: Annual monitoring for members on digoxin: At least percentage of members 18 years of age and older who Members age 18 years and older as of December 31 of the one serum potassium, at least one serum creatinine, and at received at least 180 treatment days of ambulatory medication 2326 2018 USA PMe7 C01 C03 C09 C measurement year who received at least 180 treatment days least one serum digoxin therapeutic monitoring test in the therapy for a select therapeutic agent during the of digoxin during the measurement year measurement year measurement year and at least one therapeutic monitoring ・Rate 3: Annual monitoring for members on diuretics: ・Rate 3: Annual monitoring for members on diuretics: At event for the therapeutic agent in the measurement year. Members age 18 years and older as of December 31 of the least one serum potassium and a serum creatinine measurement year who received at least 180 treatment days therapeutic monitoring test in the measurement year of a diuretic during the measurement year NQMC 135 Residents meeting the following criteria on the selected All long-stay residents with a selected influenza vaccination influenza vaccination assessment: Long-stay nursing home care: percent of residents who were 2327 2018 USA PMe5 J07 J assessment, except those with exclusions Resident was offered and declined the influenza vaccine offered and declined the seasonal influenza vaccine. NQMC 135 during the most recent influenza season. The number of lymphoma patients in your selection: Treated with anti-CD20 monoclonal -containing Non-Hodgkin lymphoma: percent of lymphoma patients The number of lymphoma patients in your selection treated regimens treated with anti-CD20 -containing 2328 2018 USA PMe7 L01 L with anti-CD20 monoclonal antibody-containing regimens AND regimens and tested for hepatitis B prior to medication Tested for hepatitis B (hepatitis B surface antigen AND administration. NQMC 135 hepatitis B core antibody) in advance of starting treatment The number of eligible members who responded to the survey and indicated that they did not have a health problem or take Aspirin use and discussion: percentage of members who are medication that makes taking aspirin unsafe, did not have an currently taking aspirin, including women 56 to 79 years of exclusion and who are: The number of members in the denominator who indicated 2329 2018 USA age with at least two risk factors for CVD; men 46 to 65 years PMe1 B01 B ・Women age 56 to 79 with at least two risk factors for CVD that they currently take aspirin daily or every other day of age with at least one risk factor for CVD; and men 66 to 79 ・Men age 46 to 65 with at least one risk factor for CVD years of age, regardless of risk factors. ・Men age 66 to 79 regardless of the number of CVD risk factors NQMC 135 Immunizations for adolescents: percentage of adolescents 13 Adolescents who received one dose of meningococcal years of age who had one dose of meningococcal vaccine Adolescents who turn 13 years of age during the vaccine and one tetanus, diphtheria toxoids and acellular 2330 2018 USA and one tetanus, diphtheria toxoids and acellular pertussis PMe1 J07 J measurement year pertussis vaccine or one tetanus, diphtheria toxoids vaccine vaccine or one tetanus, diphtheria toxoids vaccine by their by their 13th birthday NQMC 135 13th birthday. Medication reconciliation post-discharge: percentage of Discharges for Medicare members age 18 years and older as Medication reconciliation conducted by a prescribing discharges from January 1 to December 1 of the of December 31 of the measurement year who had an acute 2331 2018 USA practitioner, clinical pharmacist, or registered nurse on the measurement year for members 18 years of age and older for P Ge 6 N/A N/A or nonacute inpatient discharge on or between January 1 and date of discharge through 30 days after discharge whom medications were reconciled the date of discharge December 1 of the measurement year NQMC 135 through 30 days after discharge (31 total days). Primary open-angle glaucoma: percentage of patients aged Patients or their caregiver(s) who were counseled within 12 18 years and older with a diagnosis of POAG or their All patients aged 18 years and older with a diagnosis of months about 1) the potential impact of glaucoma on their 2332 2018 USA caregiver who were counseled within 12 months about 1) the PMe5 S01 S primary open-angle glaucoma visual functioning and quality of life and 2) the importance of potential impact of glaucoma on their visual functioning and treatment adherence quality of life, and 2) the importance of treatment adherence. NQMC 135 Eligible mothers of all infants admitted within 28 days of birth Perinatal care: proportion of mothers of infants with without having been discharged home whose gestational age gestational age between 24 and 33 completed weeks 2333 2018 USA Number of mothers who received antenatal steroids PMe1 H02 H is between 24 and 33 completed weeks, including mothers of receiving IM or IV corticosteroids (betamethasone, infants who died in the delivery room dexamethasone, hydrocortisone) at any time prior to delivery. NQMC 135 Diagnostic imaging: percentage of final reports for patients All final reports for patients aged 18 years and older with a aged 18 years and older who had a previously documented Final reports for patients 18 years and older who were pre- previously documented iodinated contrast reaction who iodinated contrast reaction who undergo any imaging 2334 2018 USA medicated with corticosteroids with or without H1 PMe1 H02 R06 V08 HRV undergo any imaging examination using intravenous iodinated examination using intravenous iodinated contrast that include antihistamines contrast documentation that the patients were pre-medicated with corticosteroids with or without H1 antihistamines. NQMC 135 Medication therapy for persons with asthma: percentage of The number of patients with persistent asthma during the patients with asthma during the measurement period who measurement period who were dispensed more than 3 Patients 5 to 50 years with consecutive fills of asthma were dispensed more than 3 canisters of short acting beta2 2335 2018 USA canisters of short acting beta2 agonist inhalers over a 90-day PMe1 R03 R medications during the measurement year agonist inhalers over a 90-day period and who did not receive period and who did not receive controller therapy during the controller therapy during the same 90-day period (absence of same 90-day period NQMC 135 controller therapy).

Residents meeting any of the following criteria on the selected influenza vaccination assessment: 1. Resident received the influenza vaccine during the most recent influenza season, either in the facility or outside the facility; or Short-stay nursing home care: percent of residents who were All short-stay residents with a selected influenza vaccination 2336 2018 USA 2. Resident was offered and declined the influenza vaccine; or assessed and appropriately given the seasonal influenza PMe15 J07 J assessment, except those with exclusions 3. Resident was ineligible due to contraindication(s) (e.g., vaccine. anaphylactic hypersensitivity to eggs or other components of the vaccine, history of Guillain-Barré syndrome within 6 weeks after a previous influenza vaccination, bone marrow transplant within the past 6 months) NQMC 135 Use of first-line psychosocial care for children and Children and adolescents age 1 to 17 years as of December adolescents on antipsychotics: percentage of children and 31 of the measurement year, with a Negative Medication Documentation of psychosocial care in the 121-day period 2337 2018 USA adolescents 1 to 17 years of age who had a new prescription PMe9 N05 N History, who were dispensed an antipsychotic medication from 90 days prior to the IPSD through 30 days after the IPSD for an antipsychotic medication and had documentation of during the Intake Period psychosocial care as first-line treatment. NQMC 135 Oncology: percentage of female patients aged 18 years and All female patients aged 18 years and older with a diagnosis older with Stage IC through IIIC, estrogen receptor or Patients who were prescribed tamoxifen or aromatase 2338 2018 USA of breast cancer with stage IC through IIIC, estrogen receptor progesterone receptor positive breast cancer who were PMe1 L02 L inhibitor during the 12-month reporting period or progesterone receptor positive breast cancer prescribed tamoxifen or aromatase inhibitor during the 12 NQMC 135 month reporting period. Patients 18 years and older who filled at least two PDC: percentage of patients who filled at least two prescriptions for a beta-blocker or beta-blocker combination The number of patients who met the PDC threshold of 80% prescriptions for a beta-blocker or beta-blocker combination 2339 2018 USA PMe5 C07 C on two unique dates of service during the measurement during the measurement year on two unique dates of service who met the PDC threshold of NQMC 135 period 80% during the measurement period. Children and adolescents age 1 to 17 years as of December Metabolic monitoring for children and adolescents on 31 of the measurement year with at least two antipsychotic Both of the following during the measurement year: antipsychotics: percentage of children and adolescents 1 to 2340 2018 USA medication dispensing events of the same or different At least one test for HbA1c PMe7 N05 N 17 years of age who had two or more antipsychotic medications on different dates of service during the At least one test for LDL-cholesterol or cholesterol prescriptions and had metabolic testing. NQMC 135 measurement year Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Tobacco treatment: percent of patients identified as tobacco Number of patients who were referred to or refused evidence- product users within the past 30 days who were referred to or Number of hospitalized inpatients 18 years of age and older based outpatient counseling AND received or refused a 2341 2018 USA refused evidence-based outpatient counseling AND received PMe15 N07 N identified as current tobacco users prescription for FDA-approved cessation medication at or refused a prescription for FDA-approved cessation discharge NQMC 135 medication upon discharge. VTE: percent of patients diagnosed with confirmed VTE Patients who received no VTE prophylaxis prior to the VTE during hospitalization (not present at admission) who did not 2342 2018 USA Patients who developed confirmed VTE during hospitalization PMe1 B01 B diagnostic test order date receive VTE prophylaxis between hospital admission and the NQMC 135 day before the VTE diagnosis testing order date. Children 3 years of age as of July 1 of the year prior to the measurement year to 18 years of age as of June 30 of the Appropriate testing for children with pharyngitis: percentage of measurement year, with a Negative Medication History, who A group A streptococcus test in the seven-day period from children 3 to 18 years of age who were diagnosed with 2343 2018 USA PMe7 J01 J had an outpatient visit, an observation visit or an ED visit with three days prior to the IESD through three days after the IESD pharyngitis, dispensed an antibiotic, and received a group A only a diagnosis of pharyngitis and a dispensed antibiotic for streptococcus test for the episode. NQMC 135 that episode of care during the Intake Period PDC: percentage of patients who filled at least two Patients 18 years and older who filled at least two The number of patients who met the PDC threshold of 80% prescriptions for a statin or statin combination on two unique 2344 2018 USA prescriptions for a statin or statin combination on two unique PMe5 C10 C during the measurement year dates of service who met the PDC threshold of 80% during dates of service during the measurement period NQMC 135 the measurement period. Perioperative care: percentage of surgical patients, aged 18 Surgical patients for whom administration of a prophylactic years and older, who receive an anesthetic when undergoing All surgical patients, aged 18 years and older, who receive an parenteral antibiotic ordered has been initiated within one procedures with the indications for prophylactic parenteral 2345 2018 USA anesthetic when undergoing procedures with the indications hour (if fluoroquinolone or vancomycin, two hours) prior to the PMe5 J01 N01 JN antibiotics for whom administration of a prophylactic for prophylactic parenteral antibiotics surgical incision (or start of procedure when no incision is parenteral antibiotic ordered has been initiated within one required) NQMC 135 hour prior to the surgical incision.

Residents meeting any of the following criteria on the selected influenza vaccination assessment: 1. Resident received the influenza vaccine during the most recent influenza season, either in the facility or outside the facility; or All long-stay residents with a selected influenza vaccination Long-stay nursing home care: percent of residents assessed 2346 2018 USA 2. Resident was offered and declined the influenza vaccine; or PMe15 J07 J assessment, except those with exclusions and appropriately given the seasonal influenza vaccine. 3. Resident was ineligible due to contraindication(s) (e.g., anaphylactic hypersensitivity to eggs or other components of the vaccine, history of Guillain-Barré syndrome within 6 weeks after a previous influenza vaccination, bone marrow transplant within the past 6 months) NQMC 135 Patients who are prescribed bisoprolol, carvedilol, or HF: percentage of HF patients who are prescribed bisoprolol, Heart failure patients with current or prior documentation of 2347 2018 USA sustained-release metoprolol succinate for LVSD at hospital carvedilol, or sustained-release metoprolol succinate for PMe1 C07 C LVEF less than 40% NQMC 135 discharge LVSD at hospital discharge. The number of MDS patients in your selection AND Being treated with erythropoietin/darbepoetin AND Bone marrow examination including iron stain within 60 days MDS: percentage of MDS patients presenting with anemia The number of MDS patients in your selection who are being 2348 2018 USA preceding erythropoietin/darbepoetin therapy who had evidence of adequate iron stores within 60 days prior PMe7 B03 B treated with erythropoietin/darbepoetin OR to receiving erythropoietin/darbepoetin therapy. Testing of blood showing serum ferritin greater than 100 ng/ml and/or the ratio of serum iron to total iron binding capacity is greater than 20 percent within 60 days preceding NQMC 135 erythropoietin/darbepoetin therapy Residents meeting the following criteria on the selected influenza vaccination assessment: Resident was ineligible due to contraindication(s) (e.g., Long-stay nursing home care: percent of residents who did All long-stay residents with a selected influenza vaccination 2349 2018 USA anaphylactic hypersensitivity to eggs or other components of not receive, due to medical contraindication, the seasonal PMe1 J07 J assessment, except those with exclusions the vaccine, history of Guillain-Barré syndrome within 6 weeks influenza vaccine. after a previous influenza vaccination, bone marrow transplant within the past 6 months). NQMC 135 The number of patients with one or more prescription claims Antipsychotic use in children: percentage of children under The number of children under 5 years old any time during the 2350 2018 USA for an antipsychotic medication with cumulative days supply age 5 using antipsychotic medications during the PMe1 N05 N measurement period NQMC 135 greater than or equal to 30 days measurement period. Ambulatory surgery: percentage of Ambulatory Surgery All Ambulatory Surgery Center admissions with a preoperative Number of Ambulatory Surgery Center admissions with an Center admissions with an order for a prophylactic IV 2351 2018 USA order for a prophylactic IV antibiotic for prevention of surgical order for a prophylactic IV antibiotic for prevention of surgical PMe5 J01 J antibiotic for prevention of surgical site infection, who received site infection site infection, who received the prophylactic antibiotic on time NQMC 135 the prophylactic antibiotic on time. Pharmacotherapy management of COPD exacerbation: Members 40 years of age or older as of January 1 of the percentage of COPD exacerbations for members 40 years of Dispensed prescription for a bronchodilator on or 30 days measurement year with a COPD exacerbation as indicated by age and older who had an acute inpatient discharge or ED 2352 2018 USA after the Episode Date. Count that are active PMe1 R03 R an acute inpatient discharge or an ED visit with a principal visit on or between January 1 and November 30 of the on the relevant date. diagnosis of COPD measurement year and who were dispensed a bronchodilator NQMC 135 within 30 days of the event. Ischemic stroke patients prescribed antithrombotic therapy at Stroke: percent of ischemic stroke patients prescribed 2353 135 2018 USA Ischemic stroke patients PMe1 B01 B NQMC hospital discharge antithrombotic therapy at hospital discharge. The number of lymphoma patients in your selection Non-Hodgkin lymphoma: percent of lymphoma patients AND 2354 2018 USA The number of lymphoma patients in your selection advised to receive immunization/vaccination aligned with CDC PMe5 J07 J Advised to receive immunization/vaccination aligned with CDC recommendations. NQMC 135 recommendations PDC: percentage of patients who filled at least two Patients 18 years and older who filled at least two The number of patients who met the PDC threshold of 80% prescriptions for a thiazolidinedione on two unique dates of 2355 2018 USA prescriptions for a thiazolidinedione on two unique dates of PMe5 A10 A during the measurement year service who met the PDC threshold of 80% during the service during the measurement period NQMC 135 measurement period. Stroke: percentage of ICH stroke patients with an INR value ICH stroke patients with INR value greater than 1.4 at hospital 2356 2018 USA ICH stroke patients treated with a procoagulant reversal agent greater than 1.4 at hospital arrival who are treated with a PMe1 B01 B arrival NQMC 135 procoagulant reversal agent. Flu vaccinations for adults ages 65 and older: percentage of The number of eligible members who responded "Yes" or The number of members in the denominator who responded Medicare members 65 years of age and older who received 2357 2018 USA "No" to the question, "Have you had a flu shot since July 1, "Yes" to the question, "Have you had a flu shot since July 1, an influenza vaccination between July 1 of the measurement PMe1 J07 J YYYY?" YYYY?" year and the date when Medicare CAHPS survey was NQMC 135 completed. Patients 18 years and older who were dispensed one or more Diabetes medication dosing: percentage of patients who were The number of patients who were dispensed a dose of a DPP- 2358 2018 USA prescriptions for a DPP-IV inhibitor during the measurement dispensed a dose higher than the daily recommended dose PMe3 A10 A IV inhibitor higher than the daily recommended dose NQMC 135 year for DPP-IV inhibitors. Substance use: percent of patients who are identified with Number of patients who received or refused at discharge a alcohol or drug use disorder who received or refused at Number of hospitalized inpatients 18 years of age and older prescription for medication for treatment of alcohol or drug 2359 2018 USA discharge a prescription for FDA-approved medication for PMe15 N07 N identified with an alcohol or drug use disorder use disorder OR received or refused a referral for addictions alcohol or drug disorder or who received or refused a referral treatment NQMC 135 for addictions treatment. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Oncology: percentage of patients aged 18 through 80 years Patients who are referred for adjuvant chemotherapy, with AJCC Stage III colon cancer who are referred for All patients aged 18 through 80 years with AJCC Stage III prescribed adjuvant chemotherapy, or who have previously 2360 2018 USA adjuvant chemotherapy, prescribed adjuvant chemotherapy, PMe1 L01 L colon cancer received adjuvant chemotherapy within the 12 month reporting or have previously received adjuvant chemotherapy within the period NQMC 135 12 month reporting period. Ischemic stroke patients who had antithrombotic therapy Stroke: percent of ischemic stroke patients administered 2361 135 2018 USA Ischemic stroke patients PMe15 B01 B NQMC administered by end of hospital day 2 antithrombotic therapy by the end of hospital day 2. Residents meeting the following criteria on the selected target Long-stay nursing home care: percent of residents who 2362 2018 USA All long-stay residents with a selected target assessment assessment: PMe1 J07 J received the pneumococcal vaccine NQMC 135 Pneumococcal vaccine status is up-to-date. Statin therapy for patients with cardiovascular disease: Male members age 21 to 75 years and female members age percentage of males 21 to 75 years of age and females 40 to 40 to 75 years as of December 31 of the measurement year The number of members who achieved a PDC of at least 80% 75 years of age during the measurement year who were 2363 2018 USA who were identified as having clinical ASCVD who had at PMe5 C10 C during the treatment period identified as having clinical ASCVD who remained on a high- least one dispensing event for a high or moderate-intensity or moderate-intensity statin medication for at least 80% of the statin medication during the measurement year NQMC 135 treatment period. Asthma medication ratio: percentage of members 5 to 85 Members 5 to 85 years of age by December 31 of the The number of members who have a medication ratio of 0.50 years of age who were identified as having persistent asthma 2364 2018 USA PMe5 R03 R measurement year with persistent asthma or greater during the measurement year and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year. NQMC 135 Members age 6 years as of March 1 of the year prior to the Follow-up care for children prescribed ADHD medication measurement year to 12 years as of February 28 of the An outpatient, intensive outpatient or partial hospitalization (initiation phase): percentage of members 6 to 12 years of age 2365 2018 USA measurement year, with a Negative Medication History, who follow-up visit with a practitioner with prescribing authority with an ambulatory prescription dispensed for ADHD PMe5 N06 N were dispensed an ADHD medication during the 12-month within 30 days after the IPSD medication who had one follow-up visit with a practitioner with Intake Period prescribing authority during the 30-day initiation phase. NQMC 135 Patients 18 years and older who filled a prescription for at PDC: percentage of patients who filled a prescription for at least two individual antiretroviral drugs (as single agents or as The number of patients who met the PDC threshold of 90% least two antiretroviral drugs on two unique dates of service 2366 2018 USA PMe5 J05 J a combination) on two unique dates of service in the during the measurement year who met the PDC threshold of 90% during the measurement NQMC 135 measurement period period. Members from the denominator who had each of the following during the measurement year: Care for older adults: percentage of adults 66 years and older Medicare Special Needs Plans members age 66 years and ・Advance care planning who had each of the following during the measurement year: 2367 2018 USA P Ge 7 N/A N/A older as of December 31 of the measurement year ・Medication review advance care planning, medication review, functional status ・Functional status assessment assessment, and pain assessment. NQMC 135 ・Pain assessment Completion rate for comprehensive medication review: The number of patients in the denominator that have received Patients 18 years and older who met eligibility criteria for percentage of prescription drug plan members who met 2368 2018 USA one or more comprehensive medication reviews during the P Ge 7 N/A N/A medication therapy management services eligibility criteria for medication therapy management services measurement year and who received a CMR during the eligibility period. NQMC 135 Residents meeting the following criteria on the selected influenza vaccination assessment: All long-stay residents with a selected influenza vaccination Long-stay nursing home care: percent of residents who 2369 2018 USA Resident received the influenza vaccine during the most PMe1 J07 J assessment, except those with exclusions received the seasonal influenza vaccine. recent influenza season, either in the facility or outside the NQMC 135 facility. PDC: percentage of patients who filled at least two Patients 18 years and older who filled at least two The number of patients who met the PDC threshold of 80% prescriptions for a RAS antagonist on two unique dates of 2370 2018 USA prescriptions for a RAS antagonist on two unique dates of PMe5 C09 C during the measurement year service who met the PDC threshold of 80% during the service during the measurement period NQMC 135 measurement period. Tobacco treatment: percent of patients who were referred to Number of patients 18 years of age and older who were evidence-based outpatient counseling AND received a Number of hospitalized inpatients 18 years of age and older referred to evidence-based outpatient counseling AND prescription for FDA-approved cessation medication upon 2371 2018 USA PMe15 N07 N identified as current tobacco users received a prescription for FDA-approved cessation discharge as well as those who were referred to outpatient medication at discharge counseling and had reason for not receiving a prescription for NQMC 135 medication. Diabetes medication dosing (DOS): percentage of patients Patients 18 years and older who were dispensed one or more The number of patients who were dispensed a dose of a 2372 2018 USA who were dispensed a dose higher than the daily PMe3 A10 A prescriptions for a sulfonylurea during the measurement year sulfonylurea higher than the daily recommended dose NQMC 135 recommended dose for . Statin therapy for patients with cardiovascular disease: Male members age 21 to 75 years and female members age The number of members who had at least one dispensing percentage of males 21 to 75 years of age and females 40 to 2373 2018 USA 40 to 75 years as of December 31 of the measurement year event for a high or moderate-intensity statin medication during 75 years of age during the measurement year who were PMe1 C10 C who were identified as having clinical ASCVD the measurement year identified as having clinical ASCVD who were dispensed at NQMC 135 least one high- or moderate-intensity statin medication. Stroke: percentage of ischemic stroke patients treated with IV Ischemic stroke patients for whom a 90 day (greater than or or IA t-PA therapy or who undergo mechanical endovascular Ischemic stroke patients treated with IV or IA t-PA therapy or 2374 2018 USA equal to 75 days and less than or equal to 105 days) Modified reperfusion therapy for whom a 90 day (greater than or equal PMe7 B01 B who undergo mechanical endovascular reperfusion therapy Rankin Scale is obtained via telephone or in-person to 75 days and less than or equal to 105 days) Modified Rankin Scale is obtained via telephone or in-person. NQMC 135 The number of lymphoma patients in your selection: The number of lymphoma patients in your selection: ・Who are greater than or equal to 65 years old ・Who are greater than or equal to 65 years old AND Non-Hodgkin lymphoma: percent of lymphoma patients who AND ・Treated with CHOP +/-R (or any regimen with the same or 2375 2018 USA are 65 years old or older and receiving CHOP +/-R, PMe1 H02 L01 L03 HL ・Treated with CHOP +/-R (or any regimen with the same or higher doses of cyclophosphamide and and, thus, prescribed prophylactic granulocyte colony-stimulating factor. higher doses of cyclophosphamide and doxorubicin and, thus, with an equivalent or higher potential for neutropenia) with an equivalent or higher potential for neutropenia) AND ・Received prophylactic filgrastim or pegfilgrastim NQMC 135 Use of high-risk medications in the elderly: percentage of Medicare members age 66 years and older as of December Members who received at least one high-risk medication 2376 2018 USA Medicare members 66 years of age and older who received at PMe1 A03 B01 C01 C02 C04 G03 M01 M02 M03 N01 N04 N05 N06 R06 A B C G M N R 31 of the measurement year during the measurement year NQMC 135 least one high-risk medication. Diagnostic imaging: percentage of surgical patients aged 18 Surgical patients who have an order for prophylactic All surgical patients aged 18 years and older undergoing years and older undergoing procedures with the indications parenteral antibiotic to be given within one hour (if 2377 2018 USA procedures with the indications for prophylactic parenteral for prophylactic parenteral antibiotics who have an order for PMe5 J01 J fluoroquinolone or vancomycin, two hours) prior to the surgical antibiotics prophylactic parenteral antibiotic to be given within 1 hour (2 if incision (or start of procedure when no incision is required) NQMC 135 fluoroquinolone or vancomycin). Residents meeting the following criteria on the selected influenza vaccination assessment: ・Resident was ineligible due to contraindication(s) (e.g., Short-stay nursing home care: percent of residents who did All short-stay residents with a selected influenza vaccination 2378 2018 USA anaphylactic hypersensitivity to eggs or other components of not receive, due to medical contraindication, the seasonal PMe1 J07 J assessment, except those with exclusions the vaccine, history of Guillain-Barré syndrome within 6 weeks influenza vaccine. after a previous influenza vaccination, bone marrow transplant within the past 6 months). NQMC 135 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Number of patients from the denominator who: ・Received an influenza vaccination (documented by the provider or reported receipt from another provider by the End stage renal disease: percentage of end stage renal patient); or disease patients aged 6 months and older receiving ・Were assessed and offered an influenza vaccination but All end stage renal disease patients aged 6 months and older hemodialysis and/or peritoneal during the time from declined; or receiving hemodialysis and/or peritoneal dialysis during the October 1 (or when the influenza vaccine became available) 2379 2018 USA ・Were assessed and determined to have a medical PMe15 J07 J time from October 1 (or when the influenza vaccine became to March 31 who: 1) receive an influenza vaccination, or 2) contraindication(s) of anaphylactic hypersensitivity to eggs or available) to March 31 were assessed and offered an influenza vaccination but other component(s) of the vaccine, history of Guillain-Barré decline, or 3) were assessed and determined to have a syndrome within 6 weeks after a previous influenza medical contraindication(s) to the influenza vaccination. vaccination, bone marrow transplant within the past 6 months (less than 6 months prior to encounters between October 1 NQMC 135 and March 31) Perioperative care: percentage of patients, aged 18 years and older, who undergo a procedure under an inhalational general All patients, aged 18 years and older, who undergo any Patients who receive combination therapy consisting of at anesthetic, AND who have three or more risk factors for procedure including surgical, therapeutic or diagnostic under 2380 2018 USA least two prophylactic pharmacologic anti-emetic agents of postoperative nausea and vomiting, who receive combination PMe1 A03 A04 H02 N01 N04 N05 R03 R06 S01 AHNRS an inhalational general anesthetic, AND who have three or different classes preoperatively or intraoperatively therapy consisting of at least two prophylactic pharmacologic more risk factors for postoperative nausea and vomiting anti-emetic agents of different classes preoperatively or NQMC 135 intraoperatively. Total knee replacement: percentage of patients undergoing a Patients who had the prophylactic antibiotic completely total knee replacement who had the prophylactic antibiotic 2381 2018 USA All patients undergoing a total knee replacement PMe1 J01 J infused prior to the inflation of the proximal tourniquet completely infused prior to the inflation of the proximal NQMC 135 tourniquet. IBD: percentage of patients aged 18 years and older with a Patients who had TB screening performed and results diagnosis of IBD for whom a TB screening was performed and 2382 2018 USA All patients aged 18 years and older with a diagnosis of IBD interpreted, within 6 months prior to receiving a first course of PMe7 L04 L results interpreted within 6 months prior to receiving a first anti-TNF therapy NQMC 135 course of anti-TNF therapy. Patients who received either a bone mineral density test or a Osteoporosis: percentage of women age 50 to 85 who Women who experienced a fracture, except fractures of the 2383 2018 USA prescription for a drug to treat osteoporosis after a fracture suffered a fracture and who either had a bone mineral density PMe17 A11 G03 H05 M05 AGHM finger, toe, face or skull occurs test or received a prescription for a drug to treat osteoporosis. NQMC 135 Residents meeting the following criteria on the selected target Short-stay nursing home care: percent of residents who were 2384 2018 USA All short-stay residents with a selected target assessment assessment: PMe15 J07 J offered and declined the pneumococcal vaccine. NQMC 135 1. Were offered and declined the vaccine. Tobacco treatment: percent of patients identified as tobacco Number of patients who received or refused practical product users within the past 30 days who receive or refuse Number of hospitalized inpatients 18 years of age and older counseling to quit AND received or refused FDA-approved 2385 2018 USA practical counseling to quit AND receive or refuse FDA- PMe15 N07 N identified as current tobacco users cessation medications during the hospital stay within the first approved cessation medications during the hospital stay three days after admission NQMC 135 within the first three days after admission. Individuals in the denominator who received two prescriptions Use of benzodiazepine sedative-hypnotic medications in the Number of individuals who are 66 years or older on the last for any benzodiazepine sedative-hypnotic medication and a elderly: percentage of individuals 65 years of age and older 2386 2018 USA day of the measurement year and enrolled in the same health cumulative days supply of greater than 90 days for any who received two or more prescription fills for any PMe4 N05 N plan for greater than 90 days benzodiazepine sedative-hypnotic during the measurement benzodiazepine sedative-hypnotic for a cumulative period of NQMC 135 year more than 90 days. Use of high-risk medications in the elderly: percentage of The number of patients who received at least two prescription Patients 65 years of age and older during the measurement patients 65 years of age and older who received two or more 2387 2018 USA fills for the same high-risk medication during the measurement PMe1 A03 B01 C01 C02 C04 G03 M01 M02 M03 N01 N04 N05 N06 R06 A B C G M N R year prescription fills for a high-risk medication during the period NQMC 135 measurement period. Residents meeting the following criteria on the selected influenza vaccination assessment: All short-stay residents with a selected influenza vaccination Short-stay nursing home care: percent of residents who 2388 2018 USA 1. Resident received the influenza vaccine during the most PMe1 J07 J assessment, except those with exclusions received the seasonal influenza vaccine. recent influenza season, either in the facility or outside the NQMC 135 facility. Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications: percentage Medicaid members age 18 to 64 years as of December 31 of A glucose test or a HbA1c test performed during the of members 18 to 64 years of age with schizophrenia or 2389 2018 USA the measurement year with schizophrenia or bipolar disorder PMe7 N05 N measurement year bipolar disorder who were dispensed an antipsychotic who were dispensed an antipsychotic medication medication and had a diabetes screening test during the NQMC 135 measurement year. COPD: percentage of patients aged 18 years and older with a All patients aged 18 years and older with a diagnosis of diagnosis of COPD and who have an FEV1/FVC less than 2390 2018 USA COPD, who have a FEV1/FVC less than 60% and have Patients who were prescribed an inhaled bronchodilator PMe1 R03 R 60% and have symptoms who were prescribed an inhaled symptoms (e.g., dyspnea, cough/sputum, wheezing) NQMC 135 bronchodilator. Children 3 months as of July 1 of the year prior to the measurement year to 18 years as of June 30 of the Appropriate treatment for children with upper respiratory measurement year, with a Negative Medication History and a Dispensed prescription for antibiotic medication on or three infection: percentage of children 3 months to 18 years of age 2391 2018 USA PMe1 J01 J Negative Competing Diagnosis, who had an outpatient visit, days after the IESD who were given a diagnosis of upper respiratory infection and an observation visit or an ED visit with only a diagnosis of were not dispensed an antibiotic prescription. upper respiratory infection during the Intake Period NQMC 135 Hepatitis C: percentage of patients aged 18 years and older All patients aged 18 years and older with a specific diagnosis Patients who have received at least one injection of hepatitis with a diagnosis of hepatitis C who have received at least one 2392 2018 USA PMe1 J07 J of chronic hepatitis C B vaccine or who have documented immunity to hepatitis B injection of hepatitis B vaccine or who have documented NQMC 135 immunity to hepatitis B. The number of patients in your selection with multiple The number of patients in your selection with ICD-10 code C90.00 (not in remission) or C90.02 (in Hematology: percentage of patients with multiple myeloma 2393 2018 USA myeloma ICD-10 code C90.00 (not in remission) or C90.02 (in relapse) PMe1 M05 M ever treated with a bisphosphonate. relapse) AND NQMC 135 Treated with a bisphosphonate Patients 18 years and older who filled at least two PDC: percentage of patients who filled at least two prescriptions for a biguanide or biguanide combination The number of patients who met the PDC threshold of 80% prescriptions for a biguanide or biguanide combination 2394 2018 USA PMe5 A10 A product on two unique dates of service during the during the measurement year product on two unique dates of service who met the PDC NQMC 135 measurement period threshold of 80% during the measurement period. Children who had four diphtheria, tetanus, and acellular Childhood immunization status: percentage of children 2 pertussis vaccinations; three polio vaccinations; one measles, years of age who had four diphtheria, tetanus, and acellular mumps, and rubella vaccination; three haemophilus influenza pertussis ; three polio ; one measles, mumps, and rubella ; Children who turn two years of age during the measurement type B vaccinations; three hepatitis B vaccinations; one 2395 2018 USA three haemophilus influenza type B ; three hepatitis B ; one PMe1 J07 J year chicken pox vaccination; four pneumococcal conjugate chicken pox; four pneumococcal conjugate; one hepatitis A; vaccinations; one hepatitis A vaccination; two or three two or three rotavirus; and two influenza vaccines by their rotavirus vaccinations; and two influenza vaccinations by their second birthday. NQMC 135 second birthday Immunization: percent of acute care hospitalized inpatients Acute care hospitalized inpatients 6 months of age and older Inpatient discharges who were screened for influenza vaccine age 6 months and older who were screened for seasonal 2396 2018 USA discharged during October, November, December, January, PMe1 J07 J status and were vaccinated prior to discharge, if indicated influenza immunization status and were vaccinated prior to February, or March NQMC 135 discharge, if indicated. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Medication management for people with asthma: percentage The number of members who achieved a PDC of at least 50% of members 5 to 85 years of age during the measurement Members 5 to 85 years of age by December 31 of the 2397 2018 USA for their asthma controller medications during the year who were identified as having persistent asthma and who PMe5 R03 R measurement year with persistent asthma measurement year were dispensed an asthma controller medication that they remained on for at least 50% of their treatment period. NQMC 135 Patients 18 years and older who filled at least two PDC: percentage of patients who filled at least two prescriptions for a non-warfarin oral anticoagulant on two prescriptions for a non-warfarin oral anticoagulant on two The number of patients who met the PDC threshold of 80% 2398 2018 USA unique dates of service at least 180 days apart during the unique dates of service at least 180 days apart, received PMe5 B01 B during the measurement yea measurement period AND who received greater than 60 days greater than 60 days supply of the medication, and who met supply of the medication during the measurement period the PDC threshold of 80% during the measurement period. NQMC 135 Residents meeting the following criteria on the selected target assessment: 1. Were ineligible due to medical contraindication(s) (e.g., Short-stay nursing home care: percent of residents who did 2399 2018 USA All short-stay residents with a selected target assessment anaphylactic hypersensitivity to components of the vaccine; not receive, due to medical contraindication, the PMe1 J07 J bone marrow transplant within the past 12 months; or pneumococcal vaccine. receiving a course of chemotherapy within the past two NQMC 135 weeks). Number of long-stay residents, 18 years and older on the prior assessment, in a skilled nursing facility with an active Antipsychotic use in persons with dementia: percentage of diagnosis of 14200 Alzheimer's disease or 14800 non- Patients in the denominator with use of an antipsychotic long-stay nursing home residents with dementia who are 2400 2018 USA Alzheimer dementia on either the prior or the target medication verified in Section N (N0410A) greater than or PMe1 N05 N persistently receiving an antipsychotic medication without assessment and/or if cognitive impairment is indicated based equal to 12 days when combining both assessments evidence of a psychotic disorder or related condition. on covariate equal to zero on either the prior or the target NQMC 135 assessment Members age 18 years and older as of December 31 of the measurement year who had two of the following with different Disease-modifying anti-rheumatic drug therapy for rheumatoid dates of service on or between January 1 and November 30 Members who had at least one ambulatory prescription arthritis: percentage of members who were diagnosed with 2401 2018 USA of the measurement year: PMe1 L04 L dispensed for a DMARD during the measurement year rheumatoid arthritis and who were dispensed at least one ・Outpatient visit, with any diagnosis of rheumatoid arthritis ambulatory prescription for a DMARD. ・Nonacute inpatient discharge, with any diagnosis of rheumatoid arthritis NQMC 135 Residents meeting the following criteria on the selected target Long-stay nursing home care: percent of residents who were 2402 2018 USA All long-stay residents with a selected target assessment assessment: PMe5 J07 J offered and declined the pneumococcal vaccine. NQMC 135 1. Were offered and declined the vaccine Follow-up care for children prescribed ADHD medication All members who meet the following criteria: Members age 6 years as of March 1 of the year prior to the (continuation and maintenance phase): percentage of ・An outpatient, intensive outpatient or partial hospitalization measurement year to 12 years as of February 28 of the members 6 to 12 years of age with an ambulatory prescription follow-up visit with a practitioner with prescribing authority measurement year, with a Negative Medication History, who dispensed for ADHD medication who remained on the 2403 2018 USA within 30 days after the IPSD PMe7 N06 N were dispensed an ADHD medication during the 12-month medication for at least 210 days and who, in addition to the and Intake Period who remained on the medication for at least 210 visit in the initiation phase, had at least two follow-up visits ・At least two follow-up visits with any practitioner, from 31 to days with a practitioner within 270 days (9 months) after the 300 days (9 months) after the IPSD NQMC 135 initiation phase ended. Ischemic stroke patients prescribed statin medication at Stroke: percent of ischemic stroke patients who are 2404 135 2018 USA Ischemic stroke patients PMe1 C10 C NQMC hospital discharge prescribed a statin medication at hospital discharge. Children and adolescents age 1 to 17 years as of December Use of multiple concurrent antipsychotics in children and Members on two or more concurrent antipsychotic 31 of the measurement year with 90 days of continuous adolescents: percentage of children and adolescents 1 to 17 2405 2018 USA medications for at least 90 consecutive days during the PMe1 N05 N antipsychotic medication treatment during the measurement years of age who were on two or more concurrent measurement year NQMC 135 year antipsychotic medications. The number of MDS patients in your selection AND Myelodysplastic syndromes: percentage of MDS patients The number of MDS patients in your selection who are being Being treated with erythropoietin/darbepoetin presenting with anemia who had a serum erythropoietin level 2406 2018 USA PMe7 B03 B treated with erythropoietin/darbepoetin AND less than or equal to 500 mU/ml prior to receiving Who have serum erythropoietin level less than or equal to 500 erythropoietin/darbepoetin therapy. mU/mL prior to receiving erythropoietin/darbepoetin therapy NQMC 135 Inflammatory bowel disease: percentage of patients aged 18 years and older with a diagnosis of IBD who have been managed by corticosteroids greater than or equal to 10 Patients prescribed a corticosteroid sparing therapy (e.g., 2407 2018 USA All patients aged 18 years and older with a diagnosis of IBD mg/day of prednisone equivalents for 60 or greater PMe1 A07 L04 AL , methotrexate, or biologic agents) consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills that have been prescribed corticosteroid sparing therapy within the last 12 months. NQMC 135 The number of eligible members who responded "Yes" or The number of members in the denominator who responded "No" to the question "Have you ever had a pneumonia shot? "Yes" to the question "Have you ever had a pneumonia shot? Pneumococcal vaccination status for older adults: percentage 2408 2018 USA This shot is usually given only once or twice in a person's This shot is usually given only once or twice in a person's of Medicare members 65 years of age and older who have PMe1 J07 J lifetime and is different from the flu shot. It is also called the lifetime and is different from the flu shot. It is also called the ever received a pneumococcal vaccination. NQMC 135 pneumococcal vaccine." pneumococcal vaccine." Number of home health episodes of care where the value Number of home health episodes of care ending with a Home health care: percentage of home health episodes of recorded on the discharge assessment indicates the same or 2409 2018 USA discharge during the reporting period, other than those care during which the patient's ability to manage their oral O Ge 5 N/A N/A less impairment in management of oral medications at covered by generic or measure-specific exclusions medications improved or stayed the same as at admission. discharge than at start (or resumption) of care NQMC 135 Number of home health episodes of care where the value Number of home health episodes of care ending with a Home health care: percentage of home health episodes of recorded on the discharge assessment indicates less 2410 2018 USA discharge during the reporting period, other than those care during which the patient improved in ability to manage O Ge 5 N/A N/A impairment in ability to manage oral medications at discharge covered by generic or measure-specific exclusions their oral medications. NQMC 135 than at start (or resumption) of care Number of patients with COPD who are prescribed appropriate therapy, including:

・Appropriate vaccinations per Centers for Disease Control and Prevention schedule Diagnosis and management of COPD: percentage of patients 2411 2018 USA Number of patients with COPD diagnosis ・Long-term oxygen assessment and prescription for long- PMe17 J07 R03 V03 JRV with COPD who are prescribed appropriate therapy. term home oxygen for those who are hypoxic and meet criteria ・Short-acting bronchodilator (when needed) ・Long-acting bronchodilator (when needed) NQMC 135 ・Corticosteroids (when needed) The numerator is the number of children, ages 1 through 17 Pediatric asthma: percentage of children, ages 1 through 17 The denominator is the number of children, ages 1 through 17 years with persistent asthma, who, during the measurement years with persistent asthma, who, during the measurement 2412 2018 USA years with persistent asthma, who, during the measurement year, presented to a hospital ED for an asthma exacerbation year, presented to a hospital ED for an asthma exacerbation PMe1 R03 R year, presented to a hospital ED for an asthma exacerbation and were prescribed an inhaled corticosteroid at the time of and were prescribed an inhaled corticosteroid at the time of NQMC 135 discharge discharge. Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka Hepatitis C: percentage of patients aged 18 years and older Patients aged 18 years and older with a specific diagnosis of Patients for whom quantitative hepatitis C virus ribonucleic with a diagnosis of chronic hepatitis C who are receiving chronic hepatitis C with initiation of antiviral treatment before 2413 2018 USA acid testing was performed at no greater than 12 weeks from antiviral treatment for whom quantitative hepatitis C virus PMe7 J05 J October of the measurement year (12 weeks before the end the initiation of antiviral treatment ribonucleic acid testing was performed between 4 and 12 of the measurement period) NQMC 135 weeks after the initiation of antiviral treatment. PDC: percentage of patients with COPD who filled at least two Patients in the eligible population who filled at least two The number of patients in the denominator who met the PDC prescriptions for any long-acting inhaled bronchodilator on two 2414 2018 USA prescriptions for any long-acting inhaled bronchodilator on two PMe5 R03 R threshold of 80% during the measurement year unique dates of service who met the PDC threshold of 80% unique dates of service during the measurement period NQMC 135 during the measurement period. Chronic stable coronary artery disease: percentage of patients All patients aged 18 years and older with a diagnosis of aged 18 years and older with a diagnosis of coronary artery coronary artery disease seen within a 12 month period who 2415 2018 USA Patients who were prescribed beta-blocker therapy disease seen within a 12 month period who also have prior MI PMe1 C07 C also have prior (within the past 3 years) MI or a current or or a current or prior LVEF less than 40% who were prescribed prior LVEF less than 40% NQMC 135 beta-blocker therapy. Hepatitis C: percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C who started antiviral Patients for whom quantitative hepatitis C virus ribonucleic Patients aged 18 years and older with a specific diagnosis of treatment within the 12 month reporting period for whom 2416 2018 USA acid testing was performed within 12 months prior to initiation PMe7 J05 J chronic hepatitis C quantitative hepatitis C virus ribonucleic acid testing was of antiviral treatment performed within 12 months prior to initiation of antiviral NQMC 135 treatment. Included populations: ・An Evaluation and Management Code for ED encounter, and ・Patients discharged/transferred to a short-term general hospital for inpatient care, or to a Federal healthcare facility, Continuous variable statement: Time (in minutes) from ED AMI: median time from ED arrival to administration of and arrival to administration of fibrinolytic therapy in AMI patients fibrinolytic therapy in ED patients with ST-segment elevation 2417 2018 USA PMe5 B01 B ・An International Classification of Diseases, Tenth Revision, with ST-segment elevation on the ECG performed closest to on the ECG performed closest to ED arrival and prior to Clinical Modification (ICD-10-CM) Principal Diagnosis Code ED arrival and prior to transfer transfer. for AMI, and ・ST-segment elevation on the ECG performed closest to ED arrival, and NQMC 135 ・Fibrinolytic Administration Preventive care and screening: percentage of patients aged 6 All patients aged 6 months and older seen for a visit between Patients who received an influenza immunization OR who months and older seen for a visit between October 1 and 2418 2018 USA PMe1 J07 J October 1 and March 31 reported previous receipt of an influenza immunization March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization. NQMC 135 Heart failure: percentage of patients aged 18 years and older Patients who were prescribed ACEI or ARB therapy either with a diagnosis of heart failure with a current or prior left All patients aged 18 years and older with a diagnosis of heart 2419 2018 USA within a 12 month period when seen in the outpatient setting LVEF less than 40% who were prescribed ACEI or ARB PMe1 C09 C failure with a current or prior LVEF less than 40% or at each hospital discharge therapy either within a 12 month period when seen in the outpatient setting or at each hospital discharge. NQMC 135 ED acute myocardial infarction or chest pain patients (with probable Cardiac Chest Pain as defined in the Data Dictionary) Included populations: ・An Evaluation and Management Code for ED encounter, and ED acute myocardial infarction or chest pain patients (with Acute myocardial infarction (AMI)/chest pain: percentage of 2420 2018 USA ・Patients discharged/transferred to a short-term general Probable Cardiac Chest Pain) who received aspirin within 24 ED patients with AMI or chest pain who received aspirin within PMe15 B01 B hospital for inpatient care, or to a Federal healthcare facility, hours before ED arrival or prior to transfer 24 hours before ED arrival or prior to transfer. and ・An ICD-10 Clinical Modification Principal Diagnosis Code for AMI or an ICD-10 Clinical Modification Principal or Other Diagnosis Codes for angina, acute coronary syndrome, or chest pain with Probable Cardiac Chest Pain NQMC 135 Hepatitis C: percentage of patients aged 18 years and older Patients aged 18 years and older with a specific diagnosis of Patients who have received at least one injection of hepatitis with a diagnosis of chronic hepatitis C who have received at 2421 2018 USA PMe1 J07 J chronic hepatitis C A vaccine or who have documented immunity to hepatitis A least one injection of hepatitis A vaccine or who have NQMC 135 documented immunity to hepatitis A. The numerator is the number of children, ages 1 through 17 Pediatric asthma: percentage of children, ages 1 through 17 The denominator is the number of children, ages 1 through 17 years, identified as having asthma, regardless of severity, who years old, identified as having asthma, regardless of severity, years, identified as having asthma, regardless of severity, who are prescribed and dispensed a new medication delivery 2422 2018 USA who are prescribed and dispensed a new medication delivery PMe5 R03 R are prescribed and dispensed a new medication delivery device and have documentation of the patient or the device and have documentation of the child or caregiver device in the measurement year caregiver(s) receiving education in the proper use of a new receiving education in the proper use of the device. medication delivery device in the measurement year NQMC 135 Adult depression in primary care: percentage of patients Number of primary care patients age 18 years and older with Number of patients whose symptoms are reassessed with whose symptoms are reassessed by the use of a quantitative 2423 2018 USA new diagnosis of major depression or persistent depressive Patient Health Questionnaire-9 at six months (+/- 30 days) PMe7 N06 N symptom assessment tool at six months (+/- 30 days) after disorder and Patient Health Questionnaire-9 greater than 9 after diagnosis or initiating treatment NQMC 135 diagnosis or initiating treatment. Hepatitis C: percentage of patients aged 18 years and older Patients for whom hepatitis C virus genotype testing was with a diagnosis of chronic hepatitis C who started antiviral Patients aged 18 years and older with a specific diagnosis of 2424 2018 USA performed within 12 months prior to initiation of antiviral treatment within the 12 month reporting period for whom PMe7 J05 J chronic hepatitis C treatment hepatitis C virus genotype testing was performed within 12 NQMC 135 months prior to initiation of antiviral treatment. Perinatal care: percentage of patients at risk of preterm Patients delivering live preterm newborns with greater than or Patients with antenatal steroids initiated prior to delivering delivery at greater than or equal to 24 and less than 34 weeks 2425 2018 USA PMe1 H02 H equal to 24 and less than 34 weeks gestation completed preterm newborns gestation receiving antenatal steroids prior to delivering NQMC 135 preterm newborns. Included populations: ・Patients with a patient age on Outpatient Encounter Date (Outpatient Encounter Date ‒ Birthdate) greater than or equal Continuous variable statement: Time (in minutes) from ED Emergency department: median time from ED arrival to time to 2 years, and arrival to time of initial oral, intranasal or parenteral pain of initial oral, intranasal or parenteral pain medication 2426 2018 USA PMe5 N02 N ・An ICD-10 Clinical Modification Principal Diagnosis Code medication administration for ED patients with a diagnosis of a administration for ED patients with a principal diagnosis of for a (long bone) fracture, and (long bone) fracture long bone fracture. ・Patients with Pain Medication and NQMC 135 ・An Evaluation and Management Code for ED encounter Heart failure: percentage of patients aged 18 years and older Patients who were prescribed beta-blocker therapy either with a diagnosis of heart failure with a current or prior LVEF All patients aged 18 years and older with a diagnosis of heart 2427 2018 USA within a 12 month period when seen in the outpatient setting less than 40% who were prescribed beta-blocker therapy PMe1 C07 C failure with a current or prior LVEF less than 40% or at each hospital discharge either within a 12 month period when seen in the outpatient setting or at each hospital discharge. NQMC 135 Donabe c- c- c- dian's QI ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC-ATC ATC ATC ATC ATC ATC ATC ATC No. Reference Year Country Denominator Numerator Definition DRP- DRP- DRP- framew typeb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1 2 3 orka (ED Care) Caregivers of children/adolescents who were evaluated in the ED for suicidality during the last 12 months 2428 2018 USA should report having been counseled on how to restrict their PGe5 N/A N/A child’s/adolescent’s access to potentially lethal means of suicide (eg, firearms, medications, car) before discharge. Parast et al. 136 (ED Care) Caregivers of children/adolescents who were evaluated in the ED for suicidality during the last 12 months and who were started on a new antidepressant or had a 2429 2018 USA change in antidepressant dose should report that they were PMe5 N06 N counseled regarding the potential benefits and risks of the medication, including the potential increased risk of suicidal Parast et al. 136 ideation. (Inpatient Care) Caregivers of children/adolescents who were hospitalized for suicidality during the last 12 months should 2430 2018 USA report having been counseled on how to restrict their PGe5 N/A N/A child’s/adolescent’s access to potentially lethal means of suicide (eg, firearms, medications, car) before discharge. Parast et al. 136 (Inpatient Care) Caregivers of children/adolescents who were admitted to the hospital for suicidality during the last 12 months and who were started on a new antidepressant or had 2431 2018 USA a change in antidepressant dose should report that they were PMe5 N06 N counseled regarding the potential benefits and risks of the medication, including the potential increased risk of suicidal Parast et al. 136 ideation. a. Donabedian’s framework, S: Structure, P: Process, O: Outcome, b. QI type, Me: Medicine class specific, Ge: General medication Abbreviation: AAOS/ADA: the American academy of orthopaedic surgeons/the American dental association, AC: ante cibum (before meals), ACCP: the American College of Chest Physicians, ACE: angiotensin-converting-enzyme, ACEI: angiotensin-converting-enzyme inhibitor, ACS: acute coronary syndrome , ACSQHC: the Australian commission on safety and quality in health care, ACTH: adrenocorticotropic hormone, ADE: adverse drug event, ADHD: attention deficit hyperactivity disorder, ADR: , AF: atrial fibrillation, AI: aromatase Inhibitor, AJCC: American Joint Committee on Cancer, ALS: amyotrophic lateral sclerosis, ALT: alanine transferase, AMI: acute myocardial infarction, AOE: acute otitis externa, APS: antiphospholipid syndrome, ARB: angiotensin receptor blocker, ASA: acetylsalicylic acid, ASCVD: atherosclerotic cardiovascular diseas, AT2: angiotensin II, AUA SI: the american urological association symptom index, AVPU: the alert, voice, pain, unresponsive scale, AZA: azathioprine, BCG: Bacille Calmette Guerin, BID: bis in die (twice daily), BMD: bone mineral density, BMS: bare stents, BNF: british national formulary, BPH: benign prostatic hypertrophy, BTX: botox , BUN: blood urea nitrogen, CABG: coronary artery bypass graft surgery, CAD: coronary artery disease, CAP: community acquired pneumonia, CBC: complete blood count, CCB: calcium channel blocker, CCRT: concurrent chemo-irradiation, CD: Crohn's disease, CDC: centers for disease control and prevention, CEA: carcinoembryonic antigen, cGVHD: chronic graft versus host disease, CHD: coronary heart disease, CHF: congestive heart failure, CHOP: cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone/prednisolone, ChT: chemotherapy, CIS: clinically isolated syndrome, CKD: chronic kidney disease, CLSC: the Centre local de services communautaires (the local Quebec community centre for health and social services), CNS: central nervous system, COPD: chronic obstructive pulmonary disease, COX: cyclooxygenase, CPG: clinical practice guidelines, cT: clinical tumour, CT: computed tomography, CV: cardiovascular, CVA: cerebrovascular accident, DBP: diastolic blood pressure, DCIS: ductal carcinoma in situ, DDD: the defined daily dose, DES: drug-eluting stents, DKA: diabetic ketoacidosis, DMARD: disease-modifying anti-rheumatic drug, DNH: do not hospitalize, DPP: dipeptidyl peptidase, DSM: the diagnostic and statistical manual of mental disorders, DTC: drug and therapeutics committee, DTP: Diphtheria-Tetanus-Pertussis, DTP/DTaP/DT: three Diptheria, Tetanus and Pertussis/Diphtheria, Tetanus, and Pertussis Vaccines/Diphtheria, and Tetanus Vaccine, DU: drug utilization, DVT: deep vein thrombosis, DXA: dual-energy x-ray absorptiometry, ECG: electrocardiogram, ECT: electroconvulsive therapy, ED: emergency department, EGD: esophagogastroduodenoscopy, eGFR: estimated glomerular filtration rate, ER: emergency room, EUS: endoscopic ultrasound, EVL: endoscopic variceal ligation, FDA: food and drug administration, FEV1: forced expiratory volume in one second, FISH: fluorescence in-situ hybridization, FS: HbSS and HbS Beta zero thalassemia, FSH: follicle-stimulating hormone, FVC: forced vital capacity, GC: gastric cancer, GDS: the geriatric depression scale, GERD: gastroesophageal reflux disease, GFR: glomerular filtration rate, GI: gastrointestinal, GnRH: gonadotropin releasing hormone, GOLD: the global initiative for obstructive lung disease, GP: general practitioner, GTN: trinitrate, H2: 2, HbA1c: glycated haemoglobin, HBIG: hepatitis B immune globulin, HBsAg: hepatitis B surface antigen, HBV: hepatitis B vaccine, BUN: blood urea nitrogen, HCT: hematopoietic cell transplantation, HDL: high-density lipoprotein, HepB: hepatitis B, HER: human epidermal growth factor receptor, HF: heart failure, Hib: Haemophilus influenzae type B, HIV: human immunodeficiency virus, H pylori: helicobacter pylori, HRT: hormone replacement therapy, HTN: hypertension, IA: intra-arterial, IBD: inflammatory bowel disease, ICCUs: inflammatory bowel disease comprehensive care units, ICD: the international statistical classification of diseases and related health problems, ICH: Intracerebral hemorrhage, ICPC-2-R: the revised second edition of international classification of primary care, ICU: intensive care unit, IESD: index episode start date, IHC: immunohistochemistry, IHD: ischemic heart disease, IM: intramuscular, INR: international normalized ratio, IPSS: international prognostic scoring system, IPV: inactivated polio vaccines, IQR: interquartile range, ISN/RPS: international society of nephrology/renal pathology society, IV: intravenous, LA: the Los Angeles classification system, LABA: long-acting β agonist, LBBB: left bundle branch block, LDL: low-density lipoprotein, LFT: liver function test, LH: luteinizing hormone, LMWH: low-molecular-weight heparin, LN: lymph node, LVEF: left ventricular ejection fraction, LVS: left ventricular systolic, LVSD: left ventricular systolic dysfunction, M: metastasis, MAOI: monoamine oxidase inhibitor, MBD: mineral and bone disorder, MDD: major depressive disorder, MDI: metered-dose inhaler, MDS: myelodysplastic syndromes, MI: myocardial infarction, MMR: measles, mumps, and rubella, 6-MP: 6-, MRI: magnetic resonance imaging, MRSA: methicillin-resistant Staphylococcus aureus, MRSE: methicillin-resistant Staphylococcus epidermidis, MS: multiple sclerosis, N: nodes, NH: nursing home, NICE: national institute for health and clinical excellence, NPH: neutral protamine hagedorn, NQMC: national quality measures clearinghouse, NSAID: non-steroidal anti-inflammatory drug, NSCLC: non-small cell lung cancer, NSTEMI: non-ST segment elevation myocardial infarction, NYHA: New York Heart Association, OA: osteoarthritis, OAB: overactive bladder, OC: oesophageal cancer, OHSS: ovarian hyperstimulation syndrome , OME: otitis media with effusion, OPV: oral poliovirus vaccines, ORS: oral rehydration solution, PCI: percutaneous coronary intervention, PCV: pneumococcal conjugate vaccine, PDC: proportion of days covered, PDE: phosphodiesterase, PE: pulmonary embolism, PEFR: peak expiratory flow rate, PID: pelvic inflammatory disease, PO: per os (by mouth or orally), POAG: primary open-angle glaucoma, POS: premature ovarian failure, PPH: postpartum hemorrhage, PPI: proton pump inhibitor, PPV: pneumococcal polysaccharide vaccine, PRAM: pediatric respiratory assessment measure, PRN: pro re nata (as needed), PRP-OMP: polyribosylribitol phosphate-outer membrane protein conjugate (Hib) vaccine, PSA: prostate-specific antigen, PTH: parathyroid hormone, PTT: partial thromboplastin time, PVD: peripheral vascular disease, QHS: quaque hora somni (every night at bedtime), RA: rheumatoid arthritis, RAS: renin–angiotensin system, Rh: rhesus, RHC: right heart catheterisation, RT: radiotherapy, r-TPA: recombinant tissue plasminogen activator, SABA: short-acting β agonist, SAH: subarachnoid hemorrhage, SBP: systolic blood pressure, SCD: sickle cell disease, SERMs: selective estrogen receptor modulators, SLE: systemic lupus erythematosus, SNM: sacral , SSRI: selective serotonin , STEMI: ST-segment elevated myocardial infarction, STD: sexually transmitted disease, SUI: stress urinary incontinence, T: tumour, t1/2: terminal half-life, T4: thyroxine, TB: tuberculosis, TC: total cholesterol, TCA: tricyclic antidepressant, T2DM: type 2 diabetes mellitus, TDM: therapeutic drug monitoring, TG: triglycerides, THR: total hip replacement, TIA: transient ischaemic attack, TID: ter in die (three times a day), TKR: total knee replacement, TNF: tumor necrosis factor, TNM: tumour, node and metastasis, tPA: tissue plasminogen activator, TPMT: thiopurine methyltransferase, TRUS: transrectal ultrasound, TSC: tuberous sclerosis complex, TSH: thyroid-stimulating hormone, TTR: percent time in therapeutic INR range, UC: ulcerative colitis, U+E: urea and electrolytes, UFH: unfractionated heparin, UI: urinary Incontinence, UTI: urinary tract infection, UUI: urge urinary incontinence, VE: vulnerable elder, VTE: venous thromboembolism, VZV: varicella-zoster virus, WBC: white blood cell, WHO: world health organization, WPSS: world health organization-based prognostic scoring system, Z drug: nonbenzodiazepine drug with effects similar to benzodiazepines. References 1 Broccoli MC, Moresky R, Dixon J, et al. Defining quality indicators for emergency care delivery: findings of an expert consensus process by emergency care practitioners in Africa. BMJ Glob Health 2018;3:e000479. 2 Tropea J, Amatya B, Brand CA. Use of consensus methods to select clinical indicators to assess activities to minimise functional decline among older hospitalised patients. Aust Health Rev 2011;35:404-11.

3 Australian Commission on Safety and Quality in Health Care. Practice-level indicators of safety and quality for primary health care specification: Australian Commission on Safety and Quality in Health Care; 2012 [accessed 5 May 2017]. Available from: https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/Practice-level-indicators-for-primary-health-care-specification-V1.0-October- 2012.pdf.

4 Australian Commission on Safety and Quality in Health Care and NSW Therapeutic Advisory Group Inc. National Quality Use of Medicines Indicators for Australian Hospitals Sydney: ACSQHC; 2014 [accessed 5 May 2017]. Available from: https://www.safetyandquality.gov.au/wp- content/uploads/2014/11/SAQ127_National_QUM_Indicators_V14-FINAL-D14-39602.pdf.

5 Caughey GE, Kalisch Ellett LM, Wong TY. Development of evidence-based Australian medication-related indicators of potentially preventable hospitalisations: A modified RAND appropriateness method. BMJ Open 2014;4:1-17. 6 Services VsgDoHH. Quality indicators in PSRACS resource materials 2015 2015 [accessed 9 April 2018]. Available from: https://www2.health.vic.gov.au/about/publications/policiesandguidelines/quality-indicators-psracs-resource-materials-2015.

7 Nag N, Millar J, Davis ID, et al. Development of Indicators to Assess Quality of Care for Prostate Cancer. European focus 2016. 8 O'Connor DW, D'Cunha C, Clifton T, et al. Quality indicators of psychotropic prescribing to people with dementia in aged psychiatry inpatient units. Aging Ment Health 2017:1-6. 9 Sibthorpe B, Agostino J, Coates H, et al. Indicators for continuous quality improvement for otitis media in primary health care for Aboriginal and Torres Strait Islander children. Aust J Prim Health 2017;23:1-9.

10 Stordeur S, Vrijens F, Devriese S, et al. Developing and measuring a set of process and outcome indicators for breast cancer. Breast 2012;21:253-60. 11 Grypdonck L, Aertgeerts B, Luyten F, et al. Development of quality indicators for an integrated approach of knee osteoarthritis. J Rheumatol 2014;41:1155-62. 12 Stordeur S, Vlayen J, Vrijens F, et al. Quality indicators for oesophageal and gastric cancer: a population-based study in Belgium, 2004-2008. Eur J Cancer Care (Engl) 2015;24:376-86.

13 De Schreye R, Houttekier D, Deliens L, et al. Developing indicators of appropriate and inappropriate end-of-life care in people with Alzheimer’s disease, cancer or chronic obstructive pulmonary disease for population-level administrative databases: A RAND/UCLA appropriateness study. Palliat Med 2017;31:932-45.

14 Leemans K, Deliens L, Van den Block L, et al. Systematic Quality Monitoring For Specialized Palliative Care Services: Development of a Minimal Set of Quality Indicators for Palliative Care Study (QPAC). Am J Hosp Palliat Care 2017;34:532-46.

15 de Carvalho AGR, de Moraes APP, Tanaka LMS, et al. Quality in intensive care units: proposal of an assessment instrument. BMC Res Notes 2017;10:222.

16 Mackinnon NJ, Hepler CD. Preventable drug-related morbidity in older adults 1. Indicator development. J Manag Care Pharm 2002;8:365-71. 17 Robertson HA, MacKinnon NJ. Development of a list of consensus-approved clinical indicators of preventable drug-related morbidity in older adults. Clin Ther 2002;24:1595-613. 18 Burge FI, Bower K, Putnam W, et al. Quality indicators for cardiovascular primary care. The Canadian journal of cardiology 2007;23:383-88.

19 Kröger E, Tourigny A, Morin D, et al. Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia. BMC Health Serv Res 2007;7:195. 20 Ko DT, Wijeysundera HC, Zhu X, et al. Canadian quality indicators for percutaneous coronary interventions. Can J Cardiol 2008;24:899-903.

21 MacKinnon NJ, Hartnell NR, Black EK, et al. Development of clinical indicators for type 2 diabetes. Canadian Pharmacists Journal 2008;141:120- 28. 22 Nigam R, Mackinnon NJ, David UD, et al. Development of canadian safety indicators for medication use. Healthcare quarterly (Toronto, Ont) 2008;11:47-53. 23 Tu JV, Khalid L, Donovan LR, et al. Indicators of quality of care for patients with acute myocardial infarction. CMAJ: Canadian Medical Association Journal 2008;179:909-15.

24 Dixon E, Armstrong C, Maddern G, et al. Development of Quality Indicators of Care for Patients Undergoing Hepatic Resection for Metastatic Colorectal Cancer Using a Delphi Process. J Surg Res 2009;156:32-38.e1. 25 Teresato, Guttmann A, Lougheed MD, et al. Evidence-based performance indicators of primary care for asthma: A modified RAND Appropriateness Method. Int J Qual Health Care 2010;22:476-85.

26 Krzyzanowska MK, Barbera L, Elit L, et al. Identifying population-level indicators to measure the quality of cancer care for women. Int J Qual Health Care 2011;23:554-64.

27 Schull MJ, Guttmann A, Leaver CA, et al. Prioritizing performance measurement for emergency department care: Consensus on evidencebased quality of care indicators. Canadian Journal of Emergency Medicine 2011;13:300-09. 28 Addington DE, McKenzie E, Wang J, et al. Development of a core set of performance measures for evaluating schizophrenia treatment services. Psychiatr Serv 2012;63:584-91.

29 Stang AS, Straus SE, Crotts J, et al. Quality indicators for high acuity pediatric conditions. Pediatrics 2013;132:752-62.

30 Darling G, Malthaner R, Dickie J, et al. Quality indicators for non-small cell lung cancer operations with use of a modified Delphi consensus process. Ann Thorac Surg 2014;98:183-90. 31 Nguyen GC, Devlin SM, Afif W, et al. Defining quality indicators for best-practice management of inflammatory bowel disease in Canada. Canadian Journal of Gastroenterology and Hepatology 2014;28:275-85.

32 Santana MJ, Stelfox HT, Asbridge M, et al. Development and evaluation of evidence-informed quality indicators for adult injury care. Ann Surg 2014;259:186-92. 33 Barber CE, Patel JN, Woodhouse L, et al. Development of key performance indicators to evaluate centralized intake for patients with osteoarthritis and rheumatoid arthritis. Arthritis Research and Therapy 2015;17:322.

34 Fernandes O, Gorman SK, Slavik RS, et al. Development of clinical pharmacy key performance indicators for hospital pharmacists using a modified Delphi approach. The Annals of pharmacotherapy 2015;49:656-69.

35 Khare SR, Batist G, Bartlett G. Identification of performance indicators across a network of clinical cancer programs. Current Oncology 2016;23:81-90. 36 McKelvie RS, Heckman GA, Blais C, et al. Canadian Cardiovascular Society Quality Indicators for Heart Failure. Can J Cardiol 2016;32.

37 Khare SR, Aprikian A, Black P, et al. Quality indicators in the management of bladder cancer: A modified Delphi study. Urologic Oncology: Seminars and Original Investigations 2017;35:328-34. 38 Tu JV, Maclagan LC, Ko DT, et al. The Cardiovascular Health in Ambulatory Care Research Team performance indicators for the primary prevention of cardiovascular disease: a modified Delphi panel study. CMAJ open 2017;5:E315-e21. 39 Tu K, Bevan L, Hunter K, et al. Quality indicators for the detection and management of chronic kidney disease in primary care in Canada derived from a modified Delphi panel approach. CMAJ open 2017;5:E74-e81.

40 Chartrand M, Guenette L, Brouillette D, et al. Development of quality indicators to assess oral anticoagulant management in community pharmacies for patients with atrial fibrillation. Journal of Managed Care and Specialty Pharmacy 2018;24:357-65. 41 Mukerji G, Halperin I, Hunter K, et al. Developing a set of indicators to monitor quality in ambulatory diabetes care using a modified Delphi panel process. Int J Qual Health Care 2018;30:65-74. 42 Sun H, Liu M, Hou S. Quality indicators for acute myocardial infarction care in China. Int J Qual Health Care 2011;23:365-74.

43 Bao H, Yang F, Wang X, et al. Developing a set of quality indicators for breast cancer care in China. Int J Qual Health Care 2015;27:291-96. 44 Chen L, Huang L-H, Xing M-Y, et al. Using the Delphi method to develop nursing-sensitive quality indicators for the NICU. J Clin Nurs 2017;26:502-13.

45 Wu Q, Huang LH, Xing MY, et al. Establishing nursing-sensitive quality indicators for the operating room: A cross-sectional Delphi survey conducted in China. Aust Crit Care 2017;30:44-52. 46 Li W, Zeng L, Li J, et al. Development of indicators for assessing rational drug use to treat community-acquired pneumonia in children in hospitals and clinics: A modified Delphi study. Medicine (Baltimore) 2017;96:e9308. 47 Wang X, Su S, Li S, et al. Development of quality indicators for non-small cell lung cancer care: A first step toward assessing and improving quality of cancer care in China. BMC Cancer 2017;17 (1) (no pagination).

48 Ju QY, Huang LH, Zhao XH, et al. Development of Evidence-based Nursing-sensitive Quality Indicators for Emergency Nursing: A Delphi study. J Clin Nurs 2018. 49 Tang X, Chen X, Pang Y, et al. The development of quality indicators for home care in China. Int J Qual Health Care 2018.

50 Saust LT, Bjerrum L, Arpi M, et al. Quality indicators for the diagnosis and antibiotic treatment of acute respiratory tract infections in general practice: a RAND Appropriateness Method. Scand J Prim Health Care 2017;35:192-200.

51 Campbell SM, Ludt S, Van Lieshout J, et al. Quality indicators for the prevention and management of cardiovascular disease in primary care in nine European countries. European Journal of Cardiovascular Prevention and Rehabilitation 2008;15:509-15. 52 Adriaenssens N, Coenen S, Tonkin-Crine S, et al. European Surveillance of Antimicrobial Consumption (ESAC): Disease-specific quality indicators for outpatient antibiotic prescribing. BMJ Quality and Safety 2011;20:764-72.

53 Petersson IF, Strombeck B, Andersen L, et al. Development of healthcare quality indicators for rheumatoid arthritis in Europe: The eumusc.net project. Ann Rheum Dis 2014;73:906-08.

54 Boulkedid R, Sibony O, Goffinet F, et al. Quality indicators for continuous monitoring to improve maternal and infant health in maternity departments: a modified Delphi survey of an international multidisciplinary panel. PLoS ONE 2013;8. 55 Follmann M, Schadendorf D, Kochs C, et al. Quality assurance for care of melanoma patients based on guideline-derived quality indicators and certification. [German, English]. JDDG - Journal of the German Society of Dermatology 2014;12:139-47.

56 Hussein RJ, Krohn R, Kaufmann-Kolle P, et al. Quality indicators for the use of systemic antibiotics in dentistry. Z Evid Fortbild Qual Gesundhwes 2017;122:1-8. 57 Hermann RC, Mattke S, Somekh D, et al. Quality indicators for international benchmarking of mental health care. Int J Qual Health Care 2006;18:31-38. 58 Barber CEH, Marshall DA, Alvarez N, et al. Development of cardiovascular quality indicators for rheumatoid arthritis: Results from an international expert panel using a novel online process. J Rheumatol 2015;42:1548-55.

59 Wakai A, O'Sullivan R, Staunton P, et al. Development of key performance indicators for emergency departments in Ireland using an electronic modified-Delphi consensus approach. Eur J Emerg Med 2013;20:109-14. 60 Murphy A, Wakai A, Walsh C, et al. Development of Key performance indicators for prehospital emergency care. Emerg Med J 2016;33:286-92.

61 Barry E, O'Brien K, Moriarty F, et al. PIPc study: Development of indicators of potentially inappropriate prescribing in children (PIPc) in primary care using a modified Delphi technique. BMJ Open 2016;6 (9) (no pagination).

62 Fukuma S, Shimizu S, Niihata K, et al. Development of quality indicators for care of chronic kidney disease in the primary care setting using electronic health data: a RAND-modified Delphi method. Clinical and experimental nephrology 2017;21:247-56. 63 Masaki H, Kawai N, Matsumoto K, et al. Consensus development of quality indicators for end-of-life care for elders in Japan. Int J Nurs Pract 2017;23:n/a-n/a.

64 Ueda K, Ohtera S, Kaso M, et al. Development of quality indicators for low-risk labor care provided by midwives using a RAND-modified Delphi method. BMC Pregnancy and 2017;17 (1) (no pagination). 65 Ntoburi S, Hutchings A, Sanderson C, et al. Development of paediatric quality of inpatient care indicators for low income countries - a Delphi study. BMC Pediatr 2010;10.

66 Perez-Cuevas R, Doubova SV, Suarez-Ortega M, et al. Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico. BMC medical informatics and decision making 2012;12:50.

67 Doubova SV, Perez-Cuevas R, Ortiz-Panozo E, et al. Evaluation of the quality of antenatal care using electronic health record information in family medicine clinics of Mexico City. BMC Pregnancy Childbirth 2014;14:168. 68 Muijrers PEM, Janknegt R, Sijbrandij J, et al. Prescribing indicators: Development and validation of guideline-based prescribing indicators as an instrument to measure the variation in the prescribing behaviour of general practitioners. Eur J Clin Pharmacol 2004;60:739-46.

69 Mourad SM, Hermens RPMG, Nelen WLDM, et al. Guideline-based development of quality indicators for subfertility care. Hum Reprod 2007;22:2665-72.

70 Draskovic I, Vernooij-Dassen M, Verhey F, et al. Development of quality indicators for memory clinics. Int J Geriatr Psychiatry 2008;23:119-28. 71 Martirosyan L, Braspenning J, Denig P, et al. Prescribing quality indicators of type 2 diabetes mellitus ambulatory care. Quality and Safety in Health Care 2008;17:318-23.

72 van der Ploeg E, Depla MF, Shekelle P, et al. Developing quality indicators for general practice care for vulnerable elders; transfer from US to The Netherlands. Qual Saf Health Care 2008;17:291-95. 73 Perry M, Draskovic I, Van Achterberg T, et al. Development and validation of quality indicators for dementia diagnosis and management in a primary care setting. J Am Geriatr Soc 2010;58:557-63. 74 Stienen JJC, Tabbers MM, Benninga MA, et al. Development of quality indicators based on a multidisciplinary, evidence-based guideline on pediatric constipation. Eur J Pediatr 2011;170:1513-19.

75 Wierenga PC, Klopotowska JE, Smorenburg SM, et al. Quality Indicators for In-Hospital Pharmaceutical Care of Dutch Elderly Patients. Drugs Aging 2011;28:295-304. 76 Luitjes SH, Wouters MG, Franx A, et al. Guideline-based development of quality indicators for hypertensive diseases in pregnancy. Hypertens 2013;32:20-31. 77 van den Bosch CMA, Hulscher MEJL, Natsch S, et al. Development of quality indicators for antimicrobial treatment in adults with sepsis. BMC Infect Dis 2014;14:345.

78 van den Bosch CMA, Geerlings SE, Natsch S, et al. Quality indicators to measure appropriate antibiotic use in hospitalized adults. Clin Infect Dis 2015;60:281-91. 79 Woiski MD, Scheepers HC, Liefers J, et al. Guideline-based development of quality indicators for prevention and management of postpartum hemorrhage. Acta Obstet Gynecol Scand 2015;94:1118-27. 80 Hommel I, Van Gurp PJ, Tack CJ, et al. Perioperative diabetes care: Development and validation of quality indicators throughout the entire hospital care pathway. BMJ Quality and Safety 2016;25:525-34.

81 Smits KP, Sidorenkov G, Bilo HJ, et al. Development and initial validation of prescribing quality indicators for patients with chronic kidney disease. Nephrol Dial Transplant 2016;31:1876-86. 82 Teichert M, Schoenmakers T, Kylstra N, et al. Quality indicators for pharmaceutical care: a comprehensive set with national scores for Dutch community pharmacies. Int J Clin Pharm 2016;38:870-79. 83 Smits KPJ, Sidorenkov G, Kleefstra N, et al. Development and validation of prescribing quality indicators for patients with type 2 diabetes. Int J Clin Pract 2017;71:n/a-n/a.

84 Idanpaan-Heikkila UM, Lambie L, Mattke S, et al. Selecting indicators for the quality of cardiac care at the health system level in Organization for Economic Co-operation and Development countries. Int J Qual Health Care 2006;18:39-44. 85 Petek D, Campbell S, Serec M, et al. Quality indicators of cardiovascular disease prevention for primary care in Slovenia. Zdravniski Vestnik 2012;81:687-98. 86 Minaya-Munoz F, Medina-Mirapeix F, Valera-Garrido F. Quality measures for the care of patients with lateral epicondylalgia. BMC Musculoskelet Disord 2013;14:310.

87 Calvet X, Panes J, Alfaro N, et al. Delphi consensus statement: Quality indicators for inflammatory bowel disease comprehensive care units. Journal of Crohn's and Colitis 2014;8:240-51. 88 Ruiz-Canela-Caceres J, Aquino-Llinares N, Sanchez-Diaz JM, et al. Indicators for childhood asthma in Spain, using the Rand method. Allergol Immunopathol (Madr) 2015;43:147-56.

89 Soria-Aledo V, Angel-Garcia D, Martinez-Nicolas I, et al. Development and pilot study of an essential set of indicators for general surgery services. Cir Esp 2016;94:502-10.

90 Bianchi V, Spitale A, Ortelli L, et al. Quality indicators of clinical cancer care (QC3) in colorectal cancer. BMJ Open 2013;3:e002818. 91 Chung KP, Lai MS, Cheng SH, et al. Organization-based performance measures of cancer care quality: Core measure development for breast cancer in Taiwan. Eur J Cancer Care (Engl) 2008;17:5-18.

92 Chung KP, Chang YJ, Lai MS, et al. Is quality of colorectal cancer care good enough? Core measures development and its application for comparing hospitals in Taiwan. BMC Health Serv Res 2010;10:27.

93 Cantrill JA, Sibbald B, Buetow S. Indicators of the appropriateness of long-term prescribing in general practice in the United Kingdom: consensus development, face and content validity, feasibility, and reliability. Qual Health Care 1998;7:130-5. 94 Morris CJ, Cantrill JA. Preventing drug-related morbidity - The development of quality indicators. Journal of Clinical Pharmacy and Therapeutics 2003;28:295-305.

95 Steel N, Melzer D, Shekelle PG, et al. Developing quality indicators for older adults: transfer from the USA to the UK is feasible. Qual Saf Health Care 2004;13:260-64. 96 Tully MP, Javed N, Cantrill JA. Development and face validity of explicit indicators of appropriateness of long term prescribing. Pharmacy World and Science 2005;27:407-13.

97 Gill PJ, O'Neill B, Rose P, et al. Primary care quality indicators for children: Measuring quality in UK general practice. Br J Gen Pract 2014;64:e752-e57.

98 Spencer R, Bell B, Avery AJ, et al. Identification of an updated set of prescribing-safety indicators for GPs. Br J Gen Pract 2014;64:e181-e90. 99 The NICE menu of general practice and clinical commissioning group indicators: The National Institute for Health and Care Excellence; 2016 [accessed 5 May 2017]. Available from: https://www.nice.org.uk/Media/Default/Standards-and-indicators/indicator-menu-update-aug-16.pdf.

100 Hadorn DC, Baker DW, Kamberg CJ, et al. Phase II of the AHCPR-sponsored heart failure guideline: translating practice recommendations into review criteria. The Joint Commission journal on quality improvement 1996;22:265-76. 101 Asch SM, Kerr EA, Lapuerta P, et al. A new approach for measuring quality of care for women with hypertension. Arch Intern Med 2001;161:1329-35. 102 Mikuls TR, MacLean CH, Olivieri J, et al. Quality of Care Indicators for Gout Management. Arthritis and Rheumatism 2004;50:937-43.

103 Saliba D, Solomon D, Rubenstein L, et al. Quality indicators for the management of medical conditions in nursing home residents. J Am Med Dir Assoc 2004;5:297-309. 104 Krumholz HM, Anderson JL, Brooks NH, et al. ACC/AHA clinical performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction - A report of the American College of Cardiology/American Heart Association Task Force on performance measures (Writing Committee to develop performance measures on ST-elevation and non-ST-elevation myocardial infarction). Circulation 2006;113:732- 61. 105 McGory ML, Shekelle PG, Ko CY. Development of quality indicators for patients undergoing colorectal cancer surgery. J Natl Cancer Inst 2006;98:1623-33.

106 Mularski RA, Curtis R, Billings JA, et al. Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Johnson Foundation Critical Care Workgroup. Crit Care Med 2006;34:S404-11.

107 Mangione-Smith R, DeCristofaro AH, Setodji CM, et al. The quality of ambulatory care delivered to children in the United States. N Engl J Med 2007;357:1515-23. 108 Smith KL, Soriano TA, Boal J. Brief communication: National quality-of-care standards in home-based primary care. Ann Intern Med 2007;146:188-92.

109 Wenger NS, Roth CP, Shekelle P, et al. Introduction to the assessing care of vulnerable elders-3 quality indicator measurement set. J Am Geriatr Soc 2007;55:S247-52.

110 Estes NAM, Halperin JL, Calkins H, et al. ACC/AHA/Physician consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter - A report of the American college of cardiology/American heart association task force on performance measures and the physician consortium for performance improvement (writing committee to develop clinical performance measures for atrial fibrillation). Circulation 2008;117:1101-20.

111 Bilimoria KY, Bentrem DJ, Lillemoe KD, et al. Assessment of pancreatic cancer care in the United States based on formally developed quality indicators. J Natl Cancer Inst 2009;101:848-59. 112 Lorenz KA, Dy SM, Naeim A, et al. Quality Measures for Supportive Cancer Care: The Cancer Quality-ASSIST Project. Journal of Pain and Symptom Management 2009;37:943-64.

113 McGory ML, Kao KK, Shekelle PG, et al. Developing quality indicators for elderly surgical patients.[Erratum appears in Ann Surg. 2009 Oct;250(4):661]. Ann Surg 2009;250:338-47.

114 Yazdany J, Panopalis P, Gillis JZ, et al. A quality indicator set for systemic lupus erythematosus. Arthritis Care and Research 2009;61:370-77. 115 Cheng EM, Crandall CJ, Bever Jr CT, et al. Quality indicators for multiple sclerosis. Mult Scler 2010;16:970-80.

116 Kanwal F, Barkun A, Gralnek IM, et al. Measuring quality of care in patients with nonvariceal upper gastrointestinal hemorrhage: Development of an explicit quality indicator set. Am J Gastroenterol 2010;105:1710-18. 117 Kanwal F, Kramer J, Asch SM, et al. An explicit quality indicator set for measurement of quality of care in patients with cirrhosis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2010;8:709-17.

118 Schenck AP, Rokoske FS, Durham DD, et al. The PEACE project: Identification of quality measures for hospice and palliative care. J Palliat Med 2010;13:1451-59. 119 Khanna D, Kowal-Bielecka O, Khanna PP, et al. Quality indicator set for systemic sclerosis. Clinical and Experimental Rheumatology 2011;29:S33-9. 120 SooHoo NF, Lieberman JR, Farng E, et al. Development of quality of care indicators for patients undergoing total hip or total knee replacement. BMJ Quality and Safety 2011;20:153-7.

121 Wang CJ, Kavanagh PL, Little AA, et al. Quality-of-care indicators for children with sickle cell disease. Pediatrics 2011;128:484-93. 122 Anger JT, Scott VCS, Kiyosaki K, et al. Development of quality indicators for women with urinary incontinence. Neurourology and Urodynamics 2013;32:1058-63.

123 Jackson GL, Zullig LL, Zafar SY, et al. Using NCCN clinical practice guidelines in oncology to measure the quality of colorectal cancer care in the veterans health administration. JNCCN Journal of the National Comprehensive Cancer Network 2013;11:431-41.

124 Melmed GY, Siegel CA, Spiegel BM, et al. Quality indicators for inflammatory bowel disease: development of process and outcome measures.[Erratum appears in Inflamm Bowel Dis. 2013 Aug;19(9):2040]. Inflamm Bowel Dis 2013;19:662-8. 125 Wang CJ, Jonas R, Fu CM, et al. Quality-of-care indicators for infantile spasms. J Child Neurol 2013;28:13-20. 126 Yadlapati R, Gawron AJ, Bilimoria K, et al. Development of quality measures for the care of patients with gastroesophageal reflux disease. Clinical Gastroenterology and Hepatology 2015;13:874-83. 127 Faro EZ, Wang CJ, Oyeku SO. Quality indicator development for positive screen follow-up for sickle cell disease and trait. Am J Prev Med 2016;51:S48-54.

128 Vila PM, Lieu JEC, Hullar TE, et al. Developing Quality Measures for Adult Cochlear Implant Centers: Preliminary Findings. Otolaryngology- Head & Neck Surgery 2016;155:748-52. 129 Yazdany J, Robbins M, Schmajuk G, et al. Development of the American College of Rheumatology's Rheumatoid Arthritis Electronic Clinical Quality Measures. Arthritis Care Res (Hoboken) 2016;68:1579-90. 130 Chowdhury DMD, Gurvitz MMDMS, Marelli AMDMPH, et al. Development of Quality Metrics in Ambulatory Pediatric Cardiology. JACC (Journal of the American College of Cardiology) 2017;69:541-55.

131 Hepner KA, Watkins KE, Farmer CM, et al. Quality of care measures for the management of unhealthy alcohol use. J Subst Abuse Treat 2017;76:11-17. 132 Ingraham A, Nathens A, Peitzman A, et al. Assessment of emergency general surgery care based on formally developed quality indicators. Surgery (United States) 2017;162:397-407. 133 Mangione-Smith R, Roth CP, Britto MT, et al. Development and testing of the pediatric respiratory illness measurement system (PRIMES) quality indicators. Hosp 2017;7:125-33.

134 Odetola FO, Freed G, Shevrin C, et al. In-Hospital Quality-of-Care Measures for Pediatric Sepsis Syndrome. Pediatrics 2017;140:1-8. 135 Quality AfHRa. National Quality Measures Clearinghouse: U.S. Department of Health & Human Services; 2017 [accessed 5 April 2018]. Available from: https://www.qualitymeasures.ahrq.gov/.

136 Parast L, Bardach NS, Burkhart Q, et al. Development of New Quality Measures for Hospital-Based Care of Suicidal Youth. Acad Pediatr 2018;18:248-55.