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Table 1 Quality measures of potentially inappropriate opioid prescribing among older adults (≥ 50 years) with chronic noncancer pain

From: Quality of opioid prescribing in older adults with or without Alzheimer disease and related dementia

Measure domain Indicators of inappropriate opioid prescribing Operationalization with 2011–2015 Medicare and MDS 3.0 data
Denominator Numerator Exclusion
1. Opioids contraindicated for older adults • Use of meperidine, propoxyphene, pentazocine, butorphanol, and nalbuphine Older adults with chronic pain Patients with contraindicated opioids Cancer, hospice, or palliative care
2. Opioid-naïve patients • Use of long-acting (LA) or extended-release (ER) prescription opioids for opioid-naïve patients Patients with chronic pain who were naïve to opioids (i.e., no opioids in 6 months before an index chronic pain diagnosis [baseline]) Patients with LA/ER prescription opioids or using medications without evidence of drug tolerance (i.e., receive ≥ 60 daily MME) for a week or longer
• Use of high-dose prescription opioids for opioid-naïve patients Patients with a daily dose of ≥ 90 MME
• Composite of any Patients with LA/ER prescription opioids or with a daily dose of ≥ 90 MME
3. Patients with neuropathic pain • Long-term (> 90 days) use of opioids Older adults with only neuropathic pain as the index diagnosis Patients with long-term use of opioids
Sensitivity analysis: older adults with only neuropathic pain who had no musculoskeletal or idiopathic pain during the 6-month baseline
4. Concurrent use of opioids and CNS depressants • Concurrent use of opioids with any CNS drugs that Beers Criteria1 recommends against Older adults with chronic pain and using prescription opioids Patients with concurrent use of Beers Criteria1 CNS depressants for ≥ 7 days
5. Patients with moderate to severe pain (NHs only) • No prescription opioids within 30 days before or after reporting moderate to severe pain Older adults with moderate to severe chronic pain Patients with no prescription opioids within 30 days before or after the qualifying pain score
• No use of scheduled pain medication regimen in the 5 days before reporting moderate to severe chronic pain (defined based on MDS 3.0 pain assessment) Patients with no scheduled pain medication regimen (defined based on MDS 3.0 item J0100A)
• Composite of any Patients with no prescription opioids or no scheduled pain medications
  1. Abbreviations: CNS central nervous system, MDS 3.0 Minimum Data Set, version 3.0, MME morphine milligram equivalent, NHs nursing homes
  2. 1American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults