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 | |||