29 Appendix A. Continued Short Title: QM-4: Medication Adherence to Drug Therapy for ACC/AHA Stage 1 With ASCVD Risk 10% or ACC/AHA Stage 2 HBP QM-4: Percentage of Adults 18 to 85 Years of Age Who Had a Diagnosis of ACC/AHA Stage 1 HBP With ASCVD Risk 10% or ACC/AHA Stage 2 HBP With 1 Prescriptions for BP Medication Who Had 80% Adherence to BP Medication(s) During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 1 HBP and ASCVD risk 10% or ACC/AHA stage 2 HBP who had 80% adherence to prescribed BP medication(s) during the measurement year Numerator Patients with 1 prescriptions for BP medication(s) who met the PDC threshold of 80% during the measurement year Denominator All patients 18 85 y of age with ACC/AHA stage 1 HBP and ASCVD risk 10% or ACC/AHA stage 2 HBP who had at least 1 outpatient encounter with a diagnosis of HBP and had 1 or more prescriptions for BP medications during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay, patients solely on nonpharmacological therapy Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Medicaid claims data, commercial claims data, Medicare claims data, Tricare claims data Attribution Physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Adherence to drug therapy lowers BP and reduces the risk of cardiovascular events and death.110 112 As many as 50% to 80% of patients prescribed antihypertensive medications demonstrate suboptimal adherence.113 Adherence to drug therapy is influenced by several interrelated factors, including large pill burden, complex drug regimen, cost of medications, side effects of multidrug antihypertensive regimens, poor patient provider relationship, and clinical No single strategy has been found to be more effective than others in improving adherence, but rather, a combination of patient-level, provider-level, and system-level strategies is likely to be the most effective. 