Gout: Serum Urate Monitoring

Percentage of patients aged 18 and older with a diagnosis of gout who were either started on urate lowering therapy (ULT) or whose dose of ULT was changed in the year prior to the measurement period, and who had their serum urate level measured within 6 months

Copyright (C) 2014, American College of Rheumatology

All materials are subject to copyrights owned by the College. The College hereby provides limited permission for the user to reproduce, retransmit or reprint for such user's own personal use (and for such personal use only) part or all of any document as long as the copyright notice and permission notice contained in such document or portion thereof is included in such reproduction, retransmission or reprinting. All other reproduction, retransmission, or reprinting of all or part of any document is expressly prohibited, unless the College has expressly granted its prior written consent to so reproduce, retransmit, or reprint the material. All other rights reserved.

This performance measure has not been tested for all potential applications. The measure and specifications are provided “as is” and without warranty of any kind.

CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Patients with hyperuricemia are subject to recurrent gout flares and formation of tophi, which can lead to joint and other tissue damage. Urate lowering therapy reduces the frequency of acute gouty attacks [1,2] and reduces the rate of growth of tophi and decreases the size of tophi [5].

For patients with indications for serum urate lowering therapy, after starting therapy, the goal of treatment is serum urate < 6 mg/dl. Lower serum urate levels are associated with fewer acute gout attacks [3] and decreased formation (and improvement) of tophi [4]. Patients on ULT that do not achieve target serum urate < 6 mg/dl are 75% more likely to flare than patients who reach target [5].

The American College of Rheumatology (ACR) guidelines on gout recommends that if a patient with gout has been treated with urate lowering therapy for at least 12 months, then the serum urate should be checked at least once yearly and the most recent serum urate should be < 6.8 mg/dl.

As a quality measure, the ACR quality improvement panel recommended a less stringent target and selected the solubility concentration of urate 6.8 mg/dl for a quality target.

The 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia recommend that all gout patients with indications for ULT should have their serum urate lowered to 6 mg/dl.  Serum urate is the hemoglobin A1C of gout.  Lower levels of serum urate are associated with less frequent gout attacks and reduction of tophaceous deposits. Based on feedback from public comment and expert panel, the less stringent level of 6.8 mg/dl cut-off was used to evaluate quality of care.  6.8 mg/dl is the solubility concentration of urate crystals.  Serum urate responds to changes in urate lowering therapy within 14-days.  The Guidelines recommends dose titration every 2-5 weeks.  Twelve months was selected as sufficient time to achieve serum urate target, evidence Level C.

Khanna, Dinesh, et. al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. Arthritis Care & Research 2013; 64: 1431-46.

Higher score indicates better quality

[1] Shoji A, Yamanaka H, Kamatani N. A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 2004;
51:321-325.

[2] Perez-Ruiz F, Atxotegi J, Hernando I, Calabozo M, Nolla JM. Using serum urate levels to determine the period free of gouty symptoms after withdrawal of long-term urate-lowering therapy: a prospective study. Arthritis Rheum 2006; 55:786-790.

[3] Becker MA, Schumacher HR, Espinoza LR, Wells AF, Mac-Donald P, Lloyd E, et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther 2010;12:R63.

[4] Perez-Ruiz F, Calabozo M, Pijoan JI, Herrero-Beites AM, Ruibal A. Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis Rheum 2002; 47: 356–60.

[5] Sarawate CA, Patel PA, Schumacher HR, Yang W, Brewer KK, Bakst AW. Serum urate levels and gout flares: analysis from managed care data. J Clin Rheumatol. 2006 Apr;12(2):61-5.

The initial patient population (IPP) of this measure identifies encounters where a patient is either newly started on urate lowering therapy (ULT) OR where a patient’s ULT therapy dosage is modified.  This measure is episode-of-care based, meaning there may be multiple encounters for a given patient that meet the IPP criteria in the measurement period, and each encounter should be evaluated separately to determine if the numerator has been met.  It is important to note that a single lab test may be applied to more than one eligible encounter in the IPP, provided the date of the encounter meets the time constraints outlined in the numerator logic.

Adult patients aged 18 and older with a diagnosis of gout who were either started on urate lowering therapy (ULT) or whose dose of ULT was changed in the year prior to the measurement period

Equals Initial Patient Population

Patients whose serum urate level was measured within six months after initiating ULT or after changing the dose of ULT

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Initial Patient Population =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Measurement Period"
- AND:
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Office Visit (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Office Visit"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts during "Occurrence A of Encounter, Performed: Office Visit"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Office Visit (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Office Visit"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Office Visit"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy (dose: 'Change in Therapy Dosage')" starts during "Occurrence A of Encounter, Performed: Office Visit"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Outpatient Consultation (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts during "Occurrence A of Encounter, Performed: Outpatient Consultation"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Outpatient Consultation (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Outpatient Consultation"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy (dose: 'Change in Therapy Dosage')" starts during "Occurrence A of Encounter, Performed: Outpatient Consultation"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Face-to-Face Interaction (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Face-to-Face Interaction (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy (dose: 'Change in Therapy Dosage')" starts during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Nursing Facility Visit (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Nursing Facility Visit (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Nursing Facility Visit"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy (dose: 'Change in Therapy Dosage')" starts during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy (dose: 'Change in Therapy Dosage')" starts during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Home Healthcare Services (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Home Healthcare Services"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts during "Occurrence A of Encounter, Performed: Home Healthcare Services"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Home Healthcare Services (reason: 'Gout')" <= 12 month(s) starts before start of "Measurement Period"
    - AND: "Occurrence A of Diagnosis, Active: Gout" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
    - AND NOT: "Occurrence A of Diagnosis, Active: Gout" ends before start of "Occurrence A of Encounter, Performed: Home Healthcare Services"
    - AND: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" starts before or during "Occurrence A of Encounter, Performed: Home Healthcare Services"
    - AND NOT: "Occurrence A of Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" ends before start of "Occurrence A of Encounter, Performed: Home Healthcare Services"
    - AND: "Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy (dose: 'Change in Therapy Dosage')" starts during "Occurrence A of Encounter, Performed: Home Healthcare Services"
Denominator =
- AND: "Initial Patient Population"
Denominator Exclusions =
- None
Numerator =
- AND: "Laboratory Test, Result: Serum Urate (result)" <= 6 month(s) starts after start of
  - OR: "Occurrence A of Encounter, Performed: Office Visit"
  - OR: "Occurrence A of Encounter, Performed: Outpatient Consultation"
  - OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
  - OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit"
  - OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
  - OR: "Occurrence A of Encounter, Performed: Home Healthcare Services"
Denominator Exceptions =
- None

"Diagnosis, Active: Gout" using "Gout Grouping Value Set (2.16.840.1.113883.3.1564.2729)"
"Encounter, Performed: Care Services in Long-Term Residential Facility" using "Care Services in Long-Term Residential Facility Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1014)"
"Encounter, Performed: Face-to-Face Interaction" using "Face-to-Face Interaction Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1048)"
"Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1016)"
"Encounter, Performed: Nursing Facility Visit" using "Nursing Facility Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1012)"
"Encounter, Performed: Office Visit" using "Office Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Outpatient Consultation" using "Outpatient Consultation Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1008)"
"Laboratory Test, Result: Serum Urate" using "Serum Urate Grouping Value Set (2.16.840.1.113883.3.1564.2737)"
"Medication, Active: Uricosuric Agents and XO Inhibitors-ULT Therapy" using "Uricosuric Agents and XO Inhibitors-ULT Therapy Grouping Value Set (2.16.840.1.113883.3.1564.2731)"
"Medication, Order: Uricosuric Agents and XO Inhibitors-ULT Therapy" using "Uricosuric Agents and XO Inhibitors-ULT Therapy Grouping Value Set (2.16.840.1.113883.3.1564.2731)"
"Patient Characteristic Birthdate: birth date" using "birth date LOINC Value Set (2.16.840.1.113883.3.560.100.4)"
Attribute: "Reason: Gout" using "Gout Grouping Value Set (2.16.840.1.113883.3.1564.2729)"
Attribute: "Dose: Change in Therapy Dosage" using "Change in Therapy Dosage Grouping Value Set (2.16.840.1.113883.3.1564.2755)"

"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDCREC Value Set (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer" using "Payer SOP Value Set (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race CDCREC Value Set (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex AdministrativeSex Value Set (2.16.840.1.113762.1.4.1)"

American College of Rheumatology - Gout Measurement Set

eMeasure Title	Gout: Serum Urate Monitoring
eMeasure Identifier (Measure Authoring Tool)		eMeasure Version number	0
NQF Number	2521 (Under Consideration)	GUID	e0677f09-4e50-46dc-b73f-f937f804472f
Measurement Period	January 1, 20xx through December 31, 20xx
Measure Steward	American College of Rheumatology
Measure Developer	American College of Rheumatology
Endorsed By	None
Description	Percentage of patients aged 18 and older with a diagnosis of gout who were either started on urate lowering therapy (ULT) or whose dose of ULT was changed in the year prior to the measurement period, and who had their serum urate level measured within 6 months
Copyright	Copyright (C) 2014, American College of Rheumatology All materials are subject to copyrights owned by the College. The College hereby provides limited permission for the user to reproduce, retransmit or reprint for such user's own personal use (and for such personal use only) part or all of any document as long as the copyright notice and permission notice contained in such document or portion thereof is included in such reproduction, retransmission or reprinting. All other reproduction, retransmission, or reprinting of all or part of any document is expressly prohibited, unless the College has expressly granted its prior written consent to so reproduce, retransmit, or reprint the material. All other rights reserved.
Disclaimer	This performance measure has not been tested for all potential applications. The measure and specifications are provided “as is” and without warranty of any kind. CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Measure Scoring	Proportion
Measure Type	Process
Stratification	None
Risk Adjustment	None
Rate Aggregation	None
Rationale	Patients with hyperuricemia are subject to recurrent gout flares and formation of tophi, which can lead to joint and other tissue damage. Urate lowering therapy reduces the frequency of acute gouty attacks [1,2] and reduces the rate of growth of tophi and decreases the size of tophi [5]. For patients with indications for serum urate lowering therapy, after starting therapy, the goal of treatment is serum urate < 6 mg/dl. Lower serum urate levels are associated with fewer acute gout attacks [3] and decreased formation (and improvement) of tophi [4]. Patients on ULT that do not achieve target serum urate < 6 mg/dl are 75% more likely to flare than patients who reach target [5]. The American College of Rheumatology (ACR) guidelines on gout recommends that if a patient with gout has been treated with urate lowering therapy for at least 12 months, then the serum urate should be checked at least once yearly and the most recent serum urate should be < 6.8 mg/dl. As a quality measure, the ACR quality improvement panel recommended a less stringent target and selected the solubility concentration of urate 6.8 mg/dl for a quality target.
Clinical Recommendation Statement	The 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia recommend that all gout patients with indications for ULT should have their serum urate lowered to 6 mg/dl. Serum urate is the hemoglobin A1C of gout. Lower levels of serum urate are associated with less frequent gout attacks and reduction of tophaceous deposits. Based on feedback from public comment and expert panel, the less stringent level of 6.8 mg/dl cut-off was used to evaluate quality of care. 6.8 mg/dl is the solubility concentration of urate crystals. Serum urate responds to changes in urate lowering therapy within 14-days. The Guidelines recommends dose titration every 2-5 weeks. Twelve months was selected as sufficient time to achieve serum urate target, evidence Level C. Khanna, Dinesh, et. al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. Arthritis Care & Research 2013; 64: 1431-46.
Improvement Notation	Higher score indicates better quality
Reference	[1] Shoji A, Yamanaka H, Kamatani N. A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 2004; 51:321-325.
Reference	[2] Perez-Ruiz F, Atxotegi J, Hernando I, Calabozo M, Nolla JM. Using serum urate levels to determine the period free of gouty symptoms after withdrawal of long-term urate-lowering therapy: a prospective study. Arthritis Rheum 2006; 55:786-790.
Reference	[3] Becker MA, Schumacher HR, Espinoza LR, Wells AF, Mac-Donald P, Lloyd E, et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther 2010;12:R63.
Reference	[4] Perez-Ruiz F, Calabozo M, Pijoan JI, Herrero-Beites AM, Ruibal A. Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis Rheum 2002; 47: 356–60.
Reference	[5] Sarawate CA, Patel PA, Schumacher HR, Yang W, Brewer KK, Bakst AW. Serum urate levels and gout flares: analysis from managed care data. J Clin Rheumatol. 2006 Apr;12(2):61-5.
Definition	None
Guidance	The initial patient population (IPP) of this measure identifies encounters where a patient is either newly started on urate lowering therapy (ULT) OR where a patient’s ULT therapy dosage is modified. This measure is episode-of-care based, meaning there may be multiple encounters for a given patient that meet the IPP criteria in the measurement period, and each encounter should be evaluated separately to determine if the numerator has been met. It is important to note that a single lab test may be applied to more than one eligible encounter in the IPP, provided the date of the encounter meets the time constraints outlined in the numerator logic.
Transmission Format	TBD
Initial Patient Population	Adult patients aged 18 and older with a diagnosis of gout who were either started on urate lowering therapy (ULT) or whose dose of ULT was changed in the year prior to the measurement period
Denominator	Equals Initial Patient Population
Denominator Exclusions	None
Numerator	Patients whose serum urate level was measured within six months after initiating ULT or after changing the dose of ULT
Numerator Exclusions	Not Applicable
Denominator Exceptions	None
Measure Population	Not Applicable
Measure Observations	Not Applicable
Supplemental Data Elements	For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents

Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements