Dermatitis – Improvement in Patient-Reported Itch Severity

Measure Specification

Various types of dermatitis are chronically pruritic and are tremendously burdensome. Atopic dermatitis (AD) is a chronic skin disease in which pruritus is responsible for much of the disease burden and morbidity borne by patients. It is estimated that in the U.S. alone, 31.6 million people have symptoms of AD, with 17.8 million meeting the criteria for AD.

The effects of this disease are substantial; with direct costs estimated to be between $1 and $4 billion. Other types of dermatitis, such as contact dermatitis and seborrheic dermatitis (SD) are also chronic, pruritic conditions which greatly affect patients. Approximately 6 million people in the U.S. have SD with direct and indirect costs estimated to be $230 million.

These various forms of dermatitis also greatly impact the quality-of-life patients have. In one study looking at the patient burden in adults with moderate to severe AD, 85% reported problems with the frequency of their itch and 41.5 percent reported itching for 18 hours or more a day. With this persistence of itching, 55 percent of patients showed AD-related sleep disturbance 5 days a week or more and 21.

8 percent showed clinically relevant anxiety or depression. In another study, investigators quantified pruritic burden in a cross-sectional analysis investigating chronic pruritus and pain. They demonstrated that the quality-of-life impact was due to the severity of the symptom, rather than whether the symptom was pain or pruritus. Moreover, they elucidated a mean health utility score of 0.

87 from CP patients, meaning that on average, a patient would give up 13 percent of their life expectancy to live without pruritus. Additionally, studies of CP have shown patients to have a 17 percent higher mortality risk as well as being strongly associated with poorer general health. Moreover, data from the National Ambulatory Medical Care Survey found that a total of 77 million patient visits for itch were made during the 11-year time period.

This was an average of 7 million visits per year, which represented approximately 1 percent of all outpatient visits. Also, further analysis showed that although the majority visits (58.6 percent) were for new instances of itch, almost a third (32 percent) were for chronic pruritus. This measure aims to improve pruritus in patients who carry a large burden with this disease; by assessing itch and aiming to make the symptom more manageable.

Evidence-based guideline: Guidelines of care for the management of atopic dermatitis. Recommendation: It is recommended that clinicians ask general questions about itch, sleep, impact on daily activity, and persistence of disease, and currently available scales be used mainly when practical. This measure enhances compliance of the guideline by routinely assessing pruritus in dermatitis patients.

For patients with moderate and severe pruritus symptoms, the measure looks to reduce pruritus burden by a minimal clinically important difference (3 or more points). Peak Pruritus Numerical Rating Scale: psychometric validation and responder definition for assessing itch in moderate-to- severe atopic dermatitis (Yosipovitch, 2019) and Tools to study the severity of itch in 8- to 17-year-old children: Validation of TweenItchyQoL and ItchyQuant (Kong, 2021).

Both the NRS and ItchyQuant are validated severity tools for pediatric patients aged 8 and older. This measure assesses pruritus in both pediatric and adult populations.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this visit measure is submitted each time a patient has a denominator eligible encounter during the performance period.