Vue.component('poly-ach-overview', {
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				'<h1 style="text-align: center; ">Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (POLY-ACH)</h1>' +
			'</el-row>' +
			'<el-row id="poly-ach-description" class="scrollspy">' +
				'<h2>Description</h2>' +
			'</el-row>' +
			'<el-row>' +
				'<p>The percentage of individuals &ge;65 years of age older adults with concurrent use of &ge;2 unique anticholinergic medications.</p>' +
				'<p>A lower rate indicates better performance.</p>' +
			'</el-row>' +
			'<el-row id="poly-ach-add-info" class="scrollspy">' +
				'<h2>Additional Information</h2>' +
			'</el-row>' +
			'<el-row>' +
				'<el-col :span="6">' +
					'<p><b>Intended Use</b></p>' +
				'</el-col>' +
				'<el-col :span="18">' +
					'<p>Performance measurement for health plans.</p>' +
				'</el-col>' +
			'</el-row>' +
			'<el-row>' +
				'<el-col :span="6">' +
					'<p><b>Data Sources</b></p>' +
				'</el-col>' +
				'<el-col :span="18">' +
					'<p>Prescription claims data.</p>' +
				'</el-col>' +
			'</el-row>' +
			'<el-row>' +
				'<el-col :span="6">' +
					'<p><b>Denominator</b></p>' +
				'</el-col>' +
				'<el-col :span="18">' +
					'<p>Individuals &ge;65 years of age with &ge;2 prescription claims for the same anticholinergic medication on different dates of service during the measurement year.</p>' +
				'</el-col>' +
			'</el-row>' +
			'<el-row>' +
				'<el-col :span="6">' +
					'<p><b>Exclusions</b></p>' +
				'</el-col>' +
				'<el-col :span="18">' +
					'<p>Hospice.</p>' +
				'</el-col>' +
			'</el-row>' +
			'<el-row>' +
				'<el-col :span="6">' +
					'<p><b>Numerator</b></p>' +
				'</el-col>' +
				'<el-col :span="18">' +
					'<p>Individuals from the denominator with concurrent use for &ge;30 cumulative days of &ge;2 unique anticholinergic medications, each with &ge;2 prescription claims on different dates of service during the measurement year.</p>' +
				'</el-col>' +
			'</el-row>' +
		'</div>'
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Vue.component('poly-ach-ref-1', {
  template: 
    '<el-popover placement="top-start" width="400" trigger="hover">' +
      '<span>American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015; 63(11):2227-46. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/26446832" target="_blank">26446832</a>.</span>' +
      '<sup slot="reference">1</sup>' +
    '</el-popover>'
});

Vue.component('poly-ach-ref-2', {
  template: 
    '<el-popover placement="top-start" width="400" trigger="hover">' +
      '<span>Durán CE, Azermai M, Vander Stichele RH. Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol. 2013; 69(7):1485-96. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/23529548" target="_blank">23529548</a>.</span>' +
      '<sup slot="reference">2</sup>' +
    '</el-popover>'
});

Vue.component('poly-ach-ref-3', {
  template: 
    '<el-popover placement="top-start" width="400" trigger="hover">' +
      '<span>Campbell N, Boustani M, Limbil T, et al. The cognitive impact of anticholinergics: a clinical review. Clin  Interv Aging. 2009; 4:225-33. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/19554093" target="_blank">19554093</a>.</span>' +
      '<sup slot="reference">3</sup>' +
    '</el-popover>'
});

Vue.component('poly-ach-ref-4', {
  template: 
    '<el-popover placement="top-start" width="400" trigger="hover">' +
      '<span>Rudolph JL, Salow MJ, Angelini MC, et al. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008; 168(5):508-13. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/18332297" target="_blank">18332297</a>.</span>' +
      '<sup slot="reference">4</sup>' +
    '</el-popover>'
});

Vue.component('poly-ach-ref-5', {
  template: 
    '<el-popover placement="top-start" width="400" trigger="hover">' +
      '<span>Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol. 2006; 46(12):1481-6. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/17101747" target="_blank">17101747</a></span>' +
      '<sup slot="reference">5</sup>' +
    '</el-popover>'
});

Vue.component('poly-ach-ref-6', {
  template: 
    '<el-popover placement="top-start" width="400" trigger="hover">' +
      '<span>Gray SL, Anderson ML, Dublin S, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015; 175(3):401-7. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/25621434" target="_blank">25621434</a>.</span>' +
      '<sup slot="reference">6</sup>' +
    '</el-popover>'
});

Vue.component('poly-ach-ref-7', {
  template: 
    '<el-popover placement="top-start" width="400" trigger="hover">' +
      '<span>Cai X, Campbell N, Khan B, et al. Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2013; 9(4):377-85. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/23183138" target="_blank">23183138</a>.</span>' +
      '<sup slot="reference">7</sup>' +
    '</el-popover>'
});

Vue.component('poly-ach-ref-8', {
  template: 
    '<el-popover placement="top-start" width="400" trigger="hover">' +
      '<span>Kalisch Ellett LM, Pratt NL, Ramsay EN, et al. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia. J Am Geriatr Soc. 2014; 62(10):1916-22. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/25284144" target="_blank">25284144</a>.</span>' +
      '<sup slot="reference">8</sup>' +
    '</el-popover>'
});

Vue.component('poly-ach-ref-9', {
  template: 
    '<el-popover placement="top-start" width="400" trigger="hover">' +
      '<span>Pasina L, Djade CD, Lucca U, et al. Association of anticholinergic burden with cognitive and functional status in a cohort of hospitalized elderly: comparison of the anticholinergic cognitive burden scale and anticholinergic risk scale: results from the REPOSI study. Drugs Aging. 2013; 30(2):103-12. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/23239364" target="_blank">23239364</a>.</span>' +
      '<sup slot="reference">9</sup>' +
    '</el-popover>'
});

Vue.component('poly-ach-rationale', {
	template: 
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			'<el-row id="poly-ach-rationale" class="scrollspy">' +
				'<h2>Rationale</h2>' +
			'</el-row>' +
			'<el-row>' +
				'<p>The American Geriatrics Society 2015 Updated Beers Criteria provides strong recommendations based on moderate evidence to avoid concurrent use of two or more anticholinergic medications in older adults because of an increased risk of cognitive decline (see Appendix for Evidence Table).' + 
				'<poly-ach-ref-1></poly-ach-ref-1>' +
				'  Numerous scales are available to rank medication anticholinergic activity. The AGS panel used a composite of several scales to compile a list of medications with strong anticholinergic properties.' + 
				'<poly-ach-ref-2></poly-ach-ref-2><sup>,</sup><poly-ach-ref-3></poly-ach-ref-3><sup>,</sup><poly-ach-ref-4></poly-ach-ref-4><sup>,</sup><poly-ach-ref-5></poly-ach-ref-5>' +
				' Several studies have shown an association between concurrent use of anticholinergic medications and an increased risk of dementia and cognitive impairment.' +
				'<poly-ach-ref-2></poly-ach-ref-2><sup>,</sup><poly-ach-ref-6></poly-ach-ref-6><sup>,</sup><poly-ach-ref-7></poly-ach-ref-7>' +
				' A systematic review of the literature determined that a high burden of anticholinergic use consistently shows a negative association with cognitive performance in older adults.' + 
				'<poly-ach-ref-3></poly-ach-ref-3>' +
				' In addition to cognitive decline, anticholinergic use in older adults is also associated with a higher risk for falls, increased hospitalizations, and decreased physical function.' + 
				'<poly-ach-ref-1></poly-ach-ref-1><sup>,</sup><poly-ach-ref-8></poly-ach-ref-8>' +
				' One study reported that older persons taking two or more anticholinergic medications had a significantly greater risk of hospitalization for confusion or dementia.</p>' +
				'<p>This measure was designed for monitoring and improving quality of care across populations of patients. Medication combinations in this measure are those for which serious adverse effects have been reported among older adults. Therefore, co-prescription of the selected combinations has an unfavorable balance of benefits and harms for many, if not most, older adults. Although the combinations should be avoided in older adults, there are older adults for whom concurrent use of multiple anticholinergic medications may be appropriate. Thus, the combinations are a potential serious safety concern (i.e., potentially inappropriate) and merit special scrutiny, but are not universally unsafe or inappropriate in all older adults. </p>' +
			'</el-row>' +
			'<el-row>' +
				'<p><strong>Polypharmacy: Use of Multiple CNS-Active Agents in Older Adults: Evidence Table - From the American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (Table 5, p15)<poly-ach-ref-1></poly-ach-ref-1></strong></p>' +
				'<table>' +
					'<tr><th>Target Class</th><th>Interacting Class</th><th>Risk Rationale</th><th>Recommendation</th><th>Quality of Evidence</th><th>Strength of Recommendation</th><th>Evidence</th></tr>' +
					'<tr><td>Anticholi nergic</td><td>Anticholi nergic</td><td>Increased risk of cognitive decline</td><td>Avoid, minimize number of anticholinergic drugs</td><td>Moderate</td><td>Strong</td><td>Cai, 2013<poly-ach-ref-7></poly-ach-ref-7> Pasina, 2013<poly-ach-ref-9></poly-ach-ref-9></td></tr>' +
				'</table>' +
			'</el-row>' +
		'</div>'
});

Vue.component('poly-ach', {
	template:
		'<div id="poly-ach" class="search-filter inview">' +
			'<poly-ach-overview></poly-ach-overview>' +
            '<poly-ach-rationale v-if="rationale"></poly-ach-rationale>' +
			'<br><br><br><br>' +
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		faqs: {
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