| eCQM Title | Initiation and Engagement of Substance Use Disorder Treatment |
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| CMS ID | 137 | eCQM Version Number | 15.0.000 |
| CBE Number | Not Applicable | GUID | c3657d72-21b4-4675-820a-86c7fe293bf5 |
| Measurement Period | January 1, 2027 through December 31, 2027 | ||
| Measure Steward | National Committee for Quality Assurance | ||
| Measure Developer | National Committee for Quality Assurance | ||
| Endorsed By | None | ||
| Description |
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| Copyright |
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| Disclaimer |
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| Measure Scoring | Proportion | ||
| Measure Type | Process | ||
| Stratification |
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| Risk Adjustment |
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| Rate Aggregation |
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| Rationale |
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| Clinical Recommendation Statement |
American Psychiatric Association (2018)
American Psychiatric Association (2006)
American Society of Addiction Medicine (2015)
Michigan Quality Improvement Consortium (2021)
Department of Veterans Affairs/Department of Defense (2015)
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| Improvement Notation |
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| Reference |
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| Definition |
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| Guidance |
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| Transmission Format |
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| Initial Population |
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| Denominator |
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| Denominator Exclusions |
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| Numerator |
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| Numerator Exclusions |
None |
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| Denominator Exceptions |
None |
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| Supplemental Data Elements |
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AgeInYearsAt(date from start of "Measurement Period") >= 13
and "First SUD Episode During Measurement Period" is not null
and not exists "History of SUD Diagnosis or Treatment"
"Initial Population"
Hospice."Has Hospice Services"
exists "Treatment Initiation With Non Medication Intervention Dates"
or exists "Treatment Initiation With Medication Order Dates"
None
None
AgeInYearsAt(date from start of "Measurement Period") in Interval[13, 17]
AgeInYearsAt(date from start of "Measurement Period") in Interval[18, 64]
AgeInYearsAt(date from start of "Measurement Period") >= 65
AgeInYearsAt(date from start of "Measurement Period") >= 13
and "First SUD Episode During Measurement Period" is not null
and not exists "History of SUD Diagnosis or Treatment"
"Initial Population"
Hospice."Has Hospice Services"
"Has Treatment Engagement With Long Acting Medication"
or "Has Two or More Treatment Engagements With Short Acting Medication or Non Medication Intervention"
None
None
AgeInYearsAt(date from start of "Measurement Period") in Interval[13, 17]
AgeInYearsAt(date from start of "Measurement Period") in Interval[18, 64]
AgeInYearsAt(date from start of "Measurement Period") >= 65
"Initial Population"
Hospice."Has Hospice Services"
["Encounter, Performed": "Emergency Department Evaluation and Management Visit"]
union ["Encounter, Performed": "Detoxification Visit"]
First(("Qualifying Encounters") ValidEncounters
with ["Diagnosis": "Substance Use Disorder"] SUDDiagnosis
such that ValidEncounters.relevantPeriod during "Measurement Period"
and SUDDiagnosis.prevalencePeriod starts during ValidEncounters.relevantPeriod
and SUDDiagnosis.prevalencePeriod starts 47 days or more before day of
end of "Measurement Period"
sort by start of relevantPeriod
)
exists ( ( ["Medication, Order": "Substance Use Disorder Long Acting Medication"] LongActingMedOrder
with ( Min("Treatment Initiation With Non Medication Intervention Dates"
union "Treatment Initiation With Medication Order Dates"
) ) InitiationTreatmentDate
such that date from LongActingMedOrder.authorDatetime 34 days or less after InitiationTreatmentDate
)
union ( ["Procedure, Performed": "Substance Use Disorder Long Acting Medication Administration"] LongActingTreatment
with ( Min("Treatment Initiation With Non Medication Intervention Dates"
union "Treatment Initiation With Medication Order Dates"
) ) InitiationTreatmentDate
such that date from start of Global."NormalizeInterval" ( LongActingTreatment.relevantDatetime, LongActingTreatment.relevantPeriod ) 34 days or less after InitiationTreatmentDate
)
)
Count((("Psychosocial Visit"
union ["Procedure, Performed": "Substance Use Disorder Short Acting Medication Administration"]) ShortActingTreatment
with(Min("Treatment Initiation With Non Medication Intervention Dates"
union "Treatment Initiation With Medication Order Dates"
)) InitiationTreatmentDate
such that date from start of Global."NormalizeInterval"(ShortActingTreatment.relevantDatetime, ShortActingTreatment.relevantPeriod) 34 days or less after InitiationTreatmentDate
return all ShortActingTreatment
)
union(["Medication, Order": "Substance Use Disorder Short Acting Medication"] ShortActingMedOrder
with(Min("Treatment Initiation With Non Medication Intervention Dates"
union "Treatment Initiation With Medication Order Dates"
)) InitiationTreatmentDate
such that date from ShortActingMedOrder.authorDatetime 34 days or less after InitiationTreatmentDate
return all ShortActingMedOrder
)
) >= 2
( ( ["Intervention, Performed": "Substance Use Disorder Treatment"]
union ["Intervention, Performed": "Psych Visit Psychotherapy"]
union ["Procedure, Performed": "Substance Use Disorder Long Acting Medication Administration"]
union ["Procedure, Performed": "Substance Use Disorder Short Acting Medication Administration"] ) Interventions
with "First SUD Episode During Measurement Period" FirstSUDEpisode
such that Global."NormalizeInterval" ( Interventions.relevantDatetime, Interventions.relevantPeriod ) starts 60 days or less before day of start of FirstSUDEpisode.relevantPeriod
)
union ( ( ( "Qualifying Encounters"
except "Emergency Department or Detoxification Visit" ) QualifyingEncounter
where ( exists QualifyingEncounter.diagnoses Diagnosis
where Diagnosis.code in "Substance Use Disorder"
) ) EncounterWithDiagnosis
with "First SUD Episode During Measurement Period" FirstSUDEpisode
such that EncounterWithDiagnosis.relevantPeriod starts 60 days or less before day of start of FirstSUDEpisode.relevantPeriod
)
union ( ( ["Medication, Order": "Substance Use Disorder Long Acting Medication"]
union ["Medication, Order": "Substance Use Disorder Short Acting Medication"] ) SUDMedication
with "First SUD Episode During Measurement Period" FirstSUDEpisode
such that SUDMedication.authorDatetime 60 days or less before day of start of FirstSUDEpisode.relevantPeriod
)
exists ( ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter
where ( InpatientEncounter.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
or InpatientEncounter.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
)
and InpatientEncounter.relevantPeriod ends during day of "Measurement Period"
)
or exists ( ["Encounter, Performed": "Hospice Encounter"] HospiceEncounter
where HospiceEncounter.relevantPeriod overlaps day of "Measurement Period"
)
or exists ( ["Assessment, Performed": "Hospice care [Minimum Data Set]"] HospiceAssessment
where HospiceAssessment.result ~ "Yes (qualifier value)"
and Global."NormalizeInterval" ( HospiceAssessment.relevantDatetime, HospiceAssessment.relevantPeriod ) overlaps day of "Measurement Period"
)
or exists ( ["Intervention, Order": "Hospice Care Ambulatory"] HospiceOrder
where HospiceOrder.authorDatetime during day of "Measurement Period"
)
or exists ( ["Intervention, Performed": "Hospice Care Ambulatory"] HospicePerformed
where Global."NormalizeInterval" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps day of "Measurement Period"
)
or exists ( ["Diagnosis": "Hospice Diagnosis"] HospiceCareDiagnosis
where HospiceCareDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
)
AgeInYearsAt(date from start of "Measurement Period") >= 13
and "First SUD Episode During Measurement Period" is not null
and not exists "History of SUD Diagnosis or Treatment"
exists "Treatment Initiation With Non Medication Intervention Dates"
or exists "Treatment Initiation With Medication Order Dates"
"Has Treatment Engagement With Long Acting Medication"
or "Has Two or More Treatment Engagements With Short Acting Medication or Non Medication Intervention"
["Intervention, Performed": "Substance Use Disorder Treatment"]
union ["Intervention, Performed": "Psych Visit Psychotherapy"]
union ( ( ["Encounter, Performed": "Telephone Visits"]
union ["Encounter, Performed": "Virtual Encounter"] ) TelehealthEncounter
where exists TelehealthEncounter.diagnoses Diagnosis
where Diagnosis.code in "Substance Use Disorder"
)
( ["Encounter, Performed": "Office Visit"]
union ["Encounter, Performed": "Emergency Department Evaluation and Management Visit"]
union ["Encounter, Performed": "Detoxification Visit"]
union ["Encounter, Performed": "Initial Hospital Inpatient Visit"]
union ["Encounter, Performed": "Discharge Services Hospital Inpatient Same Day Discharge"]
union ["Encounter, Performed": "Discharge Services Hospital Inpatient"]
union ["Encounter, Performed": "Telephone Visits"]
union ["Encounter, Performed": "Virtual Encounter"]
)
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer Type"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "Federal Administrative Sex"]
AgeInYearsAt(date from start of "Measurement Period") in Interval[13, 17]
AgeInYearsAt(date from start of "Measurement Period") in Interval[18, 64]
AgeInYearsAt(date from start of "Measurement Period") >= 65
( ( ["Medication, Order": "Substance Use Disorder Short Acting Medication"]
union ["Medication, Order": "Substance Use Disorder Long Acting Medication"] ) SUDMedication
let treatmentDate: date from SUDMedication.authorDatetime
with "First SUD Episode During Measurement Period" FirstSUDEpisode
such that treatmentDate during Interval[date from start of FirstSUDEpisode.relevantPeriod, date from start of FirstSUDEpisode.relevantPeriod + 14 days )
return all treatmentDate
)
union ( ( ["Procedure, Performed": "Substance Use Disorder Short Acting Medication Administration"]
union ["Procedure, Performed": "Substance Use Disorder Long Acting Medication Administration"] ) SUDMedAdministration
let treatmentDate: date from start of Global."NormalizeInterval" ( SUDMedAdministration.relevantDatetime, SUDMedAdministration.relevantPeriod )
with "First SUD Episode During Measurement Period" FirstSUDEpisode
such that treatmentDate during Interval[date from start of FirstSUDEpisode.relevantPeriod, date from start of FirstSUDEpisode.relevantPeriod + 14 days )
return all treatmentDate
)
"Psychosocial Visit" PsychosocialVisit
let treatmentDate: date from start of Global."NormalizeInterval" ( PsychosocialVisit.relevantDatetime, PsychosocialVisit.relevantPeriod )
with "First SUD Episode During Measurement Period" FirstSUDEpisode
such that treatmentDate during Interval[date from start of FirstSUDEpisode.relevantPeriod, date from start of FirstSUDEpisode.relevantPeriod + 14 days )
and PsychosocialVisit.id != FirstSUDEpisode.id
return all treatmentDate
if pointInTime is not null then Interval[pointInTime, pointInTime]
else if period is not null then period
else null as Interval<DateTime>
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer Type"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "Federal Administrative Sex"]
| Measure Set |
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