eCQM Title | # Initiation and Engagement of Substance Use Disorder Treatment
eCQM Identifier (Measure Authoring Tool) | 137 | eCQM Version Number | 11.0.000
NQF Number | Not Applicable | GUID | c3657d72-21b4-4675-820a-86c7fe293bf5
Measurement Period | January 1, 20XX through December 31, 20XX
Measure Steward | National Committee for Quality Assurance
Measure Developer | National Committee for Quality Assurance
Endorsed By | None
Description |
    Percentage of patients 13 years of age and older with a new substance use disorder (SUD) episode who received the following (Two rates are reported):

    a. Percentage of patients who initiated treatment, including either an intervention or medication for the treatment of SUD, within 14 days of the new SUD episode.
    b. Percentage of patients who engaged in ongoing treatment, including two additional interventions or short-term medications, or one long-term medication for the treatment of SUD, within 34 days of the initiation.
Copyright |
    This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2021 National Committee for Quality Assurance. All Rights Reserved.

    Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.

    CPT(R) contained in the Measure specifications is copyright 2004-2021 American Medical Association. LOINC(R) copyright 2004-2021 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. ICD-10 copyright 2021 World Health Organization. All Rights Reserved.
Disclaimer |
    The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

    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 |
    Report a total score, and each of the following strata:
    Stratum 1: Patients age 13-17 at the start of the measurement period
    Stratum 2: Patients age 18-64 at the start of the measurement period
    Stratum 3: Patients age 65 and older at the start of the measurement period
Risk Adjustment |
    None
Rate Aggregation |
    None
Rationale |
    There are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition. In 2018, 20.3 million individuals in the U.S. age 12 or older (approximately 8 percent of the population) were classified as having an SUD within the past year (Substance Abuse and Mental Health Services Administration, 2019). Despite the high prevalence of SUD in the U.S., fewer than 20 percent of individuals with SUD receive any substance use treatment and only 12 percent receive treatment in a specialty SUD program (SAMHSA, 2019).
Clinical Recommendation Statement |
    American Society of Addiction Medicine (2020)
    * All Food and Drug Administration approved medications for the treatment of opioid use disorder should be available to all patients. Clinicians should consider the patient’s preferences, past treatment history, current state of illness, and treatment setting when deciding between the use of methadone, buprenorphine, and naltrexone.
    * There is no recommended time limit for pharmacological treatment
    * Patients’ psychosocial needs should be assessed, and patients should be offered or referred to psychosocial treatment based on their individual needs. However, a patient’s decision to decline psychosocial treatment or the absence of available psychosocial treatment should not preclude or delay pharmacotherapy, with appropriate medication management. Motivational interviewing or enhancement can be used to encourage patients to engage in psychosocial treatment services appropriate for addressing individual needs.

    American Psychiatric Association (2018)
    * Patients with alcohol use disorder should have a documented comprehensive and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments. [1C]
    * Naltrexone or acamprosate should be offered to patients with moderate to severe alcohol use disorder who have a goal of reducing alcohol consumption or achieving abstinence, prefer pharmacotherapy or have not responded to nonpharmacological treatments alone, and have no contraindications to the use of these medications. [1B]
    * Disulfiram should be offered to patients with moderate to severe alcohol use disorder who have a goal of achieving abstinence, prefer disulfiram or are intolerant to or have not responded to naltrexone and acamprosate, are capable of understanding the risks of alcohol consumption while taking disulfiram, and have no contraindications to the use of this medication. [2C]
    * Topiramate or gabapentin should be offered to patients with moderate to severe alcohol use disorder who have a goal of reducing alcohol consumption or achieving abstinence, prefer topiramate or gabapentin or are intolerant to or have not responded to naltrexone and acamprosate, and have no contraindications to the use of these medications. [2C]

    American Psychiatric Association (2006)
    * Because many substance use disorders are chronic, patients usually require long-term treatment, although the intensity and specific components of treatment may vary over time [I rating].
    * It is important to intensify the monitoring for substance use during periods when the patient is at a high risk of relapsing, including during the early stages of treatment, times of transition to less intensive levels of care, and the first year after active treatment has ceased [I rating].
    * Outpatient treatment of substance use disorders is appropriate for patients whose clinical condition or environmental circumstances do not require a more intensive level of care [I rating]. As in other treatment settings, a comprehensive approach is optimal, using, where indicated, a variety of psychotherapeutic and pharmacological interventions along with behavioral monitoring [I rating ].
    * Disulfiram is also recommended for patients with alcohol dependence [II rating].
    * Naltrexone, injectable naltrexone, acamprosate, a y-aminobutyric acid (GABA) are recommended for patients with alcohol dependence [I rating]. Disulfiram is also recommended for patients with alcohol dependence [II rating].
    * Methadone and buprenorphine are recommended for patients with opioid dependence [I rating].
    * Naltrexone is an alternative strategy [I rating].

    American Society of Addiction Medicine (2015)
    * Methadone and buprenorphine are recommended for opioid use disorder treatment and withdrawal management.
    * Naltrexone (oral; extended-release injectable) is recommended for relapse prevention.

    Michigan Quality Improvement Consortium (2017)
    *Patients with substance use disorder or risky substance use: Patient Education and Brief Intervention by PCP or Trained Staff (e.g. RN, MSW)
    *If diagnosed with substance use disorder or risky substance use, initiate an intervention within 14 days.
    *Frequent follow-up is helpful to support behavior change; preferably 2 visits within 30 days.
    *Refer to a substance abuse health specialist, an addiction physician specialist, or a physician experienced in pharmacologic management of addiction.

    Department of Veterans Affairs/Department of Defense (2015)
    * Offer referral to specialty SUD care for addiction treatment if based on willingness to engage. [B]
    * For patients with moderate-severe alcohol use disorder, we recommend: Acamprosate, Disulfiram, Naltrexone- oral or extended release, or Topiramate. [A]
    * Medications should be offered in combined with addiction-focused counseling. offering one or more of the following interventions considering patient preference and provider training/competence: Behavioral Couples Therapy for alcohol use disorder, Cognitive Behavioral Therapy for substance use disorders, Community Reinforcement Approach, Motivational Enhancement Therapy, 12-Step Facilitation. [A]
    * For patients with opioid use disorder we recommend buprenorphine/naloxone or methadone in an Opioid Treatment Program. For patients for whom agonist treatment is contraindicated, unacceptable, unavailable, or discontinued, we recommend extended-release injectable naltrexone. [A]
    * For patients initiated in an intensive phase of outpatient or residential treatment, recommend ongoing systematic relapse prevention efforts or recovery support, individualized on the basis of treatment response. [A]
Improvement Notation |
    Higher score indicates better quality
Reference |
    Reference Type: CITATION
    Reference Text: 'American Psychiatric Association, Kleber, H. D., & McIntyre, J. S. (2006). Practice Guideline for Treatment of Patients with Substance Use Disorders (pp. 1-276). Arlington, VA: American Psychiatric Association.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Cunningham, C., Edlund, F. M. J., Fishman, M., Gordon, D. A. J., Jones, D. H. E., Langleben, D., ... & Freedman, D. K. (2020). The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Department of Veteran Affairs, Department of Defense. (2015). VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders. Washington DC: Department of Veterans Affairs, Department of Defense.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Kampman, K., Jarvis, M. (2015). American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. Journal of Addiction Medicine; 9(5), 358–367. https://doi.org/10.1097/ADM.0000000000000166'
Reference |
    Reference Type: CITATION
    Reference Text: 'Michigan Quality Improvement Consortium. (2017). Screening, diagnosis, and referral for substance use disorders. Southfield, (MI): Michigan Quality Improvement Consortium. Retrieved from http://www.mqic.org/pdf/mqic_screening_diagnosis_and_referral_for_substance_use_disorders_cpg.pdf'
Reference |
    Reference Type: CITATION
    Reference Text: 'Pietras, S., Azur, M., & Brown, J. (2015). Review of medication assisted treatment guidelines and measures for opioid and alcohol use. Washington, DC: Assistant Secretary for Planning and Evaluation.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Reus, V. et al. (2018). Practice Guideline for the Pharmacological Treatment of Patients with Alcohol Use Disorder. American Journal of Psychiatry, 175(1), 86-90. https://doi.org/10.1176/appi.ajp.2017.1750101'
Reference |
    Reference Type: CITATION
    Reference Text: 'Schneider Institute for Health Policy. (2001). Substance abuse: The nation's number one health problem. Robert Wood Johnson Foundation.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Substance Abuse and Mental Health Services Administration (SAMHSA). (2019). Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.htm#mhisudSubstance'
Definition |
    The new SUD episode is the first encounter during the Intake Period with a diagnosis of SUD with no encounter or medication treatment for a diagnosis of SUD in the 60 days prior.

    The initiation of treatment is the first SUD treatment within 14 days of a new SUD episode.

    Treatment includes inpatient SUD admissions, outpatient visits, intensive outpatient encounters or partial hospitalizations, and medications for the treatment of SUD.

    The Intake Period: January 1-November 14 of the measurement year. The Intake Period is used to capture new SUD episodes. The November 14 cut-off date ensures that all services can occur before the measurement period ends.
Guidance |
    This eCQM is a patient-based measure.

    This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Transmission Format |
    TBD
Initial Population |
    Patients age 13 years of age and older as of the start of the measurement period who were diagnosed with a new SUD episode during a visit between January 1 and November 14 of the measurement period
Denominator |
    Equals Initial Population
Denominator Exclusions |
    Exclude patients who are in hospice care for any part of the measurement period
Numerator |
    Numerator 1: Initiation of treatment includes either an intervention or medication for the treatment of SUD within 14 days of the new SUD episode

    Numerator 2: Engagement in ongoing SUD treatment within 34 days of initiation includes:

    1. A long-acting SUD medication on the day after the initiation through 34 days after the initiation of treatment

    2. One of the following options on the day after the initiation of treatment through 34 days after the initiation of treatment: a) two engagement visits, b) two engagement medication treatment events, c) one engagement visit and one engagement medication treatment event
Numerator Exclusions |
    Not Applicable
Denominator Exceptions |
    None
Supplemental Data Elements |
    For every patient evaluated by this measure also identify payer, race, ethnicity and sex

## Table of Contents

- Population Criteria
- Definitions
- Functions
- Terminology
- Data Criteria (QDM Data Elements)
- Supplemental Data Elements
- Risk Adjustment Variables

### Population Criteria

- Population Criteria 1
  - - Initial Population

      - -     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"

  - - Denominator

      - -     "Initial Population"

  - - Denominator Exclusions

      - -     Hospice."Has Hospice Services"

  - - Numerator

      - -     exists "Treatment Initiation With Non Medication Intervention Dates"
                or exists "Treatment Initiation With Medication Order Dates"

  - - Numerator Exclusions

      - -     None

  - - Denominator Exceptions

      - -     None

  - - Stratification 1

      - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[13, 17]

  - - Stratification 2

      - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[18, 64]

  - - Stratification 3

      - -     AgeInYearsAt(date from start of "Measurement Period")>= 65

- Population Criteria 2
  - - Initial Population

      - -     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"

  - - Denominator

      - -     "Initial Population"

  - - Denominator Exclusions

      - -     Hospice."Has Hospice Services"

  - - Numerator

      - -     "Has Treatment Engagement With Long Acting Medication"
                or "Has Treatment Engagement With Short Acting Medication or Non Medication Intervention"

  - - Numerator Exclusions

      - -     None

  - - Denominator Exceptions

      - -     None

  - - Stratification 1

      - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[13, 17]

  - - Stratification 2

      - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[18, 64]

  - - Stratification 3

      - -     AgeInYearsAt(date from start of "Measurement Period")>= 65

### Definitions

- - Denominator

    - -     "Initial Population"

  - Denominator Exclusions

    - -     Hospice."Has Hospice Services"

  - Emergency Department or Detoxification Visit

    - -     ["Encounter, Performed": "Emergency Department Visit"]
              union ["Encounter, Performed": "Detoxification Visit"]

  - First SUD Episode During Measurement Period

    - -     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
            )

  - Has Treatment Engagement With Long Acting Medication

    - -     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
                )
            )

  - Has Treatment Engagement With Short Acting Medication or Non Medication Intervention

    - -     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

  - History of SUD Diagnosis or Treatment

    - -     ( ( ["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
              )

  - Hospice.Has Hospice Services

    - -     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 "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 "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 "Measurement Period"
              )

  - Initial Population

    - -     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"

  - Numerator 1

    - -     exists "Treatment Initiation With Non Medication Intervention Dates"
              or exists "Treatment Initiation With Medication Order Dates"

  - Numerator 2

    - -     "Has Treatment Engagement With Long Acting Medication"
              or "Has Treatment Engagement With Short Acting Medication or Non Medication Intervention"

  - Psychosocial Visit

    - -     ["Intervention, Performed": "Substance Use Disorder Treatment"]
              union ["Intervention, Performed": "Psych Visit Psychotherapy"]
              union ( ( ["Encounter, Performed": "Telephone Visits"]
                  union ["Encounter, Performed": "Online Assessments"] ) TelehealthEncounter
                  where exists TelehealthEncounter.diagnoses Diagnosis
                    where Diagnosis.code in "Substance Use Disorder"
              )

  - Qualifying Encounters

    - -     ( ["Encounter, Performed": "Office Visit"]
                union ["Encounter, Performed": "Emergency Department Visit"]
                union ["Encounter, Performed": "Detoxification Visit"]
                union ["Encounter, Performed": "Initial Hospital Observation Care"]
                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": "Online Assessments"]
            )

  - SDE Ethnicity

    - -     ["Patient Characteristic Ethnicity": "Ethnicity"]

  - SDE Payer

    - -     ["Patient Characteristic Payer": "Payer"]

  - SDE Race

    - -     ["Patient Characteristic Race": "Race"]

  - SDE Sex

    - -     ["Patient Characteristic Sex": "ONC Administrative Sex"]

  - Stratification 1

    - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[13, 17]

  - Stratification 2

    - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[18, 64]

  - Stratification 3

    - -     AgeInYearsAt(date from start of "Measurement Period")>= 65

  - Treatment Initiation With Medication Order Dates

    - -     ( ( ["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
              )

  - Treatment Initiation With Non Medication Intervention Dates

    - -     "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

### Functions

- - Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

    - -     if pointInTime is not null then Interval[pointInTime, pointInTime]
              else if period is not null then period
              else null as Interval<DateTime>

### Terminology

- code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
- code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
- code "Hospice care [Minimum Data Set]" ("LOINC Code (45755-6)")
- code "Yes (qualifier value)" ("SNOMEDCT Code (373066001)")
- valueset "Detoxification Visit" (2.16.840.1.113883.3.464.1003.101.12.1059)
- valueset "Discharge Services Hospital Inpatient" (2.16.840.1.113883.3.464.1003.101.12.1007)
- valueset "Discharge Services Hospital Inpatient Same Day Discharge" (2.16.840.1.113883.3.464.1003.101.12.1006)
- valueset "Emergency Department Visit" (2.16.840.1.113883.3.464.1003.101.12.1010)
- valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
- valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
- valueset "Hospice Care Ambulatory" (2.16.840.1.113883.3.526.3.1584)
- valueset "Hospice Encounter" (2.16.840.1.113883.3.464.1003.1003)
- valueset "Initial Hospital Inpatient Visit" (2.16.840.1.113883.3.464.1003.101.12.1004)
- valueset "Initial Hospital Observation Care" (2.16.840.1.113883.3.464.1003.101.12.1002)
- valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
- valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
- valueset "Online Assessments" (2.16.840.1.113883.3.464.1003.101.12.1089)
- valueset "Payer" (2.16.840.1.114222.4.11.3591)
- valueset "Psych Visit Psychotherapy" (2.16.840.1.113883.3.526.3.1496)
- valueset "Race" (2.16.840.1.114222.4.11.836)
- valueset "Substance Use Disorder" (2.16.840.1.113883.3.464.1003.106.12.1001)
- valueset "Substance Use Disorder Long Acting Medication" (2.16.840.1.113883.3.464.1003.1149)
- valueset "Substance Use Disorder Long Acting Medication Administration" (2.16.840.1.113883.3.464.1003.1156)
- valueset "Substance Use Disorder Short Acting Medication" (2.16.840.1.113883.3.464.1003.1150)
- valueset "Substance Use Disorder Short Acting Medication Administration" (2.16.840.1.113883.3.464.1003.1157)
- valueset "Substance Use Disorder Treatment" (2.16.840.1.113883.3.464.1003.106.12.1005)
- valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)

### Data Criteria (QDM Data Elements)

- "Assessment, Performed: Hospice care [Minimum Data Set]" using "Hospice care [Minimum Data Set] (LOINC Code 45755-6)"
- "Diagnosis: Substance Use Disorder" using "Substance Use Disorder (2.16.840.1.113883.3.464.1003.106.12.1001)"
- "Encounter, Performed: Detoxification Visit" using "Detoxification Visit (2.16.840.1.113883.3.464.1003.101.12.1059)"
- "Encounter, Performed: Discharge Services Hospital Inpatient" using "Discharge Services Hospital Inpatient (2.16.840.1.113883.3.464.1003.101.12.1007)"
- "Encounter, Performed: Discharge Services Hospital Inpatient Same Day Discharge" using "Discharge Services Hospital Inpatient Same Day Discharge (2.16.840.1.113883.3.464.1003.101.12.1006)"
- "Encounter, Performed: Emergency Department Visit" using "Emergency Department Visit (2.16.840.1.113883.3.464.1003.101.12.1010)"
- "Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
- "Encounter, Performed: Hospice Encounter" using "Hospice Encounter (2.16.840.1.113883.3.464.1003.1003)"
- "Encounter, Performed: Initial Hospital Inpatient Visit" using "Initial Hospital Inpatient Visit (2.16.840.1.113883.3.464.1003.101.12.1004)"
- "Encounter, Performed: Initial Hospital Observation Care" using "Initial Hospital Observation Care (2.16.840.1.113883.3.464.1003.101.12.1002)"
- "Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
- "Encounter, Performed: Online Assessments" using "Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089)"
- "Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"
- "Intervention, Order: Hospice Care Ambulatory" using "Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584)"
- "Intervention, Performed: Hospice Care Ambulatory" using "Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584)"
- "Intervention, Performed: Psych Visit Psychotherapy" using "Psych Visit Psychotherapy (2.16.840.1.113883.3.526.3.1496)"
- "Intervention, Performed: Substance Use Disorder Treatment" using "Substance Use Disorder Treatment (2.16.840.1.113883.3.464.1003.106.12.1005)"
- "Medication, Order: Substance Use Disorder Long Acting Medication" using "Substance Use Disorder Long Acting Medication (2.16.840.1.113883.3.464.1003.1149)"
- "Medication, Order: Substance Use Disorder Short Acting Medication" using "Substance Use Disorder Short Acting Medication (2.16.840.1.113883.3.464.1003.1150)"
- "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
- "Patient Characteristic Payer: Payer" using "Payer (2.16.840.1.114222.4.11.3591)"
- "Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
- "Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
- "Procedure, Performed: Substance Use Disorder Long Acting Medication Administration" using "Substance Use Disorder Long Acting Medication Administration (2.16.840.1.113883.3.464.1003.1156)"
- "Procedure, Performed: Substance Use Disorder Short Acting Medication Administration" using "Substance Use Disorder Short Acting Medication Administration (2.16.840.1.113883.3.464.1003.1157)"

### Supplemental Data Elements

- SDE Ethnicity

  - -     ["Patient Characteristic Ethnicity": "Ethnicity"]

- SDE Payer

  - -     ["Patient Characteristic Payer": "Payer"]

- SDE Race

  - -     ["Patient Characteristic Race": "Race"]

- SDE Sex

  - -     ["Patient Characteristic Sex": "ONC Administrative Sex"]

### Risk Adjustment Variables

- None

Measure Set |
    None