Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Percentage of patients 13 years of age and older with a new episode of alcohol or other drug abuse or (AOD) dependence 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 AOD abuse or dependence within 14 days of the diagnosis 
b. Percentage of patients who engaged in ongoing treatment including two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention.

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Report a total score, and each of the following strata:
Stratum 1: Patients age 13-17 
Stratum 2: Patients age >=18

None

None

There are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition. Treatment of medical problems caused by substance use and abuse places a huge burden on the health care system (Schneider Institute for Health Policy, 2001). In 2011, an estimated 22.5 million persons (8.7 percent of the population aged 12 or older) were classified with substance dependence or abuse. Of these, 68 percent were dependent on or abused alcohol, but not illicit drugs, 13 percent abused or were dependent on both alcohol and illicit drugs, while 19 percent were dependent on or abused illicit drugs, but not alcohol (Substance Abuse and Mental Health Services Administration  [SAMHSA], 2012). Of the 19.3 million persons aged 12 or older in 2011 who were classified as needing substance use treatment but did not receive treatment at a specialty facility in the past year, 912,000 persons (4.7 percent) reported that they felt they needed treatment for their illicit drug or alcohol use problem. Of these 912,000 persons who felt they needed treatment, only 281,000 (30.8 percent) reported that they made an effort to get treatment, while 631,000 (69.2 percent) reported making no effort to get treatment (SAMHSA, 2012).

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 ].
* Naltrexone, injectable naltrexone, acamprosate, a ?-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].

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.

U.S. Preventive Services Task Force recommendation statement (2012): 
*The USPSTF recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse.

Higher score indicates better quality

American Psychiatric Association: Work Group on Substance Use Disorders. (2006). Practice Guideline for the Treatment of Patients With Substance Use Disorders Second Edition. American Psychiatric Association (APA); 2006 Aug. 276 pg. [1789 references]. Retrieved from https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/substanceuse.pdf

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

Schneider Institute for Health Policy, Brandeis University. 2001. Substance Abuse: The Nation's Number One Health Problem. Princeton: Robert Wood Johnson Foundation.

Substance Abuse and Mental Health Services Administration SAMHSA. (2012). Results from the 2011 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUHresults2011/NSDUHresults2011.pdf

U.S. Preventive Services Task Force. 2012. Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care.  Retrieved from http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/alcohol-misuse-screening-and-behavioral-counseling-interventions-in-primary-care 

The initiation visit is the first visit for alcohol or other drug dependence treatment within 14 days after a diagnosis of alcohol or other drug dependence.

Treatment includes inpatient AOD admissions, outpatient visits, intensive outpatient encounters or partial hospitalization.

The Intake Period: January 1-November 14 of the measurement year. The Intake Period is used to capture new episodes of Alcohol or Drug Dependence. The November 14 cut-off date ensures that all services can occur before the measurement period ends.

The new episode of alcohol and other drug dependence should be the first episode of the measurement period that is not preceded in the 60 days prior by another episode of alcohol or other drug dependence.

TBD

Patients age 13 years of age and older who were diagnosed  with a new episode of alcohol, opioid, or other drug abuse or dependency during a visit between January 1 and November 14 of the measurement period

Equals Initial Population

Patients with a previous active diagnosis of alcohol, opioid or other drug abuse or dependence in the 60 days prior to the first episode of alcohol or drug dependence

Exclude patients whose hospice care overlaps the measurement period.

Numerator 1: Initiation of treatment includes either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis 

Numerator 2: Engagement in ongoing treatment includes two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention (i.e., engagement for these members cannot be satisfied with medication treatment alone).

Not Applicable

None

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

None