eCQM Title

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

eCQM Identifier (Measure Authoring Tool) 137 eCQM Version number 8.5.000
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 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.
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) 2012-2019 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 2004-2018 American Medical Association. LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. ICD-10 copyright 2018 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 
Stratum 2: Patients age >=18
Risk Adjustment
None
Rate Aggregation
None
Rationale
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).
Clinical Recommendation Statement
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.
Improvement Notation
Higher score indicates better quality
Reference
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
Reference
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
Schneider Institute for Health Policy, Brandeis University. 2001. Substance Abuse: The Nation's Number One Health Problem. Princeton: Robert Wood Johnson Foundation.
Reference
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
Reference
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 
Reference

      
Definition
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.
Guidance
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.
Transmission Format
TBD
Initial Population
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
Denominator
Equals Initial Population
Denominator Exclusions
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
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).
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


Measure Set
None