Summary: In response to the growing opioid epidemic, the U.S. Department of Health and Human Services (HHS) announced a three-pronged initiative in March 2015 to: (1) improve opioid prescribing practices; (2) increase access to naloxone for overdose management; and (3) expand medication-assisted treatment (MAT) to reduce opioid dependence. In support of the initiative, the HHS Office of the Assistant Secretary for Planning and Evaluation contracted with Mathematica Policy Research to develop a roadmap that identifies concepts for potential quality measures that promote the appropriate use of MAT for opioid use as well as the steps needed to develop those concepts into measures. As a guiding step in roadmap development, clinical MAT guidelines and existing measures related to MAT were reviewed. This report contains the review of clinical MAT guidelines and existing measures.
Major Findings: Twenty-one MAT opioid use guidelines published between 2010 and 2015 were identified. The guidelines were largely developed using a consensus process informed by a literature review. Ninety percent of the guidelines focus on care delivered in the maintenance treatment phase, 62 percent provide information on assessment, and 62 percent address withdrawal management or detoxification. All the guidelines recommend specific medications for use in treatment and about half (57 percent) provide information on medication dosing. Two-thirds of the guidelines provide some information on psychosocial treatment. Contingency management, motivational interviewing, and cognitive behavioral approaches are the most commonly mentioned psychosocial treatments. In addition to the clinical guidelines, ten existing MAT opioid use quality measures were identified -- eight process measures and two patient satisfaction methods. Six of the process measures assess various aspects of pharmacotherapy use, including dosage and frequency of use. One measure explicitly addresses both components of MAT -- pharmacotherapy and psychosocial treatment; however, this measure assesses counseling about these treatment options, rather than utilization of MAT. One measure that was developed for use in inpatient settings has received the National Quality Forum's (NQF's) endorsement.
Purpose: This project surveyed existing clinical guidelines and quality measures related to MAT. The summarized information will be used to develop a roadmap that identifies strategies HHS could use to promote the appropriate use of MAT for opioid use.
Methods: This project searched for and reviewed existing MAT clinical guidelines, published from 2010 to 2015, in the National Guidelines Clearinghouse, the National Institute for Health and Clinical Excellence, online search engines, and bibliography scans. MAT quality measures were identified from searches in the National Quality Measures Clearinghouse, the NQF's Quality Positioning System, the HHS Measure Inventory, and online search engines.