Review of Medication-Assisted Treatment Guidelines and Measures for Opioid and Alcohol Use. Appendix C. Alcohol Use: Medication-assisted Treatment and Other Related Measures

11/25/2015

TABLE C.1. Alcohol Use: MAT and Other Related Measures
Measure Denominator Numerator Setting Data Source Developer/Steward
EFFECTIVE CLINICAL CARE (Medication Use)
Pharmacotherapy for alcohol dependence (a) offered, (b) filled, (c) refused, or (d) contraindicated. Patients with:

a) Alcohol dependence with a new treatment episode.

b) Alcohol dependence in a new treatment episode and a co-morbid mental health diagnosis (major depressive disorder, bipolar disorder, Schizophrenia, PTSD).

Patients from the denominator who were:

a) Offered a prescription for naltrexone, Antabuse (disulfiram) or acamprosate but did not fill within 30 days on or after the start of the new treatment episode.
OR
b) Offered a prescription and filled within 30 days of the start of the new treatment episode.
OR
c) Offered a prescription for naltrexone, Antabuse (disulfiram) or acamprosate but refused medication within 30 days on or after the start of the new treatment episode.
OR
d) Found to have documentation that prescription is contraindicated within 30 days on or after start of new treatment episode.
OR
e) Found to have no documentation of offer or refusal and no record of prescription being filled.

Unspecified. Administrative/Medical records. VHA
Proportion of adults with moderate or severe alcohol dependence completing a successful medically assisted withdrawal who receive relapse prevention medication. The number of adults with moderate or severe alcohol dependence completing a successful medically assisted withdrawal. The number of adults in the denominator receiving relapse prevention medication. Ambulatory and inpatient specialty settings. Unspecified. National Institute for Health and Care Excellence
EFFECTIVE CLINICAL CARE (Psychosocial Treatments)
Proportion of adults accessing specialist services for alcohol misuse who receive evidence-based psychological interventions in accordance with NICE clinical guideline 115 (http://guidance.nice.org.uk/CG115) The number of adults accessing specialist services for alcohol misuse. The number of adults in the denominator receiving evidence-based psychological interventions in accordance with NICE clinical guideline 115. Ambulatory and inpatient specialty settings. Unspecified. National Institute for Health and Care Excellence
EFFECTIVE CLINICAL CARE (Screening and Treatment Counseling)
NQF #2152
Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling
All patients aged 18 years and older who were seen twice for any visits or who had at least 1 preventive care visit during the 2-year measurement period. Patients who were screened at least once within the last 24 months for unhealthy alcohol use using a systematic screening method AND who received brief counseling if identified as an unhealthy alcohol user.

Definitions:

Systematic screening method--For purposes of this measure, 1 of the following systematic methods to assess unhealthy alcohol use must be utilized.

Systematic screening methods and thresholds for defining unhealthy alcohol use include:

AUDIT Screening Instrument (score >= 8)

AUDIT-C Screening Instrument (score >=4 for men; score >=3 for women)

Single Question Screening--How many times in the past year have you had 5 (for men) or 4 (for women and all adults older than 65 y) or more drinks in a day? (response >=2)

Brief counseling--Brief counseling for unhealthy alcohol use refers to 1 or more counseling sessions, a minimum of 5-15 minutes, which may include: feedback on alcohol use and harms; identification of high-risk situations for drinking and coping strategies; increased motivation and the development of a personal plan to reduce drinking.

Ambulatory. Electronic Clinical Data. American Medical Association--convened Physician Consortium for Performance Improvement
NQF #1661
SUB-1 Alcohol Use Screening
The number of hospitalized inpatients 18 years of age and older. The number of patients who were screened for alcohol use using a validated screening questionnaire for unhealthy drinking within the first 3 days of admission. Inpatient. Electronic Clinical Data/paper-based medical records. TJC
NQF #1663
SUB-2 Alcohol Use Brief Intervention Provided or Offered and SUB-2a Alcohol Use Brief Intervention
The number of hospitalized inpatients 18 years of age and older who screen positive for unhealthy alcohol use or an alcohol use disorder (alcohol abuse or alcohol dependence). SUB-2: The number of patients who received or refused a brief intervention.

SUB-2a: The number of patients who received a brief intervention.

Inpatient. Electronic Clinical Data/paper-based medical records. TJC
NQF #1664
SUB-3 Alcohol and Other Drug Use Disorder Treatment Provided or Offered at Discharge and SUB-3a Alcohol and Other Drug Use Disorder Treatment at Discharge
The number of hospitalized inpatients 18 years of age and older identified with an alcohol or drug use disorder SUB-3: The number of patients who received or refused at discharge a prescription for medication for treatment of alcohol or drug use disorder OR received or refused a referral for addictions treatment.

SUB-3a: The number of patients who received a prescription at discharge for medication for treatment of alcohol or drug use disorder OR a referral for addictions treatment.

Inpatient. Electronic Clinical Data/paper-based medical records. TJC
Counseling treatment options for alcohol dependence. All patients aged 18 years and older with a diagnosis of current alcohol dependence. Patients who were counseled regarding psychosocial AND pharmacologic treatment options for alcohol dependence within the 12 month reporting period. Unspecified. Administrative/electronic clinical data. APA; Physician Consortium for Performance Improvement
EFFECTIVE CLINICAL CARE (Brief Intervention)
Behavioral health: percent of patients screened for alcohol misuse with AUDIT-C who meet or exceed a threshold score of 5 who have timely brief alcohol counseling. Patients screened for alcohol misuse with AUDIT-C who meet or exceed a threshold score of 5 and who were not seen in a VA specialty SUD program in the prior 90 days. Patients screened for alcohol misuse with AUDIT-C who meet or exceed a threshold score of 5 who were not seen in a SUD addiction program in the prior 90 days and have brief alcohol counseling documented in the medical record within 14 days of the positive screen. Ambulatory, Inpatient. Administrative/paper-based medical records. VHA
Conduct brief intervention at initial visits for patients with alcohol abuse or dependence. This indicator is evaluated for the following populations:

1. All SUD patients with alcohol abuse or dependence within the study period.

2. All SUD patients with alcohol abuse or dependence in a new treatment episode.

Numerator for 1: Proportion of patients that have medical records documenting:

(a) Provider advice to drink less or abstain from alcohol and feedback was provided about risks of alcohol use to health condition or to general health during the study period.
OR
(b) Completed referral to specialty mental health during the study period.
OR
(c) Already in specialty care.
OR
(d) All other patients

Numerator for 2: Proportion of patients that have medical records documenting:

(e) Within 30 days of the new treatment episode; provider advice to drink less or abstain from alcohol and feedback was provided about risks of alcohol use to health condition or to general health.
OR
(f) Within 30 days of the new treatment episode; completed referral to specialty mental health.
OR
(g) Started the new treatment episode in specialty care.
OR
(h) All other patients.

Ambulatory. Administrative/paper-based medical records. VHA
The measure description and numerator and denominator statements are verbatim from the measure specifications or other associated documents.

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