Review of Medication-Assisted Treatment Guidelines and Measures for Opioid and Alcohol Use. E. Summary of Medication-assisted Treatment Quality Measures

11/25/2015

TABLE 3. MAT for Opioid Use Measures
Measure Denominator Numerator Setting Data Source Developer/Steward
EFFECTIVE CLINICAL CARE
Initiation of pharmacotherapy upon new episode of opioid dependence Number of individuals with index visit associated with an opioid dependence diagnosis after 60-day clean period with no SUD claims. Number of individuals who initiate pharmacotherapy with at least 1 prescription for an opioid treatment medication within 30 days following index visit with a diagnosis of opioid dependence. Several, including ambulatory care. Administrative/electronic clinical data. Washington Circle Group
Use of opioid dependence pharmacotherapy during a measurement year Number of individuals with any encounter associated with opioid dependence (primary or other) at any time during the measurement year. Number of individuals with at least 1 prescription for appropriate pharmacotherapy at any time during the measurement year. Several, including ambulatory care. Administrative/electronic clinical data. Washington Circle Group
Maintenance pharmacotherapy for substance abuse Patients who receive a service-related diagnosis of opioid or alcohol dependence during a specified period. Those patients in the denominator who receive at least 30 days' treatment with 1 or more appropriate medications (methadone, buprenorphine, or naltrexone for opiate dependence; naltrexone or disulfiram for alcohol dependence) during a specified interval. Not specified; inferred to include ambulatory settings. Administrative/paper-based medical records/pharmacy. APA
OAT as first line of defense for at least 90 days of treatment at beginning of a new treatment episode Patients with opiate dependence who are initiating OAT within 30 days on or after the start of a new treatment episode. Patients from denominator receiving 90 doses of OAT in the 90 days following the first dose. Not specified; inferred to include ambulatory settings. Administrative/paper-based medical records. VHA
Duration of OAT for selected SUD patients Veterans in the SUD cohort with opiate dependence in a new treatment episode undergoing opiate agonist treatment. Length (in days) of opiate agonist treatment for patients in the denominator in the 12 months following the start of treatment. Not specified; inferred to include ambulatory settings. Administrative/paper-based medical records. VHA
Maintenance pharmacotherapy for opiate dependence at empirically based dosages: (1) offered; (2) filled; (3) refused medication; or (4) contraindicated Patients with SUD diagnosis with opiate dependence with a new treatment episode. Patients from the denominator who were:

(1) Offered methadone or a prescription for buprenorphine at the empirically based dose but did not fill prescription within 30 days on or after the start of the new treatment episode.
OR
(2) Offered methadone or a prescription for buprenorphine at the empirically based dose and filled prescription within 30 days on or after the start of the new treatment episode.
OR
(3) Offered methadone or a prescription for buprenorphine at the empirically based dose but refused medication within 30 days on or after the start of the new treatment episode.
OR
(4) Found to have documentation that prescription is contraindicated within 30 days on or after start of new treatment episode.
OR
(5) Found to have no documentation of offer or refusal and no record of prescription being filled.

Not specified; inferred to include ambulatory settings. Administrative/paper-based medical records. VHA
NQF #1664
SUB-3 Alcohol and Other Drug Use Disorder Treatment Provided or Offered at Discharge

SUB-3a Alcohol and Other Drug Use Disorder Treatment at Discharge

The number of hospitalized inpatients age 18 years 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
COMMUNICATION AND CARE COORDINATION
Counseling on psychosocial and pharmacologic treatment options for opioid addiction All patients age 18 years and older with a diagnosis of current opioid addiction. Patients who were counseled on psychosocial AND pharmacologic treatment options for opioid addiction within the 12-month reporting period. Not specified; inferred to include ambulatory settings. Administrative/paper-based medical records/electronic clinical data. APA; Physician Consortium for Performance Improvement; NCQA
PERSON AND CAREGIVER EXPERIENCE OUTCOMES
HIV ambulatory care satisfaction: Percentage of HIV-positive adult patients in a methadone maintenance program who reported how often the dispensing line was too slow HIV-positive adult patients age 18 years and older engaged in a methadone maintenance program who completed the survey. The number of patients who indicated "All of the time," "Most times," "Sometimes," "Rarely," "Never," "Does not apply" to the item, "The dispensing line was too slow." Several. Patient survey. New York State Department of Health AIDS Institute
HIV ambulatory care satisfaction: Percentage of HIV-positive adult patients who reported whether their substance use counselors explained to them in a way they could understand how their substance use treatment (for example, methadone) and their HIV medications might interact HIV-positive adult patients age 18 years and older engaged in a substance use treatment program who completed the survey. The number of patients who indicated "Strongly Disagree," "Disagree," "Agree," "Strongly Agree," "Does Not Apply" to the item, "My substance use counselors explained to me in a way I could understand how my substance use treatment (for example, methadone) and my HIV medications might interact." Several. Patient survey. New York State Department of Health AIDS Institute
NOTE: The measure description and numerator and denominator statements are verbatim from the measure specifications.

MAT Opioid Use Measures. We identified ten measures (Table 3) that incorporate MAT -- eight process measures (that rely on administrative data and/or medical record review) and two patient satisfaction measures (that rely on patient surveys and are limited to HIV-positive patients). Only one identified measure -- focused on adults discharged from inpatient settings -- has received the NQF's endorsement. Only one measure explicitly addresses both components of MAT -- pharmacotherapy and psychosocial treatment. However, this measures assesses counseling about these treatment options, rather than utilization of MAT. The remaining process measures assess various aspects of pharmacotherapy use, including dosage and frequency of use.

MAT Alcohol Use Measures. We identified ten measures specifically related to alcohol that might be useful in the future development of MAT measures for opioid use, three of which assess the provision of MAT at various stages of treatment (e.g., post-discharge, post-withdrawal) (Appendix C provides details of the measures). One measure assessed receipt of evidence-based psychological interventions while the other measures addressed precursors to MAT: screening and brief interventions/counseling. NQF has endorsed four of the ten measures.

Other Related Measures. In addition to the above measures, we identified 58 measures (Appendix D) that reflect concepts that could be applied to MAT or are known to be important supports for MAT. They include, for example, measures related to assessment; screening; and access to, timeliness of, and retention in treatment; use of psychosocial treatment; and care coordination. The measures are largely process measures, and three have received NQF's endorsement.

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