Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement (NQF 0004)
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1 Initiatin and Engagement f Alchl and Other Drug Dependence Treatment: (a) Initiatin, (b) Engagement (NQF 0004) EMeasure Name Initiatin and Engagement f Alchl and Other Drug Dependence Treatment: (a) Initiatin, (b) Engagement EMeasure Id Pending Versin Number 1 Set Id Pending Available Date N infrmatin Measurement Perid January 1, 20xx thrugh December 31, 20xx Measure Steward Endrsed by Descriptin Measure scring Measure type Ratinale Clinical Recmmendatin Statement Natinal Cmmittee fr Quality Assurance Natinal Quality Frum The percentage f adlescent and adult patients with a new episde f alchl and ther drug (AOD) dependence wh initiate treatment thrugh an inpatient AOD admissin, utpatient visit, intensive utpatient encunter r partial hspitalizatin within 14 days f the diagnsis and wh initiated treatment and wh had tw r mre additinal services with an AOD diagnsis within 30 days f the initiatin visit. Prprtin Prcess There are mre deaths, illnesses and disabilities frm substance abuse than frm any ther preventable health cnditin. Treatment f medical prblems caused by substance use and abuse places a huge burden n the health care system. Accrding t a reprt frm the 2001 Natinal Husehld Survey n Drug Abuse (NHSDA), an estimated 16.6 millin Americans aged 12 r lder in 2001 were classified with dependence n r abuse f either alchl r illicit drugs (7.3 percent f the ttal ppulatin). Of these, 2.4 millin were classified with dependence n r abuse f bth alchl and illicit drugs, 3.2 millin were dependent n r abused illicit drugs but nt alchl, and 11.0 millin were dependent n r abused alchl but nt illicit drugs.(samhsa, 2002). The identificatin f individuals with AOD (Alchl and Other Drug) disrders is an imprtant first step in the prcess f care. Hwever, the identificatin f AOD disrders ften des nt rutinely lead t the initiatin f care. Reasns that an individual may nt initiate treatment include the scial stigma assciated with AOD disrder, denial that there is an AOD prblem, nn cmpliance t AOD treatment ffered, r the lack f immediately available treatment services. This measure is designed t ensure that treatment is initiated nce the need has been identified, and will permit cmparisn f effectiveness in initiating care. Treatment engagement is defined as an intermediate step between initially accessing care (in the first visit) and cmpleting a full curse f treatment. Numerus studies have indicated that individuals wh remain in treatment lnger have imprved utcmes. Hwever, a 1990 Drug Service Research Survey has
2 suggested that many clients (52%) with AOD disrders leave treatment prematurely. This measure is seen as an imprtant intermediate indicatr that is clsely related t utcmes. In fact, studies have tied the frequency and intensity f engagement as imprtant in treatment utcmes and reducing drug related illnesses. Imprvement ntatin Measurement duratin AOD prblems left untreated, cause a significant burden that extends beynd individuals t their cmmunities and t sciety. Empirical evidence links better utcmes t the identificatin and treatment f peple with AOD disrders. This measure may influence perfrmance by increasing screening fr AOD prblems in primary care settings and increasing cmmunicatin between primary care and specialty prviders. Mving frward, perfrmance measures are needed t establish clear standards f accuntability that, in turn, will lead t effrts t imprve the quality f care fr peple with AOD disrders. Higher scre indicates better quality 12 mnths Reference Definitin Table f Cntents Ppulatin criteria 1 Ppulatin criteria 2 Data criteria (QDS Data Elements) Summary calculatin Please refer t the spreadsheet fr this measure fr detail regarding data criteria and cde lists. Ppulatin criteria 1 Initial Patient Ppulatin = Patient characteristic: birth date (age) >=12 and <=16 years befre the measurement perid t capture all patients wh will reach ages 13 thrugh 17 years during the measurement perid ; OR: FIRST, Diagnsis: alchl r drug dependence <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; DURING: OR: Encunter: encunter ED ; OR: Encunter: encunter nn acute inpatient ;
3 OR: Encunter: encunter acute inpatient ; OR: Encunter: encunter utpatient BH ; OR: Encunter: encunter utpatient BH req POS ; Encunter: encunter pint f service mdifier ; OR: FIRST, Encunter: encunter acute inpt <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: FIRST, Encunter: encunter nn acute inpatient <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: FIRST, Prcedure perfrmed: detxificatin interventin <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; Denminatr = All patients in the initial patient ppulatin; AND NOT: Diagnsis: alchl r drug dependence BEFORE FIRST, Diagnsis active: alchl r drug dependence <= 60 days; Numeratr 1= OR: FIRST, Encunter: encunter acute inpt <= 1 year and >=45 days befre r simultaneusly t the measurement end date = FIRST Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: FIRST, Encunter: encunter nn acute inpatient <= 1 year and >=45 days befre r simultaneusly t the measurement end date = FIRST Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: Encunter: encunter nn acute inpatient <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter acute inpatient <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter utpatient BH ; <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter utpatient BH req POS <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Encunter: encunter pint f service mdifier ; Diagnsis active: alchl r drug dependence ; Numeratr 2 = COUNT >=2,
4 OR: Encunter: encunter nn acute inpatient <= (30, days ) AFTER FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter acute inpatient <= (30, days ) AFTER FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter utpatient BH <= (30, days ) AFTER FIRST OR: Encunter: encunter utpatient BH req POS <= (30, days ) AFTER FIRST Diagnsis active: alchl r drug dependence ; Encunter: encunter pint f service mdifier ; Exclusins = Nne; Ppulatin criteria 2 Initial Patient Ppulatin = Patient characteristic: birth date (age) >=17 years befre the measurement perid t capture all patients wh will reach age 18 years r greater during the measurement perid ; OR: FIRST, Diagnsis active: alchl r drug dependence <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; DURING: OR: Encunter: encunter ED ; OR: Encunter: encunter nn acute inpatient ; OR: Encunter: encunter acute inpatient ; OR: Encunter: encunter utpatient BH ; OR: Encunter: encunter utpatient BH req POS ; Encunter: encunter pint f service mdifier ; OR: FIRST, Encunter: encunter acute inpt <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: FIRST, Encunter: encunter nn acute inpatient <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: FIRST, Prcedure perfrmed: detxificatin interventin <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; Denminatr = All patients in the initial patient ppulatin;
5 AND NOT: Diagnsis active: alchl r drug dependence BEFORE FIRST, Diagnsis active: alchl r drug dependence <= 60 days; Numeratr 1= OR: FIRST, Encunter: encunter acute inpt <= 1 year and >=45 days befre r simultaneusly t the measurement end date = FIRST Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: FIRST, Encunter: encunter nn acute inpatient <= 1 year and >=45 days befre r simultaneusly t the measurement end date = FIRST Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: Encunter: encunter nn acute inpatient <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter acute inpatient <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter utpatient BH ; <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter utpatient BH req POS <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Encunter: encunter pint f service mdifier ; Diagnsis active: alchl r drug dependence ; Numeratr 2 = COUNT >=2, OR: Encunter: encunter nn acute inpatient <= (30, days ) AFTER FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter acute inpatient <= (30, days ) AFTER FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter utpatient BH <= (30, days ) AFTER FIRST OR: Encunter: encunter utpatient BH req POS <= (30, days ) AFTER FIRST Diagnsis active: alchl r drug dependence ; Encunter: encunter pint f service mdifier ; Exclusins = Nne;
6 Ppulatin criteria 3 Initial Patient Ppulatin = Patient characteristic: birth date (age) >=12 befre the measurement perid t capture all patients wh will reach age 13 years r greater during the measurement perid ; OR: FIRST, Diagnsis active: alchl r drug dependence <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; DURING: OR: Encunter: encunter ED ; OR: Encunter: encunter nn acute inpatient ; OR: Encunter: encunter acute inpatient ; OR: Encunter: encunter utpatient BH ; OR: Encunter: encunter utpatient BH req POS ; Encunter: encunter pint f service mdifier ; OR: FIRST, Encunter: encunter acute inpt <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: FIRST, Encunter: encunter nn acute inpatient <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: FIRST, Prcedure perfrmed: detxificatin interventin <= 1 year and >=45 days befre r simultaneusly t the measurement end date ; Denminatr = All patients in the initial patient ppulatin; AND NOT: Diagnsis active: alchl r drug dependence BEFORE FIRST, Diagnsis active: alchl r drug dependence <= 60 days; Numeratr 1= OR: FIRST, Encunter: encunter acute inpt <= 1 year and >=45 days befre r simultaneusly t the measurement end date = FIRST Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: FIRST, Encunter: encunter nn acute inpatient <= 1 year and >=45 days befre r simultaneusly t the measurement end date = FIRST Prcedure perfrmed: alchl, drug rehab and detx interventins ; OR: Encunter: encunter nn acute inpatient <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter acute inpatient <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Diagnsis active: alchl r drug dependence ;
7 Numeratr 2 = OR: Encunter: encunter utpatient BH ; <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter utpatient BH req POS <=(14, days ) AFTER FIRST, Diagnsis active: alchl r drug dependence = FIRST Encunter: encunter pint f service mdifier ; Diagnsis active: alchl r drug dependence ; COUNT >=2, OR: Encunter: encunter nn acute inpatient <= (30, days ) AFTER FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter acute inpatient <= (30, days ) AFTER FIRST Diagnsis active: alchl r drug dependence ; OR: Encunter: encunter utpatient BH <= (30, days ) AFTER FIRST OR: Encunter: encunter utpatient BH req POS <= (30, days ) AFTER FIRST Diagnsis active: alchl r drug dependence ; Encunter: encunter pint f service mdifier ; Exclusins = Nne; Data criteria (QDS Data Elements) Initial Patient Ppulatin = "Patient characteristic: birth date using birth date cde list befre the beginning f the measurement perid ; Diagnsis active: alchl r drug dependence using alchl r drug dependence cde list gruping ; Encunter: encunter ED using encunter ED cde list ; Encunter: encunter nn acute inpatient using encunter nn acute inpatient cde list ; Encunter: encunter acute inpatient using encunter acute inpatient cde list ; Encunter: encunter utpatient BH using encunter utpatient BH cde list ; Encunter; encunter utpatient BH req POS using encunter utpatient BH req POS cde list ; Encunter: encunter pint f service mdifier using encunter pint f service mdifier cde list ;
8 Prcedure perfrmed: alchl, drug rehab and detx interventins using alchl, drug rehab and detx interventins cde list gruping ; Prcedure perfrmed: detxificatin interventin using detxificatin interventin cde list gruping ; Denminatr = All patients in the initial ppulatin; Diagnsis active: alchl r drug dependence using alchl r drug dependence cde list gruping ; Numeratr = Diagnsis active: alchl r drug dependence using alchl r drug dependence cde list gruping ; Prcedure perfrmed: alchl, drug rehab and detx interventins using alchl, drug rehab and detx interventins cde list gruping ; Encunter: encunter nn acute inpatient using encunter nn acute inpatient cde list ; Encunter: encunter acute inpatient using encunter acute inpatient cde list ; Encunter: encunter utpatient BH using encunter utpatient BH cde list ; Encunter; encunter utpatient BH req POS using encunter utpatient BJ req POS cde list ; Encunter: encunter pint f service mdifier using encunter pint f service mdifier cde list ; Exclusins= Nne; Summary calculatin Calculatin is generic t all measures: Calculate the final denminatr by adding all that meet denminatr criteria. Subtract frm the final denminatr all that d nt meet numeratr criteria yet als meet exclusin criteria. Nte sme measures d nt have exclusin criteria. The perfrmance calculatin is the number meeting numeratr criteria divided by the final denminatr. Fr measures with multiple patient ppulatins, repeat this prcess fr each patient ppulatin and reprt each result separately. Fr measures with multiple numeratrs, calculate each numeratr separately within each ppulatin using the paired exclusin. Measure set CLINICAL QUALITY MEASURE SET
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