Percentage of patients aged 18 years and older who were screened at least once within the last 24 months for tobacco use, unhealthy alcohol use, nonmedical prescription drug use, and illicit drug use AND who received an intervention for all positive screening results

TBD

These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. 
 
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The composite measure is intended to promote screening and intervention for substance use.  Because many patients will not self-identify or have not yet developed detectable problems associated with substance use, screening can identify patients for whom intervention may be indicated. Brief motivational counseling (and pharmacotherapy for tobacco use) for these various substances has been shown to be an effective treatment for reducing problem use, particularly in primary care settings. This component of the composite measure is intended to promote unhealthy alcohol use screening and brief counseling which have been shown to be effective in reducing alcohol consumption.

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. (Grade B recommendation)

Higher score indicates better quality

Moyer VA on behalf of the U.S. Preventive Services Task Force.  Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: U.S. Preventive Services Task Force Recommendation Statement. Ann Internal Med.  2013 May 14.

Systematic screening method - For purposes of this measure, one 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 one 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.

Exceptions only apply to the screening data element of the measure; once a patient has been screened, there are no allowable exceptions for not providing the intervention.

The language ‘all positive screening results’ as used in the measure description, refers to the most recent screening result for each of the three components of the composite measure: tobacco use, unhealthy alcohol use, drug use (nonmedical prescription drug use and illicit drug use). It is expected that for each of the three components of the composite measure, if the most recent screening result is positive, the patient will receive the intervention as described in the definition field of the corresponding measure component.

Composite Measure Calculation:
A simple scoring methodology, known as opportunity-based scoring, should be used to calculate the performance rate for this composite measure. Using this methodology, the user should  identify the number of eligible patients who received the recommended care for each component measure (tobacco, unhealthy alcohol use, drug use) divided by the number of eligible patients for each component of the measure, as defined in the denominator (or “opportunities”). The opportunity-based scoring method is identical to that used by the Centers for Medicare and Medicaid Services (CMS) in its pay-for-performance programs.

TBD

All patients aged 18 years and older who were seen twice for any visits or who had at least one preventive care visit during the 12 month measurement period

Equals Initial Patient Population

None

Patients who received the following substance use screenings at least once within the last 24 months AND who received an intervention for all positive screening results:

Unhealthy alcohol use component
Patients who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user

Not Applicable

Documentation of medical reason(s) for not screening for unhealthy alcohol use (eg, limited life expectancy, other medical reasons)

Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.