eMeasure Title Substance Use Screening and Intervention Composite – Tobacco Use Component
eMeasure Identifier
(Measure Authoring Tool)
eMeasure Version number 0
NQF Number Not Applicable GUID 1c433e82-7a77-4079-bad0-9cc2393c0a07
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Society of Addiction Medicine (ASAM)
Measure Developer American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Endorsed By None
Description
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
Copyright
TBD
Disclaimer
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. 
 
THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. 
 
Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. 
 	
CPT (R) contained in the Measure specifications is copyright 2004-2013 American Medical Association.  
 
LOINC (R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2013 International Health Terminology Standards Development Organization. All Rights Reserved. 
 
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
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 have 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 adult tobacco screening and tobacco cessation interventions for those who use tobacco products. There is good evidence that tobacco screening and brief cessation intervention (including counseling and/or pharmacotherapy) are successful in helping tobacco users quit. Tobacco users who are able to stop smoking lower their risk for heart disease, lung disease, and stroke.
Clinical Recommendation Statement
PHS Guideline (1):
All patients should be asked if they use tobacco and should have their tobacco use status documented on a regular basis. Evidence has shown that clinic screening systems, such as expanding the vital signs to include tobacco use status or the use of other reminder systems such as chart stickers or computer prompts, significantly increase rates of clinician intervention. (Strength of Evidence = A)

All physicians should strongly advise every patient who smokes to quit because evidence shows that physician advice to quit smoking increases abstinence rates. (Strength of Evidence = A)

Minimal interventions lasting less than 3 minutes increase overall tobacco abstinence rates. Every tobacco user should be offered at least a minimal intervention, whether or not he or she is referred to an intensive intervention. (Strength of Evidence = A)

The combination of counseling and medication is more effective for smoking cessation than either medication or counseling alone. Therefore, whenever feasible and appropriate, both counseling and medication should be provided to patients trying to quit smoking. (Strength of Evidence = A)

Clinicians should encourage all patients attempting to quit to use effective medications for tobacco dependence treatment, except where contraindicated or for specific populations for which there is insufficient evidence of effectiveness (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents). (Strength of Evidence = A)

USPSTF Recommendation (2):
The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products. This is a grade A recommendation.
Improvement Notation
Higher score indicates better quality
Reference
1. Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Reference
2. U.S. Preventive Services Task Force. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2009 Apr 21;150(8):551-5.
Definition
Tobacco use – includes use of any type of tobacco

Cessation intervention – Cessation intervention includes brief counseling for tobacco use (3 minutes or less), and/or pharmacotherapy
Guidance
If a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation: either counseling and/or pharmacotherapy.

If tobacco use status of a patient is unknown, the patient does not meet the screening component required to be counted in the numerator and should be considered a measure failure.  Instances where tobacco use status of "unknown" is recorded include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer.  If the patient does not meet the screening component of the numerator but has an allowable medical exception, then the patient should be removed from the denominator of the measure and reported as a valid exception.

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.
Transmission Format
TBD
Initial Patient Population
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
Denominator
Equals Initial Patient Population
Denominator Exclusions
None
Numerator
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:

Tobacco use component
Patients who were screened for tobacco use at least once within the last 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Numerator Exclusions
Not Applicable
Denominator Exceptions
Documentation of medical reason(s) for not screening for tobacco use (eg, limited life expectancy, other medical reasons)
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set