eMeasure Title Substance Use Screening and Intervention Composite – Drug Use Component
eMeasure Identifier
(Measure Authoring Tool)
eMeasure Version number 0
NQF Number Not Applicable GUID dff464f5-a150-4e9d-bff5-da2f1c750c54
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 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 screening for nonmedical prescription drug use and illicit drug use and brief counseling for those who were identified as a nonmedical prescription drug user or illicit drug user. Although the 2008 USPSTF recommendation statement on screening for illicit drug use found insufficient evidence to assess the balance of benefits and harms of screening asymptomatic individuals, the USPSTF noted that “there is good evidence that various treatments are effective in reducing illicit drug use in the short term. Evidence is insufficient, however, either to demonstrate that treatment reliably improves social and legal outcomes for patients, or to link treatment directly to longer term improvements in morbidity or mortality. Since all but one published clinical trial of treatment interventions involved individuals who had already developed problems due to their drug use, it is not known whether the findings are generalizable to asymptomatic individuals whose illicit drug use is detected through screening. There is fair evidence that, regardless of the patient's history of treatment, reducing or stopping drug use is associated with improvement in some health outcomes.”  Individual studies have documented the effectiveness of screening and brief interventions for drug use including a growing body of literature since the 2008 publication of the USPSTF statement, with an additional 20 ongoing trials awaiting results that will likely add further evidence to support this measure component.
Clinical Recommendation Statement
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening adolescents, adults, and pregnant women for illicit drug use.  (Grade: I Statement)
Improvement Notation
Higher score indicates better quality
Reference
U.S. Preventive Services Task Force. Screening for Illicit Drug Use: U.S. Preventive Services Task Force Recommendation Statement. January 2008. http://www.uspreventiveservicestaskforce.org/uspstf08/druguse/drugrs.htm
Definition
Systematic screening method - For purposes of this measure, one of the following systematic methods to assess nonmedical prescription drug use and illicit drug use must be utilized. Systematic screening methods and thresholds for defining a nonmedical prescription drug user or illicit drug user include:
DAST (score >= 6)
DAST-10 (score >= 3)
Single question screening [i.e., How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?] (response >=1)
  
Brief counseling for nonmedical prescription drug use and illicit drug use  - Brief counseling refers to one or more counseling sessions, a minimum of 5-15 minutes, which may include: raising awareness of the risks of substance use, assessing motivation for change, and helping persons commit to utilizing self-management skills for changing their substance abuse behaviors.
Guidance
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:

Drug use component (nonmedical prescription drug use and illicit drug use)
Patients who were screened for nonmedical prescription drug use and illicit drug use at least once within the last 24 months using a systematic screening method AND who received brief counseling if identified as a nonmedical prescription drug user or illicit drug user
Numerator Exclusions
Not Applicable
Denominator Exceptions
Documentation of medical reason(s) for not screening for nonmedical prescription drug use and illicit drug 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