Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement (NQF 0004)

eMeasure Name Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement eMeasure Id A84433B9-C17E-4644-85FB-C2DDFF5B71B7
Version number 1 eMeasure Set Id 5C0EFBF2-AD1E-4BB1-B8E3-A765DD595769
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Endorsed by National Quality Forum
Description The percentage of adolescent and adult patients with a new episode of alcohol and other drug (AOD) dependence who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis and who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initial visit.
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
Population 1 - all patients who will reach the age of 13-17
Population 2 - all patients who will reach the age of >=18
Population 3 - all patients who will reach the age of >=13
Risk Adjustment
None
Data Aggregation
Rationale
There are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition.  Treatment of medical problems caused by substance use and abuse places a huge burden on the health care system. According to a report from the 2001 National Household Survey on Drug Abuse (NHSDA), an estimated 16.6 million Americans aged 12 or older in 2001 were classified with dependence on or abuse of either alcohol or illicit drugs (7.3 percent of the total population). Of these, 2.4 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.2 million were dependent on or abused illicit drugs but not alcohol, and 11.0 million were dependent on or abused alcohol but not illicit drugs.(SAMHSA, 2002).
Clinical Recommendation Statement
The identification of individuals with AOD (Alcohol and Other Drug) disorders is an important first step in the process of care. However, the identification of AOD disorders often does not routinely lead to the initiation of 
care. Reasons that an individual may not initiate treatment include the social stigma associated with AOD 
disorder, denial that there is an AOD problem, non-compliance to AOD treatment offered, or the lack of immediately available treatment services. This measure is designed to ensure that treatment is initiated once the need has been identified, and will permit comparison of effectiveness in initiating care. 

Treatment engagement is defined as an intermediate step between initially accessing care (in the first visit) and completing a full course of treatment. Numerous studies have indicated that individuals who remain in treatment longer have improved outcomes. However, a 1990 Drug Service Research Survey has suggested that many 
clients (52%) with AOD disorders leave treatment prematurely. This measure is seen as an important 
intermediate indicator that is closely related to outcomes. In fact, studies have tied the frequency and intensity of engagement as important in treatment outcomes and reducing drug-related illnesses. 

AOD problems left untreated, cause a significant burden that extends beyond individuals to their communities and to society.  Empirical evidence links better outcomes to the identification and treatment of people with AOD disorders.  This measure may influence performance by increasing screening for AOD problems in primary care settings and increasing communication between primary care and specialty providers. Moving forward, performance measures are needed to establish clear standards of accountability that, in turn, will lead to efforts to improve the quality of care for people with AOD disorders.
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Definition
Initial Patient Population(s): All patients 13 years and older during the measurement period.
Definition
Denominator(s): 
Patients in the initial population with a diagnosis of alcohol or drug dependence (AOD) during an encounter (emergency department <ED>, outpatient behavioral health, acute inpatient or non-acute inpatient), and the first detoxification intervention. This measure is stratified into three age groups: 
Population 1: All patients 13-17 years of age. 
Population 2: All patients 18 years of age and older.
Population 3: All patients 13 years of age and older.
Definition
Denominator Exclusion(s): 
Patients with a previous active diagnosis of alcohol or drug dependence within 60 days of the first presentation to an encounter referenced in the population criteria.
Definition
Numerator(s): 
Numerator 1 (in each of the three populations): The number of patients who had initiation of AOD treatment within 14 days of diagnosis. 
Numerator 2 (in each of the three populations): The number of patients who had an AOD treatment and two or more encounters or partial hospitalizations within 30 days after the first encounter referenced in the population criteria.
Definition
Denominator Exception(s): N/A
Guidance
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

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Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012