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2021 MIPS Measure #305: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Quality ID 305
eMeasure ID CMS137v9
High Priority Measure Yes
Specifications EHR
Measure Type Process
Specialty Family Medicine Internal Medicine Pediatrics

Measure description

Percentage of patients 13 years of age and older with a new episode of alcohol or other drug abuse or (AOD) dependence who received the following. Two rates are reported.

a. Percentage of patients who initiated treatment including either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis
b. Percentage of patients who engaged in ongoing treatment including two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention.

 

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 (Schneider Institute for Health Policy, 2001). In 2011, an estimated 22.5 million persons (8.7 percent of the population aged 12 or older) were classified with substance dependence or abuse. Of these, 68 percent were dependent on or abused alcohol, but not illicit drugs, 13 percent abused or were dependent on both alcohol and illicit drugs, while 19 percent were dependent on or abused illicit drugs, but not alcohol (Substance Abuse and Mental Health Services Administration  [SAMHSA], 2012). Of the 19.3 million persons aged 12 or older in 2011 who were classified as needing substance use treatment but did not receive treatment at a specialty facility in the past year, 912,000 persons (4.7 percent) reported that they felt they needed treatment for their illicit drug or alcohol use problem. Of these 912,000 persons who felt they needed treatment, only 281,000 (30.8 percent) reported that they made an effort to get treatment, while 631,000 (69.2 percent) reported making no effort to get treatment (SAMHSA, 2012).


Clinical Recommendation Statements

American Psychiatric Association (2006)
* Because many substance use disorders are chronic, patients usually require long-term treatment, although the intensity and specific components of treatment may vary over time [I rating]. 
* It is important to intensify the monitoring for substance use during periods when the patient is at a high risk of relapsing, including during the early stages of treatment, times of transition to less intensive levels of care, and the first year after active treatment has ceased [I rating].
* Outpatient treatment of substance use disorders is appropriate for patients whose clinical condition or environmental circumstances do not require a more intensive level of care [I rating]. As in other treatment settings, a comprehensive approach is optimal, using, where indicated, a variety of psychotherapeutic and pharmacological interventions along with behavioral monitoring [I rating ].
* Naltrexone, injectable naltrexone, acamprosate, a ?-aminobutyric acid (GABA) are recommended for patients with alcohol dependence [I rating]. Disulfiram is also recommended for patients with alcohol dependence [II rating]. 
* Methadone and buprenorphine are recommended for patients with opioid dependence [I rating]. Naltrexone is an alternative strategy [I rating].

Michigan Quality Improvement Consortium (2017)
*Patients with substance use disorder or risky substance use: Patient Education and Brief Intervention by PCP or Trained Staff (e.g. RN, MSW)
*If diagnosed with substance use disorder or risky substance use, initiate an intervention within 14 days.
*Frequent follow-up is helpful to support behavior change; preferably 2 visits within 30 days.
*Refer to a substance abuse health specialist, an addiction physician specialist, or a physician experienced in pharmacologic management of addiction.

U.S. Preventive Services Task Force recommendation statement (2012): 
*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.

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