Measure Title: Alcohol Use Disorder Outcome Response
Description: The percentage of adult patients (18 years of age or older) who report problems with drinking alcohol (e.g., can be noted through a screening measure such as the AUDIT-C as described in MIPS Clinical Quality Measure Quality ID #431 aka NQF 2152 or other drug/alcohol screeners such as the DAST and TAPS) AND demonstrated a response to treatment at three months (+/- 60 days) after the index visit.
This measure relies on three assessment tools: the PROMIS negative consequences assessment, the BARC-10: assessment, or the RAS-DS. They can be found here, here, or here, respectively.
Denominator:
Denominator (Submission Criteria):
Adult patients (18 years of age or older) with one of the Alcohol-Related diagnoses (see Diagnostic list) and a validated symptom measure for the treatment index visit
Denominator Criteria (Eligible cases):
Patients aged 18 of age or older
AND
Patient encounter during the denominator identification period (CPT or HCPCS):
0362T, 0373T, 90785, 90791, 90792, 90832,90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90863, 90875, 90876, 96110, 96112, 96113, 96116, 96121, 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146, 96156, 96158, 96159, 96164, 96165, 96167, 96170, 96171, 96178, 97129, 97130, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 98966, 98967, 98968, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215,99354, 99355, 99406, 99407, 99408, 99409, 99446, 99447, 99448, 99449, 99484, 99492, 99493, 99494, G2011, G2061, G2062, G2063, G0396, G0397, G0402, G0438, G0439
AND
Diagnosis for Alcohol Use Disorder related issues: F10.X, G62.1, G31.2, G72.1, I42.6, K29.2, K70-K70.4, K70.9, K86.0
AND
A baseline of any of the three types of scores
Denominator Identification Period: The period in which eligible patients can have an index event. The denominator identification period occurs prior to the measurement period and is defined as 3 months (+/- 60 days) prior to the start of the measurement period to 3 months prior to the end of the measurement period.
Index Event Date: The date on which the validated alcohol use disorder related measure first score documented during the twelve-month denominator identification period to the measurement period
Measure Assessment Period: For patients with an index event, there needs to be enough time following the index for the patients to have the opportunity to reach response to treatment status +/- 60 days after the index event date.
Numerator:
The number of patients in the denominator who demonstrated a response to treatment, with an improvement score using at least one of the validated alcohol self-report measures (PROMIS negative consequences, BARC, or RAS) by three months (+/- 60 days) after an index visit.
Response to treatment for the following measures are defined as:
1) PROMIS Negative Consequences of Alcohol Use short form includes a minimum index visit score of 52 or higher AND a drop of 2 or more points at follow-up
The Patient-Reported Outcomes Measurement Information System (PROMIS) Negative Consequences of Alcohol Use short form is comprised of 7 items. The measure and scoring instructions are available online, at no cost.
After confirming that all responses were provided, sum the values of the response to each question. Locate the score conversion table in the Appendix and use this table to translate the total raw score into a T-score for each respondent. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10. Therefore, a person with a T-score of 40 is one SD below the mean. Alternatively, one can use the free online HealthMeasures Scoring Service which automatically scores raw responses into T-scores. Click to learn more.
For most PROMIS instruments, a score of 50 is the average for the United States general population with a standard deviation of 10 because calibration testing was performed on a large sample of the general population. However, Alcohol Use – Negative Consequences items were calibrated in a large sample of people from the general population and people participating in community-based substance use disorder treatment programs. All participants were screened and included only if they drank alcohol in the past 30 days. Therefore, a score of 50 likely represents individuals with more substance use issues than the general population. The T-score is provided with an error term (Standard Error or SE). The Standard Error is a statistical measure of variance and represents the “margin of error” for the T-score.
2) BARC includes an index score of 48 or higher AND a drop to 47 or less at follow-up
The Brief Assessment of Recovery Capital (BARC) has a cut-off score associated with recovery. Total scores above 47 are associated with sustained recovery at 12 months posttreatment.
3) RAS includes an index average score of 4.0 or less AND a drop of .5 or more at follow-up.
The Recovery Assessment Scale (RAS, 24 items) does not have published change scores or cutoffs for severity that help guide clear change score criteria for improvement. Rather, all items are scored on a 5-point scale across all 24 items, which can be averaged. Across 28 studies, RAS scale score averages ranged from 3.14 to 4.12, with an interquartile range of 3.72-3.90. The average for all reported mean scores was 3.78 +/- .19. Any reduction on the RAS should be considered responsive.
Denominator Exclusions:
· Patients who die OR
· Are enrolled in hospice in the measurement year OR
· Are unable to complete a measure at follow-up due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, AND a suitable recorder (e.g., advocate) is not available
Denominator Exceptions:
-
Patient refused to complete a measure at follow-up OR
-
Ongoing care not indicated (e.g., referred to another provider or facility, consultation only) OR
-
Patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) OR
-
Medical reasons (e.g., admitted to hospital, severe illness)
National Quality Forum (NQF) number, if applicable
N/A
Care setting(s)
Ambulatory Care: Clinician Office/Clinic; Ambulatory Care: Hospital; Home Care; Hospital; Hospital Inpatient; Hospital Outpatient; Long Term Care; Nursing Home; Outpatient Services; Rehabilitation Facility; Rehabilitation Facility: Inpatient
Telehealth, if applicable
Yes
Number of performance rates required for measures
1
Traditional vs. inverse measure
Traditional
Proportional, continuous variable, and/or ratio measure indicator
Proportional
Risk adjustment, if applicable
No
Submission pathway
Traditional MIPS