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## Complete Summary

#### TITLE

Substance use disorders: percentage of patients aged 18 years and older
with a diagnosis of current alcohol dependence who were counseled
regarding psychosocial AND pharmacologic treatment options for alcohol
dependence within the 12 month reporting period.

#### SOURCE(S)

American Psychiatric Association (APA), Physician Consortium for
Performance Improvement® (PCPI), National Committee for Quality
Assurance (NCQA). Substance use disorders physician performance
measurement set. Chicago (IL): American Medical Association (AMA); 2008
Jul. 22 p. \[11 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients aged 18 years
and older with a diagnosis of current alcohol dependence who were
counseled regarding psychosocial AND pharmacologic treatment options for
alcohol dependence within the 12 month reporting period.

#### RATIONALE

Research has shown that among patients diagnosed with alcohol
dependence, only 4.64% were referred for psychosocial treatment in the
form of substance abuse counseling, inpatient rehabilitation programs,
outpatient rehabilitation programs, or mutual help groups. While
pharmacologic therapy has established efficacy, often in combination
with psychosocial therapy, in promoting abstinence and preventing
relapse in alcohol-dependent patients, physician rates of prescribing
pharmacologic therapy for alcohol dependence are also considerably low.
A recent study found that these low rates prevail even among addiction
medicine physicians who prescribed naltrexone to only 13% of their
alcohol dependent patients. Pharmacotherapy and psychosocial treatment
should be routinely considered for all patients with alcohol dependence,
and patients should be informed of this option.

The following clinical recommendation statements are quoted
[verbatim]{.underline} from the referenced clinical guidelines (from the
American Psychiatric Association \[APA\]) and represent the evidence
base for the measure:

Psychosocial treatments found effective for some patients with an
alcohol use disorder include motivational enhancement therapy (MET),
cognitive-behavioral therapy (CBT), behavioral therapies, 12-step
facilitation (TSF), marital and family therapies, group therapies, and
psychodynamic therapy/interpersonal therapy (IPT). (APA, 2006)

Specific pharmacotherapies for alcohol-dependent patients have
well-established efficacy and moderate effectiveness:

-   Naltrexone may attenuate some of the reinforcing effects of alcohol,
    although data on its long-term efficacy are limited. The use of
    long-acting, injectable naltrexone may promote adherence, but
    published research is limited and FDA approval is pending. \[Note:
    Extended-release naltrexone for injection has since received FDA
    approval\]

-   Acamprosate, a gamma-aminobutyric acid (GABA) analog that may
    decrease alcohol craving in abstinent individuals, may also be an
    effective adjunctive medication in motivated patients who are
    concomitantly receiving psychosocial treatment.

-   Disulfiram is an effective adjunct to a comprehensive treatment
    program for reliable, motivated patients whose drinking may be
    triggered by events that suddenly increase alcohol craving. (APA,
    2006)

Empirically validated psychosocial treatment interventions should be
initiated for all patients with substance use illnesses. Pharmacotherapy
should be offered and available to all adult patients diagnosed with
alcohol dependence and without medical contraindications.
Pharmacotherapy, if prescribed, should be provided in addition to and
directly linked with psychosocial treatment/support. (National Quality
Forum \[NQF\], 2007)

#### PRIMARY CLINICAL COMPONENT

Alcohol dependence; psychosocial counseling; pharmacologic treatment

#### DENOMINATOR DESCRIPTION

All patients aged 18 years and older with a diagnosis of current alcohol
dependence

#### NUMERATOR DESCRIPTION

Patients who were counseled regarding psychosocial AND pharmacologic
treatment options for alcohol dependence within the 12 month reporting
period

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Practice guideline for the treatment of patients with substance use
    disorders.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9316)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Overall poor quality for the performance measured\
Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Asch SM, Kerr EA, Keesey J, Adams JL, Setodji CM, Malik S, McGlynn EA.
Who is at greatest risk for receiving poor-quality health care. N Engl J
Med2006 Mar 16;354(11):1147-56. \[32 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16540615)

Mark TL, Kranzler HR, Song X. Understanding US addiction physicians\'
low rate of naltrexone prescription. Drug Alcohol Depend2003 Sep
10;71(3):219-28.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12957340)

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Community Health Care\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians\
Psychologists/Non-physician Behavioral Health Clinicians\
Social Workers

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Age greater than or equal to 18

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

See the \"Rationale\" field.

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients aged 18 years and older with a diagnosis of current alcohol
dependence

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients aged 18 years and older with a diagnosis of current alcohol
dependence

**Exclusions**\
None

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients who were counseled regarding psychosocial AND pharmacologic
treatment options for alcohol dependence within the 12 month reporting
period

**Exclusions**\
None

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Measure #1: counseling regarding psychosocial and pharmacologic
treatment options for alcohol dependence.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2056&doc=178)

#### MEASURE SET NAME

[Substance Use Disorders Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2056&doc=12642)

#### SUBMITTER

American Medical Association on behalf of the American Psychiatric
Association, the Physician Consortium for Performance Improvement®, and
the National Committee for Quality Assurance

#### DEVELOPER

American Psychiatric Association\
National Committee for Quality Assurance\
Physician Consortium for Performance Improvement®

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Daniel Kivlahan, PhD (*Co-Chair*); Mark L. Willenbring, MD (*Co-Chair*);
James G. Adams, MD; Joann Albright, PhD; Charles E. Argoff, MD; Ray M.
Baker, MD; Richard L. Brown, MD, MPH; Audrey Burnam, PhD; Mirean
Coleman, MSW, LICSW, CT; Edward C. Covington, MD; Thomas J. Craig, MD,
MPH; Ann Doucette, PhD; Larry M. Gentilello, MD; Eric Goplerud, PhD, MA;
Constance Horgan, ScD; Herbert D. Kleber, MD; Petros Levounis, MD;
Bertha K. Madras, PhD; Frank McCorry, PhD; Ann H. Messer, MD; Michael M.
Miller, MD, FASAM, FAPA; Doug Nemecek, MD, MBA; Harold Alan Pincus, MD;
Rhonda Robinson-Beale, MD; Richard N. Rosenthal, MD; Darlene Warrick
McLaughlin, MD; Scott C. Williams, PsyD

Beatrice Eld, American Psychiatric Association; Robert Plovnick, MD, MS,
American Psychiatric Association

Joseph Gave, MPH, American Medical Association; Karen Kmetik, PhD,
American Medical Association; Shannon Sims, MD, PhD, American Medical
Association; Samantha Tierney, MPH, American Medical Association;
Richard Yoast, PhD, American Medical Association

Lisa Nern, MSW, National Committe for Quality Assurance; Philip Renner,
MBA, National Committe for Quality Assurance

Sylvia Publ, MBA, RHIA, Centers for Medicare & Medicaid Service

Rebecca Kresowik, PCPI Consultant; Timothy Kresowik, MD PCPI Consultant

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Conflicts, if any, are disclosed in accordance with the Physician
Consortium for Performance Improvement® conflict of interest policy.

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2008 May

#### REVISION DATE

2008 Jul

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Psychiatric Association (APA), Physician Consortium for
Performance Improvement® (PCPI), National Committee for Quality
Assurance (NCQA). Substance use disorders physician performance
measurement set. Chicago (IL): American Medical Association (AMA); 2008
Jul. 22 p. \[11 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Measure #1: Counseling Regarding Psychosocial
and Pharmacologic Treatment Options for Alcohol Dependence,\" is
published in the \"Substance Use Disorders Physician Performance
Measurement Set.\" This document and technical specifications are
available in Portable Document Format (PDF) from the American Medical
Association (AMA)-convened Physician Consortium for Performance
Improvement® Web site:
[www.physicianconsortium.org](http://www.physicianconsortium.org/).

For further information, please contact AMA staff by e-mail at
<cqi@ama-assn.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on June 25, 2008. The
information was verified by the measure developer on August 13, 2008.

#### COPYRIGHT STATEMENT

© 2008 American Medical Association and National Committee for Quality
Assurance. All Rights Reserved.

CPT® Copyright 2007 American Medical Association

### Disclaimer

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008