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## Complete Summary

#### TITLE

Assessment and management of chronic pain: percentage of patients
diagnosed with chronic pain who are prescribed an opioid who have an
opioid agreement form and urine toxicology screen documented in the
medical record.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Assessment and
management of chronic pain. Bloomington (MN): Institute for Clinical
Systems Improvement (ICSI); 2008 Jul. 84 p. \[171 references\]

### 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 diagnosed with
chronic pain who are prescribed an opioid who have an opioid agreement
form and urine toxicology screen documented in the medical record.

#### RATIONALE

The priority aim addressed by this measure is to improve the effective
use of opioid medications in the treatment of adult patients with
chronic pain.

#### PRIMARY CLINICAL COMPONENT

Chronic pain; cervical and lumbar pain; headache; other disorders of
soft tissues; myalgia/myositis and unspecified fibromyositis; opioids;
opioid agreement form; urine toxicology screen

#### DENOMINATOR DESCRIPTION

All patients 16 years and older who meet the criteria for chronic pain
or related diagnosis who are prescribed an opioid (see the related
\"Denominator Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Number of medical records that are reviewed that have evidence of an
opioid agreement form and a urine toxicology screen

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

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

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### 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

Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

#### TARGET POPULATION AGE

Age greater than or equal to 16 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients age 16 years and older with chronic pain

Each month, a sample of patients with chronic pain seen in the past
month is identified by specific International Classification of
Diseases, Ninth Revision (ICD-9) codes (see the \"Denominator
Inclusions/Exclusions\" field) or other ICD-9 codes identified by the
organization\*.

A chart abstraction is conducted to determine whether or not there is
any evidence of an \"Opioid Agreement\" and a urine toxicology screen in
the medical record.

Suggested data collection time frame is monthly.

\*Refer to the original measure documentation for suggestions on
identifying other ICD-9 codes.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients 16 years and older who meet the criteria for chronic pain\*
or related diagnosis as identified by the following International
Classification of Diseases, Ninth Revision (ICD-9) codes who are
prescribed an opioid

A few examples are:

-   Chronic Pain: 338.xx\*\*

-   Cervical and Lumbar Pain: 720.x, 721.x, 722.x, 723.x, 724.x, 847.x

-   Headache: 307.8x, 784.0

-   Other disorders of soft tissues: 729.x

-   Myalgia and myositis, unspecified fibromyositis: NOS: 729.1

\*Chronic pain is defined as:

-   Persistent pain

-   Either continuous or recurrent

-   Of sufficient duration and intensity to adversely affect a
    patient\'s well-being, level of function, and quality of life

At six weeks (or longer than the anticipated healing time), patients
should be thoroughly evaluated for the presence of chronic pain.

Chronic pain syndrome is defined by the work group as a constellation of
behaviors related to persistent pain that represents significant life
role disruption that occurs at the end of the spectrum of chronic pain.

\*\*Refer to the International Classification of Diseases 2008 ICD-9-CM,
page 13, regarding specifications for the 338 ICD-9 codes.

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

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

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter\
Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of medical records that are reviewed that have evidence of an
opioid agreement form and a urine toxicology screen

**Exclusions**\
Unspecified

#### 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

Episode of care

#### 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

Percentage of patients diagnosed with chronic pain who are prescribed an
opioid who have an opioid agreement form and urine toxicology screen
documented in the medical record.

#### MEASURE COLLECTION

[Assessment and Management of Chronic Pain
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=26&doc=10686)

#### DEVELOPER

Institute for Clinical Systems Improvement

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2007 Mar

#### REVISION DATE

2008 Jul

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems
Improvement (ICSI). Assessment and management of chronic pain.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI);
2007 Mar. 87 p.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Assessment and
management of chronic pain. Bloomington (MN): Institute for Clinical
Systems Improvement (ICSI); 2008 Jul. 84 p. \[171 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Percentage of Patients Diagnosed with Chronic
Pain Who Are Prescribed an Opioid Who Have an Opioid Agreement Form and
Urine Toxicology Screen Documented in the Medical Record,\" is published
in \"Health Care Guideline: Assessment and Management of Chronic Pain.\"
This document is available from the [Institute for Clinical Systems
Improvement (ICSI) Web
site](http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/).

For more information, contact ICSI at, 8009 34th Avenue South, Suite
1200, Bloomington, MN 55425; phone: 952-814-7060; fax: 952-858-9675; Web
site: [www.icsi.org](http://www.icsi.org/); e-mail:
<icsi.info@icsi.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI on May 29, 2007. This NQMC
summary was updated by ECRI Institute on October 24, 2008.

#### COPYRIGHT STATEMENT

This NQMC summary (abstracted Institute for Clinical Systems Improvement
\[ICSI\] Measure) is based on the original measure, which is subject to
the measure developer\'s copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be
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If the abstracted ICSI Measures are downloaded by an organization,
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All other copyright rights in the abstracted ICSI Measures are reserved
by the Institute for Clinical Systems Improvement, Inc. The Institute
for Clinical Systems Improvement, Inc. assumes no liability for any
adaptations or revisions or modifications made to the abstracts of the
ICSI Measures.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/17/2008