Clinical Quality Measures: Process
Does not apply to this measure
This measure is used to assess the percentage of patients with bipolar disorder who receive an initial assessment that considers alcohol and chemical substance use. See the related National Quality Measures Clearinghouse (NQMC) summary of the STABLE Project National Coordinating Council measure Depression: the percentage of patients diagnosed with unipolar depression who receive an initial assessment that considers alcohol and chemical substance use.
Bipolar Disorder, Major Depression & Substance Use
- Between 40-70% of people with bipolar disorder have a history of substance use disorder.
- A current or past comorbid substance use disorder may lead to worse outcomes for bipolar disorders, including more symptoms, more suicide attempts, longer episodes and lower quality of life.
- Substance abuse may obscure or exacerbate mood swings that have no other apparent external cause.
- Substance abuse may also precipitate mood episodes or be used by patients to self-treat in an attempt to improve the symptoms of episodes.
- Alcohol or chemical substance abuse or dependence is a frequent comorbidity of major depressive disorder and a detailed history of the patient's substance use should be obtained.
- Patients suffering from major depressive disorder with comorbid addiction are more likely to require hospitalization, more likely to attempt suicide and less likely to comply with treatment than are patients with these disorders of similar severity not complicated by these factors.
|American Psychiatric Association practice guideline for the treatment of patients with major depressive disorder. Am J Psychiatry. 2000 Apr;157(4 Suppl):1-45. [325 references]|
|Ostacher MJ, Sachs GS. Update on bipolar disorder and substance abuse: recent findings and treatment strategies. J Clin Psychiatry. 2006 Sep;67(9):e10. PubMed|
|Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry. 2002 Apr;159(4 Suppl):1-50. [472 references] PubMed|
|Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990 Nov 21;264(19):2511-8. PubMed|
Bipolar disorder; alcohol/chemical substance use assessment
Patients diagnosed with bipolar disorder (see the related "Denominator Inclusions/Exclusions" field)
Patients who receive an initial assessment for bipolar disorder that includes consideration of alcohol/chemical substance use (see the related "Numerator Inclusions/Exclusions" field)
- A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
- A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
- One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
- The STABLE measures were developed using the RAND Appropriateness Method and have been shown to have content validity and face validity.
- Data feasibility testing was performed to determine the availability of the data elements required in the measure numerator and denominator specifications.
- Inter-abstractor reliability testing was performed to assess the data collection strategy. The data collection strategy included data collection forms; data dictionary references and abstractor instructions.
- A field study was conducted to determine measure conformance in an appropriate convenience sample.
Refer to the references listed below for further information.
|STABLE performance measures: data feasibility testing & results. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 2 p.|
|STABLE performance measures: development process & validity ratings. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 3 p.|
|STABLE performance measures: field study process & conformance findings. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 3 p.|
|STABLE performance measures: inter-abstractor reliability testing & results. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. 2 p.|
Current routine use
Internal quality improvement
Behavioral Health Care
Advanced Practice Nurses
Psychologists/Non-physician Behavioral Health Clinicians
Individual Clinicians or Public Health Professionals
Age greater than or equal to 18 years
Either male or female
Prevention and Treatment of Leading Causes of Mortality
Patients associated with provider
Patient/Individual (Consumer) Characteristic
Does not apply to this measure
Patients 18 years of age or older with an initial diagnosis or new presentation/episode of bipolar disorder
- Documentation of a diagnosis involving bipolar disorder; to include at least one of the following: Codes 296.0x ; 296.1x; 296.4x; 296.5x; 296.6x; 296.7; 296.80; 296.81; 296.82; 296.89; 301.13 documented in body of chart, such as a pre-printed form completed by a clinician and/or codes documented in chart notes/forms
- Diagnosis or impression documented in chart indicating bipolar disorder
- Use of a screening/assessment tool for bipolar disorder with a score or conclusion that patient has bipolar disorder and indication that this information is used to establish or substantiate the diagnosis
Documented assessment for use of alcohol and chemical substance use; to include at least one of the following:
- Clinician documentation regarding presence or absence of alcohol and chemical substance use
- Patient completed history/assessment form that addresses alcohol and chemical substance use that is documented as being noted/acknowledged by clinician performing the assessment
- Use of screening tools that address alcohol and chemical substance use
Documentation of the assessment for alcohol and chemical substance use must be present prior to, or concurrent with, the visit where the diagnosis and/or treatment plan is first documented.
Administrative clinical data
Paper medical record
Does not apply to this measure
- Alcohol Use Disorder Identification Test - Consumption (AUDIT-C): Brief self-report tool for alcohol use (available at www.cqaimh.org/stable.html )
- CAGE-AID Drug and Alcohol Screen (Cut-down, Annoyed, Guilty, Eye-opener - Adapted to Include Drugs): Brief self-report tool (available at www.cqaimh.org/stable.html )
Does not apply to this measure
Desired value is a higher score
Internal time comparison
Bipolar disorder or depression: assessment for substance use.
Standards for Bipolar Excellence (STABLE) Performance Measures
Center for Quality Assessment and Improvement in Mental Health - Clinical Specialty Collaboration
STABLE Project National Coordinating Council - Clinical Specialty Collaboration
AstraZeneca LLP, Wilmington, Delaware, provided financial sponsorship for the STABLE Project. They did not otherwise participate in the development of either the measures or toolkit.
The STABLE National Coordinating Council (NCC) was comprised of national experts in bipolar disorder, psychiatry, primary care, and performance improvement. The NCC guided and directed the STABLE Project. NCC members agreed to serve with the understanding that the STABLE Performance Measures and Resource Toolkit would be fully transparent and available without cost in the public domain.
EPI-Q, Inc. , is a consulting company providing practice-based outcomes research, pharmacoeconomic studies, and quality improvement services. EPI-Q managed the STABLE Project.
Physician Quality Reporting System
This measure was not adapted from another source.
This is the current release of the measure.
The measure developer reaffirmed the currency of this measure in September 2015.
|STABLE (STAndards for BipoLar Excellence) performance measures. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007. various p.|
Source available from the Center for Quality Assessment and Improvement in Mental Health (CQAIMH) Web site .
The following is available:
- STABLE National Coordinating Council Resource Toolkit Workgroup. STABLE resource toolkit. Boston (MA): Center for Quality Assessment and Improvement in Mental Health; 2007 Mar. 67 p. This document is available in Portable Document Format (PDF) from the Center for Quality Assessment and Improvement in Mental Health (CQAIMH) Web site .
This NQMC summary was completed by ECRI Institute on January 10, 2008. The information was verified by the measure developer on April 14, 2008.
This NQMC summary was retrofitted into the new template on June 27, 2011.
The information was reaffirmed by the measure developer on September 30, 2015.
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