Skip to main content

The AHRQ National Quality Measures Clearinghouse (NQMC, qualitymeasures.ahrq.gov) Web site will not be available after July 16, 2018 because federal funding
through AHRQ will no longer be available to support the NQMC as of that date. For additional information, read our full announcement.
  • Measure Summary
  • NQMC:004007
  • Jul 2008

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.

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]

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in December 2015.

Measure Hierarchy

Substance Use Disorders Physician Performance Measurement Set

Age Group

UMLS Concepts (what is this?)

ICD9CM
Behavior therapy (94.33), Family therapy (94.42)
SNOMEDCT_US
Acamprosate (391698009), Acamprosate (420804003), Alcoholics anonymous (161109002), Alcoholism (284591009), Alcoholism (66590003), Alcoholism (7200002), Behavioral therapy (166001), Cognitive therapy (183383008), Cognitive therapy (228553007), Cognitive therapy (228557008), Cognitive therapy (304891004), Counseling (129441002), Counseling (409063005), Disulfiram (387212009), Disulfiram (39516004), Drug therapy (416608005), Family psychotherapy procedure (108313002), Family psychotherapy procedure (51484002), Marital counseling (68168001), Motivation (106121005), Motivation (363882003), Naltrexone (373546002), Naltrexone (87617007), Psychodynamic psychotherapy (314034001), Psychodynamic-interpersonal psychotherapy (304822001), Psychosocial analysis assessment (371585000), Psychosocial analysis assessment (408920002), Substance use treatment: alcohol withdrawal (386449006)

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

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 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)

Evidence for Rationale

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]

American Psychiatric Association (APA). Practice guideline for the treatment of patients with substance use disorders. 2nd ed. Washington (DC): American Psychiatric Association (APA); 2006 Aug. 275 p. [1789 references]

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 Med. 2006;354(11):1147-56. [32 references] PubMed External Web Site Policy

Mark TL, Kranzler HR, Song X. Understanding US addiction physicians' low rate of naltrexone prescription. Drug Alcohol Depend. 2003 Sep 10;71(3):219-28. PubMed External Web Site Policy

National Quality Forum. National voluntary consensus standards for the treatment of substance use conditions: evidence-based treatment practices; a consensus report. Washington (DC): National Quality Forum; 2007.

Primary Health Components

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

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Professional certification

Measurement Setting

Ambulatory/Office-based Care

Community Health Care

Professionals Involved in Delivery of Health Services

Physicians

Psychologists/Non-physician Behavioral Health Clinicians

Social Workers

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age greater than or equal to 18

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Patient-centeredness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

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

Exclusions
None

Exclusions/Exceptions

Unspecified

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

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

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

Measure Collection Name

Substance Use Disorders Physician Performance Measurement Set

Submitter

American Psychiatric Association - Medical Specialty Society

Developer

American Psychiatric Association - Medical Specialty Society

National Committee for Quality Assurance - Health Care Accreditation Organization

Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration

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

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2008 Jul

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in December 2015.

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

Source not available electronically.

For more information, contact the American Psychiatric Association (APA) at 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209; Phone: 888-357-7924; E-mail: apa@psych.org; Web site: www.psychiatry.org External Web Site Policy.

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.

This NQMC summary was retrofitted into the new template on June 13, 2011.

The information was reaffirmed by the measure developer on December 16, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

NQMC Disclaimer

The National Quality Measures Clearinghouse™ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.

All measures summarized by NQMC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public and private organizations, other government agencies, health care organizations or plans, individuals, and similar entities.

Measures represented on the NQMC Web site are submitted by measure developers, and are screened solely to determine that they meet the NQMC Inclusion Criteria.

NQMC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or its reliability and/or validity of the quality measures and related materials represented on this site. Moreover, the views and opinions of developers or authors of measures represented on this site do not necessarily state or reflect those of NQMC, AHRQ, or its contractor, ECRI Institute, and inclusion or hosting of measures in NQMC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding measure content are directed to contact the measure developer.

About NQMC Measure Summaries

NQMC provides structured summaries containing information about measures and their development.

Measure Summary FAQs


Measure Summaries

New This Week

View more and sign up for our Newsletter

Get Adobe Reader