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  • Measure Summary
  • NQMC:010147
  • Oct 2015
  • NQF-Endorsed Measure

Substance use: percent of patients who screened positive for unhealthy alcohol use who received the brief intervention during the hospital stay.

Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital inpatient quality measures, version 4.3b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2014 Apr. various p.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percent of hospitalized patients 18 years of age and older who screened positive for unhealthy alcohol use who received the brief intervention during the hospital stay.

Rationale

Excessive use of alcohol and drugs has a substantial harmful impact on health and society in the United States. It is a drain on the economy, and a source of enormous personal tragedy (National Quality Forum, 2007). In 1998 the economic costs to society were 185 billion dollars for alcohol misuse and 143 billion dollars for drug misuse (Harwood, 2000). Health care spending was 19 billion dollars for alcohol problems and 14 billion dollars was spent treating drug problems.

Nearly a quarter of a trillion dollars per year in lost productivity is attributable to substance use. More than 537,000 die each year as a consequence of alcohol, drug, and tobacco use, making use of these substances the cause of one out of four deaths in the United States (Mokdad et al., 2004).

An estimated 22.6 million adolescents and adults meet criteria for a substance use disorder. In a multi-state study that screened 459,599 patients in general hospital and medical settings, 23% of patients screened positive (Madras et al., 2009).

Clinical trials have demonstrated that brief interventions, especially prior to the onset of addiction, significantly improve health and reduce costs, and that similar benefits occur in those with addictive disorders who are referred to treatment (Fleming et al., 2002).

In a study on the provision of evidence-based care and preventive services provided in hospitals for 30 different medical conditions, quality varied substantially according to diagnosis. Adherence to recommended practices for treatment of substance use ranked last, with only 10% of patients receiving proper care (Gentilello et al., 2005). Currently, less than one in twenty patients with an addiction are referred for treatment (Gentilello et al., 1999).

Hospitalization provides a prime opportunity to address the entire spectrum of substance use problems within the health care system (Bernstein et al., 2005).

Evidence for Rationale

Bernstein J, Bernstein E, Tassiopoulos K, Heeren T, Levenson S, Hingson R. Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug Alcohol Depend. 2005 Jan 7;77(1):49-59. PubMed External Web Site Policy

Fleming MF, Mundt MP, French MT, Manwell LB, Stauffacher EA, Barry KL. Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis. Alcohol Clin Exp Res. 2002 Jan;26(1):36-43. PubMed External Web Site Policy

Gentilello LM, Ebel BE, Wickizer TM, Salkever DS, Rivara FP. Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis. Ann Surg. 2005 Apr;241(4):541-50. PubMed External Web Site Policy

Gentilello LM, Villaveces A, Ries RR, Nason KS, Daranciang E, Donovan DM, Copass M, Jurkovich GJ, Rivara FP. Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff. J Trauma. 1999 Dec;47(6):1131-5; discussion 1135-9. PubMed External Web Site Policy

Harwood H. Updating estimates of the economic costs of alcohol abuse in the United States: estimates, update methods and data. [internet]. Falls Church (VA): The Lewin Group for the National Institute on Alcohol Abuse and Alcoholism; 2000 [accessed 2003 Mar 01].

Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009 Jan 1;99(1-3):280-95. PubMed External Web Site Policy

Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004 Mar 10;291(10):1238-45. [97 references] 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.

Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

Primary Health Components

Substance use; alcohol use; brief intervention

Denominator Description

Number of hospitalized inpatients 18 years of age and older who screen positive for unhealthy alcohol use or an alcohol use disorder (alcohol abuse or alcohol dependence) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients who screen positive for unhealthy alcohol use who received a brief intervention

Type of Evidence Supporting the Criterion of Quality for the Measure

  • 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

Twenty-four hospitals from nineteen states volunteered to participate in a six month pilot test of the draft measures, commencing with discharges beginning March 1, 2010 and concluding on July 31, 2010. There were three tests conducted during the development phase for this measure; public comment, survey of the pilot sites, and a Technical Advisory Panel (TAP) assessment. The purpose was threefold: to gather information regarding face validity, to determine feasibility of data collection, and to gather information about each data element regarding clarity and suggested enhancement that could be made. 2,177 persons responded to the public comment. A total of eleven hospitals and eight TAP members completed the evaluation.

The final phase of testing consisted of site visits to a sample of participating pilot hospitals to assess the reliability of data abstracted and reported by those hospitals. Reliability test site visits were conducted at nine randomly selected pilot hospitals. Selection of the test sites was based on multiple characteristics; including hospital demographics, populations served, bed size and type of facility.

All of the substance use (SUB) measures have undergone a rigorous process of public comment, alpha testing and broad-scale pilot testing and are recognized by the field as important indicators of substance abuse treatment.

Evidence for Extent of Measure Testing

Domzalski K. (Associate Project Director, Division of Healthcare Quality Evaluation, Department of Quality Measurement, The Joint Commission. Oakbrook Terrace, IL). Personal communication. 2013 Aug 28.  1 p.

State of Use

Current routine use

Current Use

Accreditation

Collaborative inter-organizational quality improvement

Internal quality improvement

Public reporting

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Patient-centeredness

Case Finding Period

Discharges October 1 through June 30

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Diagnostic Evaluation

Institutionalization

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of hospitalized inpatients 18 years of age and older who screen positive for unhealthy alcohol use or an alcohol use disorder (alcohol abuse or alcohol dependence)

Exclusions

  • Patients less than 18 years of age
  • Patients who are cognitively impaired
  • Patients who refused or were not screened for alcohol use during the hospital stay
  • Patients who have a duration of stay less than or equal to three days or greater than 120 days
  • Patients receiving Comfort Measures Only (as defined in the Data Dictionary) documented

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of patients who screen positive for unhealthy alcohol use who received a brief intervention

Exclusions
None

Numerator Search Strategy

Institutionalization

Data Source

Administrative clinical data

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

  • Global Initial Patient Population Algorithm Flowchart
  • SUB-2a: Alcohol Use-Brief Intervention Flowchart

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

Unspecified

Original Title

SUB-2a: alcohol use brief intervention.

Measure Collection Name

National Hospital Inpatient Quality Measures

Measure Set Name

Substance Use

Submitter

The Joint Commission - Health Care Accreditation Organization

Developer

The Joint Commission - Health Care Accreditation Organization

Funding Source(s)

All external funding for measure development has been received and used in full compliance with The Joint Commission's Corporate Sponsorship policies, which are available upon written request to The Joint Commission.

Composition of the Group that Developed the Measure

Technical advisory panel of stakeholders. Panel membership may be viewed at: http://www.jointcommission.org/assets/1/6/Substance_Use_Measure_Advisory_Panel.pdf External Web Site Policy

Financial Disclosures/Other Potential Conflicts of Interest

Expert panel members have made full disclosure of relevant financial and conflict of interest information in accordance with the Conflict of Interest policies, copies of which are available upon written request to The Joint Commission.

Endorser

National Quality Forum

NQF Number

1663

Date of Endorsement

2015 Apr 30

Measure Initiative(s)

Inpatient Psychiatric Facility Quality Reporting Program

Quality Check®

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Oct

Measure Maintenance

This measure is reviewed and updated every 6 months.

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital inpatient quality measures, version 4.3b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2014 Apr. various p.

Source(s)

Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

Measure Availability

Source available from The Joint Commission Web site External Web Site Policy. Information is also available from the QualityNet Web site External Web Site Policy. Check The Joint Commission Web site and QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.

NQMC Status

The Joint Commission originally submitted this NQMC measure summary to ECRI Institute on March 28, 2012. This NQMC summary was reviewed accordingly by ECRI Institute on November 27, 2012.

The Joint Commission informed NQMC that this measure was updated on July 16, 2013 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on December 6, 2013.

The Joint Commission informed NQMC that this measure was updated on April 16, 2014 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on June 23, 2014.

The Joint Commission informed NQMC that this measure was updated on April 14, 2015 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on July 10, 2015.

This NQMC summary was edited by ECRI Institute on November 16, 2015.

Copyright Statement

The Specifications Manual for National Hospital Inpatient Quality Measures [Version 5.0b, October, 2015] is the collaborative work of the Centers for Medicare & Medicaid Services and The Joint Commission. The Specifications Manual is periodically updated by the Centers for Medicare & Medicaid Services and The Joint Commission. Users of the Specifications Manual for National Hospital Inpatient Quality Measures must update their software and associated documentation based on the published manual production timelines.

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