2020 MBHR Measure: Alcohol Use Disorder Outcome Response

QCDR Name: MBHR Mental and Behavioral Health Registry

Measure Title Alcohol Use Disorder Outcome Response
NQS Domain Effective Clinical Care
Measure ID MBHR8
NQF ID N/A
Measure Type Patient Reported Outcome (PRO)
High Priority? Yes
Description The percentage of adult patients (18 years of age or older) who report problems with drinking alcohol AND with documentation of a standardized screening tool (e.g., AUDIT, AUDIT-C, DAST, TAPS) AND demonstrated a response to treatment at three months (+/- 60 days) after the index visit
Denominator Adult patients (18 years of age or older) with one of the Alcohol-Related diagnoses (see Diagnostic list) and a validated symptom measure for the treatment index visit
Denominator Exclusion Death
Denominator Exception Patient refuses to participate or is unable to complete the questionnaire.
Numerator The number of patients in the denominator who demonstrated a response to treatment, with an improvement score using at least one of the validated alcohol self-report measures (PROMIS negative consequences, BARC, or RAS) by three months (+/- 60 days) after an index visit. The Patient-Reported Outcomes Measurement Information System (PROMIS) Negative Consequences of Alcohol Use short form is comprised of 7 items. The measure and scoring instructions are available, at no cost, at: http://www.healthmeasures.net/index.php?option=com_instruments&view=measure&id=139&Itemid=992.
After confirming that all responses were provided, sum the values of the response to each question. Locate the score conversion table in the Appendix and use this table to translate the total raw score into a T-score for each respondent. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10. Therefore a person with a T-score of 40 is one SD below the mean. Alternatively, one can use the free online HealthMeasures Scoring Service (https://www.assessmentcenter.net/ac_scoringservice) which automatically scores raw responses into T-scores. To learn more, see http://www.healthmeasures.net/score-and-interpret/calculate-scores/scoring-instructions For most PROMIS instruments, a score of 50 is the average for the United States general population with a standard deviation of 10 because calibration testing was performed on a large sample of the general population. However, Alcohol Use – Negative Consequences items were calibrated in a large sample of people from the general population and people participating in community-based substance use disorder treatment programs. All participants were screened and included only if they drank alcohol in the past 30 days. Therefore, a score of 50 likely represents individuals with more substance use issues than the general population. The T-score is provided with an error term (Standard Error or SE). The Standard Error is a statistical measure of variance and represents the “margin of error” for the T-score.The Brief Assessment of Recovery Capital (BARC) has a cut-off score associated with recovery. Total scores above 47 are associated with sustained recovery at 12 months posttreatment (Vilsaint et al., 2017).The Recovery Assessment Scale (RAS, 24 items) does not have published change scores or cutoffs for severity that help guide clear change score criteria for improvement. Rather, all items are scored on a 5-point scale across all 24 items, which can be averaged. Across 28 studies, RAS scale score averages ranged from 3.14 to 4.12, with an interquartile range of 3.72-3.90 (Salzer & Brusilovskiy, 2014). The average for all reported mean scores was 3.78 +/- .19. Any reduction on the RAS should be considered responsive.
Data Source Claims, EHR, Paper Medical Record, Registry
Meaningful Measure Area Prevention, Treatment, and Management of Mental Health
Meaningful Measure Rationale Measuring alcohol use disorder response in treatment will promote interventions and best practices that are effective at reducing symptoms and improve functional status and quality of life.
Inverse Measure? No
Proportional Measure? Yes
Continuous Variable Measure? No
Ratio Measure No
Number of Performance Rates 1
Risk Adjusted Yes
Preferred Specialty mental and behavioral health
Applicable Specialties Family Practice, Internal Medicine, Geriatric Medicine, Psychiatry, Behavioral Health

Measure Justification

AUD is associated with significant social, occupational (Knight, et al., 2016; Nicholson & Mayho, 2016), and cognitive (Lee et al., 2015) disability. Further, most major psychiatric disorders carry an increased risk of AUD (Connor et al., 2016). Accordingly, AUD has the potential to serve as a disabling condition in its own right, or can significantly complicate and exacerbate other psychiatric conditions. Symptoms of AUD include: drinking more than intended in a single occasion; experienced difficulty in reducing alcohol consumption; spent excessive time drinking or were frequently sick as a result of alcohol consumption; experienced strong urges to drink; an inability to perform usual home and/or family responsibilities as a result of alcohol consumption; persisted in alcohol consumption despite a breakdown in interpersonal functioning (i.e., difficulties with friends or family); limited activities of interest because of drinking; engaged in risky behavior due to alcohol use; persisted in consumption even if physical or emotional consequences accrued due to drinking; had to consume increased amounts of alcohol to achieve same effect as earlier drinking episodes (i.e., tolerance); and developed withdrawal symptoms when going periods without alcohol consumption.

Untreated, AUD can be expected to be chronic in nature. Even when treated, the clinical course of the condition can be expected to be marked by lapses necessitating regular check-ins with providers, even if acute level intervention is no longer necessary (for review, see Maisto, Kirouac, & Witkiewitz, 2014). AUD disorder represents a significant public health burden, including high rates of mortality associated with usage (World Health Organization, 2018). It was estimated that when lost workplace productivity, healthcare expenses, vehicular accidents, and criminal justice costs were combined, excessive alcohol use accounted for approximately $249 billion in costs in 2010 (Centers for Disease Control, 2012).

Treatments for AUD include behavioral interventions, such as controlled drinking and harm reduction; cognitive-behavioral interventions, such as motivational enhancement therapy, attribution-retraining, and cognitive restructuring; and twelve step approaches, where complete abstinence is emphasized. Medications have been recommended as well, such as naltrexone for moderate to severe AUD. Given the disability associated with AUD, high levels of morbidity, mortality risk, and chronicity, evaluating outcomes for treatment of the condition is critical to ensure that the most effective intervention is being used, and that adjustments in treatment may be made in the event of non-response.