2021 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. To see additional details, please view the workflow diagram for this measure: View diagram
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 Criteria (Eligible cases):
Patients aged 18 of age or older
AND
Patient encounter during the denominator identification period (CPT or HCPCS):
0362T, 0373T, 90785, 90791, 90792, 90832,90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90863, 90875, 90876, 96110, 96112, 96113, 96116, 96121, 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146, 96156, 96158, 96159, 96164, 96165, 96167, 96170, 96171, 96178, 97129, 97130, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 98966, 98967, 98968, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215,99354, 99355, 99406, 99407, 99408, 99409, 99446, 99447, 99448, 99449, 99484, 99492, 99493, 99494, G2011, G2061, G2062, G2063, G0396, G0397, G0402, G0438, G0439
AND
Diagnosis for Alcohol Use Disorder related issues: F10.X, G62.1, G31.2, G72.1, I42.6, K29.2, K70-K70.4, K70.9, K86.0
AND
a baseline of any of the three types of scores

 

INCLUDES TELEHEALTH?  YES

Denominator Exclusion • Patients who die OR
• Are enrolled in hospice in the measurement year OR
• Are unable to complete a measure at follow-up due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, AND a suitable recorder (e.g., advocate) is not available
Denominator Exception • Patient refused to complete a measure at follow-up OR
• Ongoing care not indicated (e.g., referred to another provider or facility, consultation only) OR
• Patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) OR
• Medical reasons (e.g., admitted to hospital, severe illness)
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. Response to treatment for the following measures are defined as: 1) PROMIS Negative Consequences of Alcohol Use short form includes a minimum index visit score of 52 or higher AND a drop of 2 or more points at follow-up; BARC includes an index score of 48 or higher AND a drop to 47 or less at follow-up; RAS includes an index average score of 4.0 or less AND a drop of .5 or more at follow-up.
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
Care Settings Ambulatory Care: Hospital; Inpatient; Rehabilitation Facility; Nursing Home; Outpatient Services; Long Term Care

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.

Alcohol Use Disorder (AUD) is commonly treated by mental health providers, either as a stand-alone presenting condition, or as a comorbid disorder with other major psychiatric disturbance. Evidence-based treatments (i.e., Miller et al., 2006; Campbell et al., 2018) have been developed for AUD, and these interventions require assessment of several domains of usage, including: alcohol use history with social and behavioral consequences for use; extent of desire and planning for future use; and personal and social resources that may facilitate treatment outcome and mitigate relapse risk. The majority of psychiatric disorders are associated with AUD risk, and thus screening for AUD is warranted in most individuals seeking mental health care. Treatment guidelines emphasize psychosocial interventions (NIAAA Clinical Guidelines; NIDA Principles of Drug Addiction Treatment; American Psychiatric Association). Each of these organizations emphasize the application of behavioral and cognitive-behavioral interventions with or without other medically-based therapy.