Brief Description of Measure:
Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge
Description of Issue:
The measure does not currently exclude patients receiving medications for treatment of opioid use disorder (M-OUD).
During measure development, we specifically looked at patients receiving methadone or buprenorphine, two of the most common M-OUDs, as part of our measure testing. We found that a very small percentage of patients included in the measure numerator (ranging from 0-6.3%) were receiving methadone or buprenorphine with a concomitant opioid.
In reviewing these results, the expert work group felt it was important that the measure continue to include patients on methadone and buprenorphine (including patients prescribed these medications for treatment of substance abuse) because (1) this population has the highest risk of concurrent prescriptions, (2) this population can experience delays before adverse events occur, and (3) even low doses of methadone and buprenorphine can cause adverse drug events if an overlap with benzodiazepines occurs. However, we realize that the environment continues to shift, and we are exploring whether these limitations and the current proportion of M-OUD users has changed.
Should patients receiving M-OUD be excluded from the measure? If so, we are interested in your comments on the proposed methods of exclusion.
If you agree that patients receiving M-OUD should be excluded from the measure, please comment on the proposed header, logic, and value sets below.
Proposed denominator exclusion language:
Inpatient hospitalizations where patients have cancer that begins prior to or during the encounter or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the encounter, patients discharged to another inpatient care facility, patients receiving medication-assisted treatment for opioid use disorder, and patients who expire during the inpatient stay.
We can exclude these patients using one of the two pieces of logic below. One method looks specifically at medications used to treat OUD and the second looks at patients receiving buprenorphine or methadone in conjunction with an OUD diagnosis.
"Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter
where exists ( ["Intervention, Performed": "Opioid Medication Assisted Treatment (MAT)"] OUDTreatment
with ["Diagnosis": "Opioid Use Disorder"] OUD
such that OUDTreatment.relevantPeriod 30 days or less on or before InpatientEncounter.relevantPeriod
and OUD.prevalencePeriod overlaps OUDTreatment.relevantPeriod)
or exists ( ["Diagnosis": "Opioid Use Disorder"] OUD
with ( ["Medication, Administered": "Buprenorphine and Buprenorphine/Naloxone"]
union ["Medication, Administered": "Methadone Medications"] ) TreatmentMedication
such that TreatmentMedication.authorDatetime during OUD.prevalencePeriod
and TreatmentMedication.authorDatetime during InpatientEncounter.relevantPeriod)
Proposed value sets:"Diagnosis: Opioid Use Disorder" using "Opioid Use Disorder (2.16.840.1.1137188.8.131.521.171)""Intervention, Performed: Opioid Medication Assisted Treatment (MAT)" using "Opioid Medication Assisted Treatment (MAT) (2.16.840.1.1137184.108.40.2066.225)""Medication, Administered: Buprenorphine and Buprenorphine/Naloxone" using "Buprenorphine and Buprenorphine/Naloxone (2.16.840.1.1137220.127.116.111.146)"
"Medication, Administered: Methadone Medications" using "Methadone Medications (2.16.840.1.113883.3.3157.1002.71)""Medication, Discharge: Buprenorphine and Buprenorphine/Naloxone" using "Buprenorphine and Buprenorphine/Naloxone (2.16.840.1.113718.104.22.1681.146)""Medication, Discharge: Methadone Medications" using "Methadone Medications (2.16.840.1.113883.3.3157.1002.71)"
Rationale for Change:
The measure developer seeks CRP feedback on the proposed addition of a denominator exclusion for patients receiving M-OUD, which may align with the changing environment and practice.