-
EC eCQMs
-
Resolution: Answered
-
Moderate
-
None
Brief Description of Measure:
CMS137: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment:
Percentage of patients 13 years of age and older with a new episode of alcohol or other drug abuse or (AOD) dependence who received the following. Two rates are reported.
a. Percentage of patients who initiated treatment including either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis
b. Percentage of patients who engaged in ongoing treatment including two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention.
Description of Issue:
The intent of the definition "Treatment Initiation with Non Medication Intervention" is to capture initiation treatments on the day of substance use disorder (SUD) diagnosis or during 13 days after (14 total days). However, the measure developer has identified an opportunity to revise the logic to better reflect this intent and ensure the appropriate 14-day assessment period is specified.
The following two examples illustrate the behavior of current logic:
//Example 1: Treatment initiation occurred on the same day as SUD diagnosis
SUD diagnosis start time: 5/5 12:05PM
Treatment initiation start time: 5/5 11:59PM
Timeframe requirement: 5/5 12:00AM -5/18 11:59PM
Actual result: false
Expected result: true
//Example 2:Treatment initiation occurred 13 days after SUD diagnosis
SUD diagnosis:5/5 12:05PM
Treatment initiation:5/19 12:00AM
Timeframe requirement:5/5 12:00AM -5/18 11:59PM
Actual result: true
Expected result: false
To ensure the measure assesses the 14-day period starting on the day of the diagnosis through 13 days after, the measure developer proposes to update the CQL syntax from "starts 14 days or less after day of start of" to "starts during Interval[date from start of ..., date from start of ... + 14 days)".
Note that with the use of exclusive bracket ")", the expression can also be read as "starts during Interval[date from start of ..., date from start of ... + 13 days]". However, since "14 days" are mentioned in the measure description, the measure developer believes being consistent with the number included in the logic will decrease confusion and better align with the measure header.
In addition, the measure developer proposes adding a new syntax "...id !~ ...id" to ensure that the two events being compared are not the same events because, for example, a telephone visit with an SUD diagnosis can meet both criteria for an SUD episode and psychosocial treatment.
The definition of "Treatment Initiation With Medication Order" will also be modified to ensure that the Numerator logic expressions are consistent.
Proposed Solution:
Note: Please note that changes beyond the 14-day criteria are documented in another issue, e.g., definition name and alias changes.
//Before
define "Treatment Initiation with Non Medication Intervention":
"Psychosocial Visit" TreatmentInitiatedWithIntervention
with "First Dependence Diagnosis During Measurement Period" FirstDiagnosed
such that Global."NormalizeInterval" ( TreatmentInitiatedWithIntervention.relevantDatetime, TreatmentInitiatedWithIntervention.relevantPeriod ) starts 14 days or less after day of start of FirstDiagnosed.prevalencePeriod
//After
define "Treatment Initiation with Non Medication Intervention":
"Psychosocial Visit" PsychosocialVisit
with "First SUD Episode During Measurement Period" FirstSUDEpisode
such that date from start of Global."NormalizeInterval" ( PsychosocialVisit.relevantDatetime, PsychosocialVisit.relevantPeriod ) during Interval[date from start of FirstSUDEpisode.relevantPeriod, date from start of FirstSUDEpisode.relevantPeriod + 14 days )
and PsychosocialVisit.id !~ FirstSUDEpisode.id
//Before
define "Treatment Initiation With Medication Order"
... TreatmentInitiatedWithMedication
with "First Dependence Diagnosis During Measurement Period" FirstDiagnosed
such that TreatmentInitiatedWithMedication.authorDatetime 14 days or less on or after day of start of FirstDiagnosed.prevalencePeriod
//After
define "Treatment Initiation With Medication Order":
... SUDMedication
with "First SUD Episode During Measurement Period" FirstSUDEpisode
such that date from SUDMedication.authorDatetime during Interval[date from start of FirstSUDEpisode.relevantPeriod, date from start of FirstSUDEpisode.relevantPeriod + 14 days )
and SUDMedication.id !~ FirstSUDEpisode.id
Rationale for Change:
The logic revisions clarify the intended assessment timeframe criteria in the logic, further aligning the measure with the measure intent.