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  1. eCQM Issue Tracker
  2. CQM-5615

CRP: Exclude opioids given in the operating room

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    • Other
    • Resolution: Unresolved
    • Moderate
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      Brief description of measure
      CMS819/HH-03: Hospital Harm - Opioid-Related Adverse Events
      This measure assesses the proportion of inpatient hospital encounters where patients ages 18 years of age or older have been administered an opioid medication and are subsequently administered an opioid antagonist (naloxone) within 12 hours, an indication of an opioid-related adverse event. This measure excludes opioid antagonist (naloxone) administration occurring in the operating room setting.

      Description of issue
      ​During Spring 2022, feedback from public comment and external review of the measure included a recommendation to exclude opioids given in the operating room (OR) from the measure calculation. The measure developer's internal clinical leads agree with this recommendation, as most general anesthesia cases involve opioid administration.

      Measure testing confirmed that there is variability in how hospitals document medications administered in the OR; in some cases, documentation of OR medications are not done within the EHR, potentially creating an imbalance in eCQM rates across hospitals because so many patients receive opioids in the OR. Most general anesthesia cases involve opioid administration for pain control and rapid induction. Thus, the measure denominator could easily be twice as high in hospitals that document OR meds in the EHR versus those who do not.

      Goal of review
      Obtain clinical and technical feedback
      Show
      Brief description of measure CMS819/HH-03: Hospital Harm - Opioid-Related Adverse Events This measure assesses the proportion of inpatient hospital encounters where patients ages 18 years of age or older have been administered an opioid medication and are subsequently administered an opioid antagonist (naloxone) within 12 hours, an indication of an opioid-related adverse event. This measure excludes opioid antagonist (naloxone) administration occurring in the operating room setting. Description of issue ​During Spring 2022, feedback from public comment and external review of the measure included a recommendation to exclude opioids given in the operating room (OR) from the measure calculation. The measure developer's internal clinical leads agree with this recommendation, as most general anesthesia cases involve opioid administration. Measure testing confirmed that there is variability in how hospitals document medications administered in the OR; in some cases, documentation of OR medications are not done within the EHR, potentially creating an imbalance in eCQM rates across hospitals because so many patients receive opioids in the OR. Most general anesthesia cases involve opioid administration for pain control and rapid induction. Thus, the measure denominator could easily be twice as high in hospitals that document OR meds in the EHR versus those who do not. Goal of review Obtain clinical and technical feedback
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      Proposed solution
      ​Do not consider opioids administered in the OR when evaluating for the initial population/denominator criteria.

      Header - Current:

      Initial Population:
      Inpatient hospitalizations for patients 18 years or older during which at least one opioid medication was administered

      Guidance:
      Remove all events where an opioid antagonist (naloxone) was only administered in the operating room.

      Header - Proposed:

      Initial Population:
      Inpatient hospitalizations for patients 18 years or older during which at least one opioid medication was administered outside of the operating room

      Guidance:
      Remove all events where an opioid or opioid antagonist (naloxone) was administered in the operating room.

      Logic - Current:

      define "Encounter With Opioid Administration"
      "Qualifying Encounter" InpatientEncounter
        with "Opioid Administration" OpioidGiven
          such that Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) starts during Global.HospitalizationWithObservation ( InpatientEncounter )

      Logic - Proposed:

      define "Encounter With Opioid Administration"
       "Qualifying Encounter" InpatientEncounter
          with "Opioid Administration" OpioidGiven
            such that Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( InpatientEncounter )
              and not exists ( InpatientEncounter.facilityLocations EncounterLocation
                  where EncounterLocation.code ~ "Operating Room/Suite"
                    and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) starts during EncounterLocation.locationPeriod )

      Terminology:
      HSLOC Code (1096-7) "Operating Room/Suite"

      Rationale for change
      ​During Spring 2022, feedback from public comment/ external review of the measure included a recommendation to exclude opioids given in the OR from measure calculation because of the frequent use of opioids in the OR, coupled with the inconsistency of documenting OR medications in the EHR which may negatively impact performance.
      Show
      Proposed solution ​Do not consider opioids administered in the OR when evaluating for the initial population/denominator criteria. Header - Current: Initial Population: Inpatient hospitalizations for patients 18 years or older during which at least one opioid medication was administered Guidance: Remove all events where an opioid antagonist (naloxone) was only administered in the operating room. Header - Proposed: Initial Population: Inpatient hospitalizations for patients 18 years or older during which at least one opioid medication was administered outside of the operating room Guidance: Remove all events where an opioid or opioid antagonist (naloxone) was administered in the operating room. Logic - Current: define "Encounter With Opioid Administration" "Qualifying Encounter" InpatientEncounter   with "Opioid Administration" OpioidGiven     such that Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) starts during Global.HospitalizationWithObservation ( InpatientEncounter ) Logic - Proposed: define "Encounter With Opioid Administration"  "Qualifying Encounter" InpatientEncounter     with "Opioid Administration" OpioidGiven       such that Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( InpatientEncounter )         and not exists ( InpatientEncounter.facilityLocations EncounterLocation             where EncounterLocation.code ~ "Operating Room/Suite"               and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) starts during EncounterLocation.locationPeriod ) Terminology: HSLOC Code (1096-7) "Operating Room/Suite" Rationale for change ​During Spring 2022, feedback from public comment/ external review of the measure included a recommendation to exclude opioids given in the OR from measure calculation because of the frequent use of opioids in the OR, coupled with the inconsistency of documenting OR medications in the EHR which may negatively impact performance.

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          sgearhart Mathematica EH eCQM Team
          sgearhart Mathematica EH eCQM Team
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            Updated: