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  1. eCQM Issue Tracker
  2. CQM-5616

CRP: Limit opioid antagonist administration to non-oral medications

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    • Other
    • Resolution: Unresolved
    • Moderate
    • None
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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
      ​Recent evidence shows an increase in the use of the opioid antagonist naloxone for “off label” indications; specifically, opioid-induced constipation and pruritis. Oral naloxone is never used to reverse opioid CNS depression or opioid overdose, so restricting  the numerator to count only administration of naloxone by intravenous, intramuscular, subcutaneous, intranasal, and inhalation routes (and not oral route) would eliminate opioid-induced constipation as a potential source of false positives.

      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 ​Recent evidence shows an increase in the use of the opioid antagonist naloxone for “off label” indications; specifically, opioid-induced constipation and pruritis. Oral naloxone is never used to reverse opioid CNS depression or opioid overdose, so restricting  the numerator to count only administration of naloxone by intravenous, intramuscular, subcutaneous, intranasal, and inhalation routes (and not oral route) would eliminate opioid-induced constipation as a potential source of false positives. Goal of review Obtain clinical and technical feedback
    • Hide
      Proposed solution
      ​Restrict the numerator to only count non-oral administration of opioid antagonist (naloxone).  

      Logic - Current:

      Encounter With Opioid Antagonist Administration Outside of Operating Room and Within 12 Hrs After Opioid
      // Opioids administered before opioid antagonist AND excludes opioid antagonist administered in operating room
      from
        ["Medication, Administered": "Opioid Antagonist"] OpioidAntagonistGiven,
        "Opioid Administration" OpioidGiven,
        "Denominator" EncounterWithQualifyingAge
        where not exists ( EncounterWithQualifyingAge.facilityLocations EncounterLocation
            where EncounterLocation.code ~ "Operating Room/Suite"
              and Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod ) starts during EncounterLocation.locationPeriod
        )
          and ( Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( EncounterWithQualifyingAge )
              and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( EncounterWithQualifyingAge )
              and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) ends 12 hours or less before start of Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod )
          )
        return EncounterWithQualifyingAge

      Logic - Proposed:

      Encounter With Opioid Antagonist Administration Outside of Operating Room and Within 12 Hrs After Opioid
      // Opioids administered before opioid antagonist AND excludes opioid antagonist administered in operating room
      from
        ["Medication, Administered": "Opioid Antagonist"] OpioidAntagonistGiven,
        "Opioid Administration" OpioidGiven,
        "Denominator" EncounterWithQualifyingAge
        where not exists ( EncounterWithQualifyingAge.facilityLocations EncounterLocation
            where EncounterLocation.code ~ "Operating Room/Suite"
              and Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod ) starts during EncounterLocation.locationPeriod
        )
          and ( Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( EncounterWithQualifyingAge )
              and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( EncounterWithQualifyingAge )
              and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) ends 12 hours or less before start of Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod )
              and OpioidGiven.route in "Non Oral Route" )
        return EncounterWithQualifyingAge

      Rationale for change
      Limiting the measure to account for non-oral opioid antagonist administration would eliminate opioid-induced constipation as a potential source of false positives.
      Show
      Proposed solution ​Restrict the numerator to only count non-oral administration of opioid antagonist (naloxone).   Logic - Current: Encounter With Opioid Antagonist Administration Outside of Operating Room and Within 12 Hrs After Opioid // Opioids administered before opioid antagonist AND excludes opioid antagonist administered in operating room from   ["Medication, Administered": "Opioid Antagonist"] OpioidAntagonistGiven,   "Opioid Administration" OpioidGiven,   "Denominator" EncounterWithQualifyingAge   where not exists ( EncounterWithQualifyingAge.facilityLocations EncounterLocation       where EncounterLocation.code ~ "Operating Room/Suite"         and Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod ) starts during EncounterLocation.locationPeriod   )     and ( Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( EncounterWithQualifyingAge )         and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( EncounterWithQualifyingAge )         and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) ends 12 hours or less before start of Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod )     )   return EncounterWithQualifyingAge Logic - Proposed: Encounter With Opioid Antagonist Administration Outside of Operating Room and Within 12 Hrs After Opioid // Opioids administered before opioid antagonist AND excludes opioid antagonist administered in operating room from   ["Medication, Administered": "Opioid Antagonist"] OpioidAntagonistGiven,   "Opioid Administration" OpioidGiven,   "Denominator" EncounterWithQualifyingAge   where not exists ( EncounterWithQualifyingAge.facilityLocations EncounterLocation       where EncounterLocation.code ~ "Operating Room/Suite"         and Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod ) starts during EncounterLocation.locationPeriod   )     and ( Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( EncounterWithQualifyingAge )         and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( EncounterWithQualifyingAge )         and Global."NormalizeInterval" ( OpioidGiven.relevantDatetime, OpioidGiven.relevantPeriod ) ends 12 hours or less before start of Global."NormalizeInterval" ( OpioidAntagonistGiven.relevantDatetime, OpioidAntagonistGiven.relevantPeriod )         and OpioidGiven.route in "Non Oral Route" )   return EncounterWithQualifyingAge Rationale for change Limiting the measure to account for non-oral opioid antagonist administration would eliminate opioid-induced constipation as a potential source of false positives.

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          sgearhart Mathematica EH eCQM Team
          sgearhart Mathematica EH eCQM Team
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