False‑Positive HH‑ORAE Events from Low‑Dose Naloxone Infusions in Sickle Cell Disease

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Damaris Rivera
    • 4074490839
    • Orlando Health
    • Hide
      Thank you for your question regarding CMS819v3 and CMS819v4, Hospital Harm - Opioid-Related Adverse Events. Patients with sickle cell disease who receive naloxone infusions are not excluded from the measure. This measure is focused on inpatient hospitalizations where an opioid antagonist was administered, outside of the operating room and within 12 hours of the administration of an opioid medication, regardless of the reason for the administration. The measure developer will consider updates to the measure to exclude sickle cell disease in a future annual update.
      Show
      Thank you for your question regarding CMS819v3 and CMS819v4, Hospital Harm - Opioid-Related Adverse Events. Patients with sickle cell disease who receive naloxone infusions are not excluded from the measure. This measure is focused on inpatient hospitalizations where an opioid antagonist was administered, outside of the operating room and within 12 hours of the administration of an opioid medication, regardless of the reason for the administration. The measure developer will consider updates to the measure to exclude sickle cell disease in a future annual update.
    • CMS0819v4
    • CMS0819v3
    • Hide
      This issue results in false‑positive HH‑ORAE numerator events, requiring additional clinical review and validation effort by our team while creating inaccurate measure results that do not reflect true patient harm. It also complicates interpretation of performance data and increases the risk of misrepresenting appropriate pain management practices for patients with sickle cell disease.
      Show
      This issue results in false‑positive HH‑ORAE numerator events, requiring additional clinical review and validation effort by our team while creating inaccurate measure results that do not reflect true patient harm. It also complicates interpretation of performance data and increases the risk of misrepresenting appropriate pain management practices for patients with sickle cell disease.

      During a recent internal measure review of Hospital Harm – Opioid Related Adverse Events, we observed false-positive numerator harm events when patients with sickle cell disease receive a continuous, very low-dose naloxone infusions.  These infusions are specifically intended to treat opioid side effects (e.g. pruritus/itching, headache nausea) while they are receiving opioid analgesia.  In these cases, naloxone is not administered for reversal of opioid toxicity and does not represent an opioid-related adverse event as clinically intended by HH-ORAE.

      We are requesting a specification clarification and/or numerator exclusion so that continuous low‑dose naloxone infusions used for opioid side‑effect management (particularly common in SCD pain crisis management) are not counted as opioid‑related adverse events.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Damaris Rivera
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