Measure Information Form

Measure Set: Substance Use Measures (SUB)

Set Measure ID: SUB-04

Performance Measure Name: Alcohol & Drug Use: Assessing Status After Discharge

Description: Discharged patients who screened positive for unhealthy alcohol use or who received a diagnosis of alcohol or drug disorder during their inpatient stay, who are contacted within 30 days after hospital discharge and follow-up information regarding their aclochol or drug use status post discharge is collected.

Rationale: Excessive use of alcohol and drugs have a catastrophic impact on health and society in the United States.¹ In 1998 the costs to society were $185 billion dollars for alcohol misuse, and $143 billion dollars for drugs.² This includes annual health care spending of over $19 billion for consequences of alcohol problems, and $14 billion related to drugs. Businesses suffer from one-quarter of a trillion dollars per year in lost productivity. Alcohol, drug, and tobacco use cause over one out of four of the 2.4 million annual deaths in the U.S.³

An estimated 22.6 million adolescents and adults meet criteria for a substance use disorder, but addictions are not the most common type of problem. For every patient with alcohol dependence there are six who drink in an excessive manner that harms their health. For every patient with a drug addiction there are three who risk their health through use, but are not dependent. In a multi-state study that screened 459,599 patients in general hospital and medical settings, 23% were positive. Of these, 16% used alcohol or drugs above safe limits, an additional 3% were very heavy users, but only 4% had an addictive use pattern.⁴

Clinical trials have demonstrated that brief interventions significantly improve health and reduce costs in non-dependent drinkers; similar benefits occur in those with addictions who are referred to treatment.⁵

Substance use contributes to over 50 medical problems commonly treated in hospitals.⁶ A hospital admission provides a unique opportunity to address substance use. For many patients, addressing substance use is the only way to control their other health problems.⁷

Type Of Measure: Outcome

Improvement Noted As: Increase in the rate

Numerator Statement: The number of discharged patients who are contacted within 30 days after hospital discharge and follow-up information regarding alcohol or drug use status is collected

Included Populations: Not applicable
Excluded Populations:

None

Data Elements:

Alcohol or Drug Use Status Post-Discharge (Not used in measure calculation)

Follow-up Contact

Follow-up Contact Date

Denominator Statement: The number of discharge patients 18 years of age and older who screened positive for unhealthy alcohol use or who received a diagnosis of alcohol or drug use disorder during their hospital stay.

Included Populations:

Patients with an ICD-9-CM Principal or Other Diagnosis Code for alcohol or drug use disorder listed in Appendix A on Table 13.1 or 13.2

Patients with an ICD-9-CM Principal or Other Procedure Code listed in Appendix A on Table 13.3

Patients who screened positive for unhealthy alcohol use

Excluded Populations:

Patients less than 18 years of age

Patients who expired

Patients who have a duration of stay less than or equal to one day and greater than 120 days

Patients who do not screen positive for unhealthy alcohol use

Patients discharged to another hospital

Patients who left against medical advice

Patients discharged to another health care facility

Patients discharged to home for hospice care

Patients who do not reside in the United States

Patients who do not have a phone or cannot provide any contact information

Patients discharged to a detention facility, jail, or prison

Data Elements:

Admission Date

Alcohol Use Status

Alcohol or Drug Disorder

Birthdate

Cognitive Impairment

Discharge Date

Discharge Disposition

ICD-9-CM Other Diagnosis Codes

ICD-9-CM Other Procedure Codes

ICD-9-CM Principal Diagnosis Code

ICD-9-CM Principal Procedure Code

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal and other ICD-9-CM diagnoses which require retrospective data entry.

Data Accuracy: Data accuracy is enhanced when all definitions are used without modification. The data dictionary should be referenced for definitions and abstraction notes when questions arise during data collection.

Measure Analysis Suggestions: Hospitals may wish to analyze the measure data using the data element Alcohol or Drug Use Status Post Discharge to determine the difference in use status related to interventions made during the hospital stay or referrals at discharge.

Sampling: Yes. For additional information see the Population and Sampling Specifications section

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References: 1. The National Quality Forum, National Voluntary Consensus Standards for the Treatment of Substance Use Conditions: Evidence-Based Treatment Practices; A Consensus Report; 2007.

2. Harwood, HJ, 2000. Updating Estimates of the Economic Costs of Alcohol Abuse in the United States. National Institute on Alcohol Abuse and Alcoholism. Available from: http://pubs.niaaa.nih.gov/publications/economic-2000,

3. Office of National Drug Control Policy. The Economic Costs of Drug Abuse in the United States: 1992—2002. Washington, DC: Executive Office of the President (Publication No. 207303), 2004.

4. Mokdad AH, Marks JS, Stroup DS, Gerberding JL. Actual Causes of Death in the United States, 2000. JAMA. 2004 Mar 10;291(10):1238-45 (Erratum in: JAMA. 2005 Jan 19;293(3):293-4.)

5. Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and 6 months later. Drug Alcohol Depend. 2009 Jan 1;99(1-3):280-95. Epub 2008 Oct 16.

6. Fleming MF, Mundt MP, French MT, Manwell LB, Stauffacher EA, Barry KL. Brief physician advice for problem drinkers: Long-term efficacy and cost-benefit analysis. Alcohol Clin Exp Res. 2002 Jan;26(1):36-43.

7. Gentilello LM, Ebel BE, Wickizer TM, Salkever DS Rivera FP. Alcohol interventions for trauma patients treated in emergency departments and hospitals: A cost benefit analysis. Ann Surg. 2005 Apr;241(4):541-50.

8. Gentilello LM, Villaveces A, Ries RR, Nason KS, Daranciang E, Donovan DM Copass M, Jurkovich GJ Rivara FP. Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff. J Trauma. 1999 Dec;47(6):1131-5; discussion 1135-9.

9. Bernstein J, Bernstein E, Tassiopoulos K, Heren T, Levenson S, Hingson R. Brief motivational interventions at a clinic visit reduces cocaine and heroin use. Drug Alcohol Depend. 2005 Jan 7;77(1):49-59.

10. McGlynn EA, Asch SM, Adams J. The Quality of Healthcare Delivered to Adults in the United States. N Engl J Med. 2003 Jun 26;348(26):2635-45.

11. Smothers BA, Yahr HT, Ruhl CE. Detection of alcohol use disorders in general hospital admissions in the United States. Arch Intern Med. 2004 Apr 12;164(7):749-56.

12. Kirchner JE, Owen RR, Nordquist C, Fischer EP. Diagnosis and management of substance use disorders among inpatients with schizophrenia. Psychiatr Serv. 1998 Jan;49(1):82-5.

13. Havassy BE, Alvidrez J, Owen KK. Comparisons of patients with comorbid psychiatric and substance use disorders: implications for treatment and service delivery. Am J Psychiatry. 2004 Jan;161(1):139-45.

14. Prochaska JJ, Gill PH, Stephen E, Hall SM. Identification and Treatment of Substance Misuse on an Inpatient Psychiatry Unit. Psychiatr Serv. 2005 Mar;56(3):347-9.

15. Kirchner JE, Owen RR, Nordquist C, Fischer EP. Diagnosis and management of substance use disorders among inpatients with schizophrenia. Psychiatr Serv. 1998 Jan;49(1):82-5.

16. Havassy BE, Alvidrez J, Owen KK. Comparisons of patients with comorbid psychiatric and substance use disorders: implications for treatment and service delivery. Am J Psychiatry. 2004 Jan;161(1):139-45.

17. Prochaska JJ, Gill PH, Stephen E, Hall SM. Identification and Treatment of Substance Misuse on an Inpatient Psychiatry Unit. Psychiatr Serv. 2005 Mar;56(3):347-9.

Measure Algorithm:

Specifications Manual for Joint Commission National Quality Measures (v2020A)
Discharges 01-01-20 (1Q20) through 6-30-20 (2Q20)

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