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Measure Information Form
Version 2010A1


Measure Information Form

Measure Set: Screening and Treating Tobacco and Alcohol Use(TAM)

Set Measure ID: TAM-07

Performance Measure Name: Alcohol & Other Drug Dependence-Treatment Management at Discharge

Description: Hospitalized patients who are identified with alcohol or drug dependence who receive at discharge a prescription for FDA-approved medications for alcohol or drug dependence, or who receive a referral for addictions treatment.

Rationale: Excessive use of alcohol and drugs has a substantial harmful impact on health and society in the United States. It is a drain on the economy and a source of enormous personal tragedy.1 In 1998 the economic costs to society were $185 billion dollars for alcohol misuse, and $143 billion dollars for drug misuse.2 Health care spending was $19 billion for alcohol problems, and $14 billion was spent treating drug problems.

Nearly a quarter of a trillion dollars per year in lost productivity is attributable to substance use. More than 537,000 die each year as a consequence of alcohol, drug, and tobacco use making use of these substances the cause of one out of four deaths in the United States.3

An estimated 22.6 million adolescents and adults meet criteria for a substance use disorder. In a multi-state study that screened 459,599 patients in general hospital and medical settings, 23% of patients screened positive.4

Clinical trials have demonstrated that brief interventions, especially prior to the onset of addiction, significantly improve health and reduce costs, and that similar benefits occur in those with addictive disorders who are referred to treatment.5

In a study on the provision of evidence-based care and preventive services provided in hospitals for 30 different medical conditions, quality varied substantially according to diagnosis. Adherence to recommended practices for treatment of substance use ranked last, with only 10% of patients receiving proper care.6 Currently, less than one in twenty patients with an addiction are referred for treatment.7

Hospitalization provides a prime opportunity to address the entire spectrum of substance use problems within the health care system.6 7 Approximately 8% of general hospital inpatients and 40 to 60 percent of traumatically-injured inpatients and psychiatric inpatients have substance use disorders.7

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: The number of patients who received or declined at discharge a prescription for medication for treatment of an alcohol or drug dependence OR a referral for addictions treatment.

Included Populations:
  • Patients who declined a prescription for FDA-approved medication for treatment of an alcohol or drug dependence
  • Patients who declined a referral for addictions treatment

Excluded Populations: None

Data Elements:

Denominator Statement: The number of hospitalized inpatients 18 years of age and older identified with alcohol or drug dependence

Included Populations:
  • Patients screening on a standardized alcohol or drug use questionnaire (such as the AUDIT ASSIST or DAST) as probable dependent (e.g. AUDIT>20)
  • Patients with ICD-9-CM Principal or Other Diagnosis Code for alcohol or drug dependence
  • Patients with a progress or discharge note indicating drug or alcohol dependence

Excluded Populations:

  • Patients less than 18 years of age
  • Patients drinking at unhealthy levels who do not meet criteria for dependence (e.g., AUDIT< 20)
  • Patients who are cognitively impaired
  • Patients who expire during the hospital stay

Data Elements:

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.

Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: Hospitals may wish to analyze data to show patients that refused both a medication prescription and referral and those who refused only one or the other.

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, 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.

3. 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.)

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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:

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Related Topics

Measure Information Form TAM-07
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)