NQF 0004 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Sources

  1. NQF_HQMF_HumanReadable_0004.pdf
  2. NQF_Retooled_Measure_0004 (2).xlsx
  3. QDS Model Version 2 1_September 2010.pdf

Description

The percentage of adolescent and adult patients with a) new episode of alcohol and other drug (AOD dependence who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis and who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.

Intent of measure

This measure is designed to ensure that treatment is initiated once the need has been identified, and will permit comparison of effectiveness in initiating care. (Source 2)

Questions

  1. To qualify as a New Episode: a 60-day Negative Diagnosis History prior to the Index Episode Start Date. If the Index Episode Start Date was an inpatient visit, use the admission date to determine the 60-day negative diagnosis history.
  2. Given the above requirement, determining whether the Index Episode is a New Episode will not be possible if the Index Episode (i.e. the earliest encounter) falls within the first 60 days of the current measurement period (unless the encounters in the last 60 days of the previous measurement year are also considered). For example, if the Index Episode in the current measurement period is Jan 15, going back 60 days to confirm Negative Diagnosis History would bring it to Nov 15 of the previous year (which is outside of the measurement period of Jan 1 – Nov 15)
  3. What is the definition of episode / encounter? Is the 60-day Negative Diagnosis History a standard definition for new episode?
  4. Do we need to capture the facility code? (In the “Adjustment” for this measure (in NQF website), the following statement exists: “Inpatient Facility Code: The place of service or facility code, indicating that care was provided at an inpatient facility)? Is capturing the visit type sufficient (e.g. acute inpatient)? (How is this actually used in the measure (it is not referenced in the numerator nor denominator)

General Questions

  1. What is the difference between a Procedure and Service?
  2. Does the standard_concept for (1) Procedure; (2) Diagnosis / Condition / Problem; and (3) Encounter in the NQF Retooled Measure need to be captured (e.g. in NQF 0004, there are two standards_concepts for Procedure (“alcohol, drug, rehab and detox interventions” and “detoxification interventions”). In the chart below, the standard_concept is intended to be captured under “type of procedure”, “type of diagnosis”, and “type of procedure” respectively.
  3. Do we want to distinguish primary diagnosis or principal procedure in the encounter? This distinction maybe important if the data is based on a claim e.g. billing data

Feedback to NQF Comment Period

  1. (Typo in Description in “NQF_HQMF_HumanReadable_0004.pdf”) “The percentage of adolescent and adult patients with a new episode of alcohol and other drug (AOD) dependence who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis and who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.”
  2. Should the following statement (in the NQF website) included in the Numerator not be in the Adjustment or Exclusion section? “Step 4: Exclude from the denominator patients whose initiation service was an inpatient stay with a discharge date after December 1.”.
  3. In the NQF website, section “b” of the numerator seems to be a duplicate of “a”.
  4. In the NQF website, in the Adjustment section, there is typo: To quality (must be changed to qualify) as a New Episode…

Information class / Information attribute / relationship / Definition / Repetition[MAJ1] / Information type
Patient / dob / date and time the patient was born / 1 / date/time
has visit / represents interaction between a healthcare provider and a patient with a face‐to-face patient visit to a clinician’s office, or any electronically remote interaction with a clinician for any form of diagnostic treatment and/or therapeutic event. * / 1..* / visit
has diagnosis / a scientific interpretation of result, assessment, and treatment response data that persists over time and tends to require intervention or management, or a clinical feature that is treated, monitored, evaluated, or impacts other treatment or venues of care (e.g., encounters or lengths of stay). * / 1..* / diagnosis
has procedure / a course of action intended to achieve a result in the care of persons with health problems. It is generally invasive and involves physical contact. A procedure may be a surgery or other type of physical manipulation of a person’s body in whole or in part for purposes of making observations and diagnoses and/or providing treatment. * / 1..* / procedure
Visit / type of visit / further identifies the type of visit
list of encounter specializations:
  • encounter acute inpt
  • encounter ED
  • encounter non-acute inpatient
  • encounter outpatient BH
  • encounter outpt BH req POS
  • Encounter point of service modifier

visit code / code that identifies what the visit is / 1..* / coded value
start and end date / date and time when the visit started and finished / 1 / date/time
Substance Abuse Diagnosis / type of diagnosis / further identifies the type of diagnosis: alcohol or drug dependence
diagnosis code / code that identifies what the diagnosis is / 1..* / coded value
onset date / date and time when the / 1 / date/time
Procedure / type of procedure / further identifies the type of procedure
list procedure specializations:.
  • Alcohol, drug rehab and detox interventions
  • detoxification interventions

procedure code / code that identifies the procedure performed / 1..* / coded value
procedure date / date and time when the procedure was performed / 1 / date/time

[MAJ1]

The current cardinality is meant to indicate that this particular measure is interested in multiple visit types, and each visit type has multiple codes. But from a modeling perspective, an instance of a visit will have 0..1 type of visit and 0..1 visit code.

The vocabulary bindings are different.