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Complete Summary


TITLE

Assessment and management of chronic pain: percentage of patients diagnosed with chronic pain who are prescribed an opioid who have an opioid agreement form and urine toxicology screen documented in the medical record.

SOURCE(S)

  • Institute for Clinical Systems Improvement (ICSI). Assessment and management of chronic pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Jul. 84 p. [171 references]

Measure Domain

PRIMARY MEASURE DOMAIN

SECONDARY MEASURE DOMAIN

Does not apply to this measure

Brief Abstract

DESCRIPTION

This measure is used to assess the percentage of patients diagnosed with chronic pain who are prescribed an opioid who have an opioid agreement form and urine toxicology screen documented in the medical record.

RATIONALE

The priority aim addressed by this measure is to improve the effective use of opioid medications in the treatment of adult patients with chronic pain.

PRIMARY CLINICAL COMPONENT

Chronic pain; cervical and lumbar pain; headache; other disorders of soft tissues; myalgia/myositis and unspecified fibromyositis; opioids; opioid agreement form; urine toxicology screen

DENOMINATOR DESCRIPTION

All patients 16 years and older who meet the criteria for chronic pain or related diagnosis who are prescribed an opioid (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

NUMERATOR DESCRIPTION

Number of medical records that are reviewed that have evidence of an opioid agreement form and a urine toxicology screen

Evidence Supporting the Measure

EVIDENCE SUPPORTING THE CRITERION OF QUALITY

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

NATIONAL GUIDELINE CLEARINGHOUSE LINK

Evidence Supporting Need for the Measure

NEED FOR THE MEASURE

Unspecified

State of Use of the Measure

STATE OF USE

Current routine use

CURRENT USE

Internal quality improvement

Application of Measure in its Current Use

CARE SETTING

Physician Group Practices/Clinics

PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

TARGET POPULATION AGE

Age greater than or equal to 16 years

TARGET POPULATION GENDER

Either male or female

STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

Characteristics of the Primary Clinical Component

INCIDENCE/PREVALENCE

Unspecified

ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

BURDEN OF ILLNESS

Unspecified

UTILIZATION

Unspecified

COSTS

Unspecified

Institute of Medicine National Healthcare Quality Report Categories

IOM CARE NEED

Living with Illness

IOM DOMAIN

Effectiveness
Patient-centeredness

Data Collection for the Measure

CASE FINDING

Users of care only

DESCRIPTION OF CASE FINDING

Patients age 16 years and older with chronic pain

Each month, a sample of patients with chronic pain seen in the past month is identified by specific International Classification of Diseases, Ninth Revision (ICD-9) codes (see the "Denominator Inclusions/Exclusions" field) or other ICD-9 codes identified by the organization*.

A chart abstraction is conducted to determine whether or not there is any evidence of an "Opioid Agreement" and a urine toxicology screen in the medical record.

Suggested data collection time frame is monthly.

*Refer to the original measure documentation for suggestions on identifying other ICD-9 codes.

DENOMINATOR SAMPLING FRAME

Patients associated with provider

DENOMINATOR INCLUSIONS/EXCLUSIONS

Inclusions
All patients 16 years and older who meet the criteria for chronic pain* or related diagnosis as identified by the following International Classification of Diseases, Ninth Revision (ICD-9) codes who are prescribed an opioid

A few examples are:

  • Chronic Pain: 338.xx**
  • Cervical and Lumbar Pain: 720.x, 721.x, 722.x, 723.x, 724.x, 847.x
  • Headache: 307.8x, 784.0
  • Other disorders of soft tissues: 729.x
  • Myalgia and myositis, unspecified fibromyositis: NOS: 729.1

*Chronic pain is defined as:

  • Persistent pain
  • Either continuous or recurrent
  • Of sufficient duration and intensity to adversely affect a patient's well-being, level of function, and quality of life

At six weeks (or longer than the anticipated healing time), patients should be thoroughly evaluated for the presence of chronic pain.

Chronic pain syndrome is defined by the work group as a constellation of behaviors related to persistent pain that represents significant life role disruption that occurs at the end of the spectrum of chronic pain.

**Refer to the International Classification of Diseases 2008 ICD-9-CM, page 13, regarding specifications for the 338 ICD-9 codes.

Exclusions
Unspecified

RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the numerator

DENOMINATOR (INDEX) EVENT

Clinical Condition
Encounter
Therapeutic Intervention

DENOMINATOR TIME WINDOW

Time window is a single point in time

NUMERATOR INCLUSIONS/EXCLUSIONS

Inclusions
Number of medical records that are reviewed that have evidence of an opioid agreement form and a urine toxicology screen

Exclusions
Unspecified

MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

NUMERATOR TIME WINDOW

Episode of care

DATA SOURCE

Administrative data
Medical record

LEVEL OF DETERMINATION OF QUALITY

Individual Case

PRE-EXISTING INSTRUMENT USED

Unspecified

Computation of the Measure

SCORING

Rate

INTERPRETATION OF SCORE

Better quality is associated with a higher score

ALLOWANCE FOR PATIENT FACTORS

Unspecified

STANDARD OF COMPARISON

Internal time comparison

Evaluation of Measure Properties

EXTENT OF MEASURE TESTING

Unspecified

Identifying Information

ORIGINAL TITLE

Percentage of patients diagnosed with chronic pain who are prescribed an opioid who have an opioid agreement form and urine toxicology screen documented in the medical record.

MEASURE COLLECTION

DEVELOPER

Institute for Clinical Systems Improvement

FUNDING SOURCE(S)

The following Minnesota health plans provide direct financial support: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, PreferredOne and UCare Minnesota. In-kind support is provided by the Institute for Clinical Systems Improvement's (ICSI) members.

COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Work Group Members: Richard Timming, MD (Work Group Leader) (HealthPartners Medical Group) (Physicial Medicine and Rehabilitation); Steven Daniels, MD (MeritCare) (Anesthesiology); W. Michael Hooten, MD (Mayo Clinic) (Anesthesiology); Brian Bonte, DO (Hutchinson Medical Center) (Family Medicine); David von Weiss, MD (Park Nicollet Health Services) (Family Medicine); Susan Ferron, MD (Community University Health Care Center) (Internal Medicine); James Smith, MD (HealthPartners Medical Group) (Internal Medicine); Miles Belgrade, MD (Fairview Health Services) (Neurology); Patrick Rivard, RN (Gillette Children's Specialty Healthcare) (Nursing); Fozia Abrar, MD (HealthPartners Medical Group) (Occupational Medicine); Neal Walker, RPh (Fairview Range Regional Health Services) (Pharmacy); Michael Gonzales, MD (MeritCare) (Physical Medicine and Rehabilitation); Barbara Bruce, PhD (Mayo Clinic) (Psychology); Janet Jorgenson-Rathke, PT (Institute for Clinical Systems Improvement) (Measurement/Implementation Advisor); Pam Pietruszewski, MA (Institute for Clinical Systems Improvement) (Facilitator)

FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

ADAPTATION

Measure was not adapted from another source.

RELEASE DATE

2007 Mar

REVISION DATE

2008 Jul

MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems Improvement (ICSI). Assessment and management of chronic pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Mar. 87 p.

SOURCE(S)

  • Institute for Clinical Systems Improvement (ICSI). Assessment and management of chronic pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Jul. 84 p. [171 references]

MEASURE AVAILABILITY

NQMC STATUS

This NQMC summary was completed by ECRI on May 29, 2007. This NQMC summary was updated by ECRI Institute on October 24, 2008.

COPYRIGHT STATEMENT

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.

Disclaimer

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