Summit: Using Performance and Outcome Measures to Improve Treatment National Quality Forum National Voluntary Consensus Standards for Treatment of Substance Use Conditions: Evidence-Based Treatment Practices Los Angeles, CA March 20,2008 Victor A Capoccia PhD

Our Context How do we know that what we do is right? If it is right, how do we know if we are doing it well? If we are doing it well, how do we know if it makes a difference?

The Context Of NQF Quality Measurement of Addiction Treatment RWJF strategy for promoting quality in addiction treatment The NQF process and legitimacy for consensus standards

Why NQF Consensus? 6. What Is The Policy For Federal Use Of Standards? All federal agencies must use voluntary consensus standards in lieu of government-unique standards in their procurement and regulatory activities, except where inconsistent with law or otherwise impractical. In these circumstances, your agency must submit a report describing the reason(s) for its use of government-unique standards in lieu of voluntary consensus standards to the Office of Management and Budget (OMB) through the National Institute of Standards and Technology (NIST). a. When must my agency use voluntary consensus standards? –Your agency must use voluntary consensus standards, both domestic and international, in its regulatory and procurement activities in lieu of government-unique standards, unless use of such standards would be inconsistent with applicable law or otherwise impractical. In all cases, your agency has the discretion to decline to use existing voluntary consensus standards if your agency determines that such standards are inconsistent with applicable law or otherwise impractical. –(1) "Use" means incorporation of a standard in whole, in part, or by reference for procurement purposes, and the inclusion of a standard in whole, in part, or by reference in regulation(s). –(2) "Impractical" includes circumstances in which such use would fail to serve the agency's program needs; would be infeasible; would be inadequate, ineffectual, inefficient, or inconsistent with agency mission; or would impose more

NQF Standards for Evidence Based Practices: Domain 1 Identification of Substance Use Conditions:  Screening and case finding  Assessment and diagnoses for positive screens

NQF Standards for Evidence Based Practices: Domain 2 Initiation and Engagement in Treatment  Brief intervention  Promoting engagement  Withdrawal management

NQF Standards for Evidence Based Practices: Domain 3 Therapeutic Interventions to Treat Substance use Illness  Psychosocial interventions  Pharmacotherapy

NQF Standards for Evidence Based Practices: Domain 4 Continuing Care Management of Substance Use Illness  Long term continuing care management, self management, and recovery support

Let’s look at another condition: Diabetes

National Quality Measures Clearing House: Diabetes 89 measures 3 levels of patient indicators Primary outcome: HbA1c Secondary outcome: weight loss, blood pressure, etc. Quality of life: satisfaction, worry, etc Treatment practices: e.g. foot exam, Rx System practices: e.g. patient registry

Let’s look at addiction disorders

National Quality Measures Clearing House: Substance Use Disorders 64 measures Levels of patient indicators Primary outcome: none (What would you use?) Secondary outcome: screening for use Quality of life: family, job, justice involvement Treatment practices: MAT, other NQF,NOMS System practices: access, retention, NOMS, WCG Community practices: crime, employment, housing, other NOMS

AHRQ Clearinghouse Criteria

WCG, NQF, NOMS Aligning Quality Measures Focus of measures Adoption of measures Operationalize measures Availability of data

Focus of Measures Patient outcome Primary, secondary, self report Treatment intervention or practice System process or performance Community

Adoption of Measures Mandate (Oregon law, congress) Voluntary (early adopter) Purchaser required (SSA, MCO) Accreditation (CARF, JCAHCO)

Operationalize Measures Definition (key element, e.g. ‘continuing care’) Quantified (time, dose, dichotomous more/less) Tested (field tested) Reported (feedback)

Availability of Data: Billing system ( # visits) Electronic Medical Record (level of functioning) Special survey (any type) State MIS report (demographic, utilization) Existing survey (e.g.TEDS NSTATS)

Focus of Measures Adoption of Measures Operationalize Measure Data Available NQF -Ident -Init and Engage -Treat Intervent -Continuing Care Washington Circ -SBI -MAT -Recov Mgmt NOMS -level of funct -emp and schl -CJ involv -stability fam _access -bed use -socl supp -client report -cost effect -use of EBP

NQF Next Steps Disseminate standards Coordinate with WCG, NOMS (SAMHSA) Operationalize 2-4 practice measures Test measures Incorporate into regular reporting mechanism