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SUB-3a Alcohol & Other Drug Use Disorder Treatment Provided or Offered at Discharge and SUB-3a Alcohol & Other Drug Use Disorder

The measure is reported as an overall rate which includes all hospitalized patients 18 years of age and older to whom alcohol or drug use disorder treatment was provided, or offered and refused, at the time of hospital discharge, and a second rate, a subset of the first, which includes only those patients who received alcohol or drug use disorder treatment at discharge. The Provided or Offered rate (SUB-3) describes patients who are identified with alcohol or drug use disorder who receive or refuse at discharge a prescription for FDA-approved medications for alcohol or drug use disorder, OR who receive or refuse a referral for addictions treatment. The Alcohol and Other Drug Disorder Treatment at Discharge (SUB-3a) rate describes only those who receive a prescription for FDA-approved medications for alcohol or drug use disorder OR a referral for addictions treatment. Those who refused are not included.

These measures are intended to be used as part of a set of 4 linked measures addressing Substance Use (SUB-1 Alcohol Use Screening ; SUB-2 Alcohol Use Brief Intervention Provided or Offered; SUB-3 Alcohol and Other Drug Use Disorder Treatment Provided or Offered at Discharge; SUB-4 Alcohol and Drug Use: Assessing Status after Discharge [temporarily suspended]).

Date Reviewed: July 21, 2018

Measure Info

NQF 1664CMS SUB-3aNQF Endorsement Removed
Measure Type: 
Process
Measure Steward: 
The Joint Commission
Clinical Topic Area: 
Prevention and Wellness
Substance Use

Care Setting: 
Inpatient
Data Source: 
Electronic Health Records
Paper Medical Records

ACP does not support NQF measure #1664: “SUB-3a Alcohol & Other Drug Use Disorder Treatment Provided or Offered at Discharge and SUB-3a Alcohol & Other Drug Use Disorder.” This measure represents an important clinical concept; however, we note several suggestions for developers to consider when submitting the measure to NQF for re-endorsement. First, implementation may encourage overuse of medically assisted therapies while the best evidence for treating drug- and alcohol-use disorders includes pharmacotherapy coupled to counseling. Second, there is insufficient evidence to support the benefit of referring patients to counseling upon discharge from the inpatient setting on improvements in drug and alcohol consumption rates. Third, referrals to Alcoholics Anonymous or to the primary care clinician should fulfill the numerator requirements. Otherwise, implementation could unfairly penalize clinicians who practice in rural areas where patients have limited access to counseling services. Fourth, the numerator specifies FDA-approved medications as appropriate options for pharmacotherapy. There is limited evidence to support the benefit of all FDA-approved medications (e.g., disulfiram) on drug and alcohol consumption rates. Better data exists to support the benefit of off-label prescribing on improvements in drug and alcohol consumption rates (e.g., Topiramate).

As part of an ongoing effort to improve user experience, we have made some updates to the Performance Measures section of ACP. Tell us what you think!