Overview
In partnership with CMS, NQF will convene a multistakeholder Committee of experts to oversee the development of a measurement framework that addresses polysubstance use involving synthetic or semi-synthetic opioids (SSSO) among individuals with co-occurring Behavioral Health (BH) conditions. This activity will further identify measure gaps and priorities relevant to the United States opioid overdose epidemic and the broad healthcare quality challenges that surround it.
The Opportunity
Opioid-related overdose deaths and morbidity have emerged as a complex and evolving challenge for the U.S. healthcare system. According to the National Center for Health Statistics, there were an estimated 100,306 drug overdose deaths in the United States from April 2020 – April 2021, with 75,673 opioid related overdose deaths.1 This provisional data represents a stark increase from overdose deaths in the preceding year.1 Overdose deaths from synthetic opioids also increased in the 12-month period ending in April 2021.1
Quality measures related to opioid use are a key component to holding care providers, payors, and policy-makers accountable for the best possible care regarding pain management and substance use dependence treatment and prevention.3 In 2019-2020, NQF convened a 28-member TEP with expertise in pain management and opioid use disorder (OUD) to address opioid measurement challenges. The NQF Opioid TEP made a series of recommendations related to identifying and prioritizing gaps in quality measures needed to be filled in order to reduce OUD and opioid overdose deaths without undermining effective pain management.4 The TEP recognized an emerging “fourth wave” of the opioid epidemic related to polysubstance use. Increasingly, individuals with OUD are more likely to use psychostimulants such as amphetamines, use opioids with other substances during the same use period, and suffer from concomitant psychiatric conditions such as anxiety, depression, and suicidal ideation.5 In 63% of opioid overdose deaths, evidence of co-occurring prescription or illicit drug use was also present.6 Because of the clear connection of concomitant BH conditions with OUD and the impact of polysubstance use on opioid mortality and morbidity, the TEP prioritized the identification and development of measures that address comorbidities of OUD with psychiatric conditions and substance use disorders (SUD).
About the Project
Base Year
During the Base Year, NQF convened a 28-member Committee to help develop a quality measurement framework to address overdose and mortality resulting from polysubstance use involving synthetic and semi-synthetic opioids (SSSOs) among individuals with co-occurring behavioral health conditions. The goal of the measurement framework is to improve the prevention and monitoring of SUD/OUD, opioid-related overdoses, and opioid-related mortality among individuals with co-occurring behavioral health conditions who use SSSOs with other legal and/or illegal drugs. At the end of the Base Year, NQF, in collaboration with the Committee, produced an Environmental Scan and a Final Report titled, Addressing Opioid-Related Outcomes Among Individuals With Co-occurring Behavioral Health Conditions.
Option Year
The Option Year builds on the foundational work established in the Base Year by further refining the Final Report to help users implement the measurement framework.
Objectives
During the Option Year, the Committee will provide input and guidance to:
- Revise the measure inventory to reflect any new and relevant quality measures
- Identify a series of guiding principles for successful and equitable implementation of the three domains in the measurement framework
- Create a detailed use case to support various stakeholders applying and adapting the measurement framework
NQF Process
During the Option Year period of performance, NQF will convene the multistakeholder Committee for seven web meetings to elicit input from the Committee. Committee expertise will inform the updates the measurement framework from the Base Year, and will guide the measure inventory update, identification of the guiding principles, and creation of the use case for inclusion in the Final Report.
Funding
This project is funded under NQF’s contract with the Department of Health and Human Services. For information about the availability of auxiliary aids and services for NQF’s federally funded projects, please visit
http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.
Related NQF Work
Contact Information
For more information, please contact the project team at opioidbehavioralhealth@qualityforum.org.
Footnotes:
1 Wilson N, Kariisa M, Seth P, Smith H, Davis N. Drug and Opioid-Involved Overdose Deaths – United States, 2017-18. MMWR Morb Mortal Wkly Rep. 69(11);290–297. DOI: 10.15585/mmwr.mm6911a4
2 Barry C. Fentanyl and the Evolving Opioid Epidemic: What Strategies Should Policy Makers Consider? Psychiatric Services. 2018, 69:100- 103. DOI: 10.1176/appi.ps.201700235
3Nicholson A. Medication-Assisted Treatment for Opioid Use Disorder, Proceedings of a Workshop—in Brief. The National Academies Press. http://nap.edu/25322.
4National Quality Forum. Opioid and Opioid Use Disorder: Quality Measurement Priorities Final Report. Feb 2020. Accessed at https://www.qualityforum.org/Opioid_and_Opioid_Use_Disorder_TEP.aspx
5 Snyder SM, Morse SA, Bride BE. A Comparison of 2013 and 2017 Baseline Characteristics Among Treatment-seeking Patients Who Used Opioids with Co-occurring Disorders. Substance Abuse. April 2019, Volume 99, pp. 134-138. doi: 10.1016/j.jsat.2019.01.023
6 Gladden RM, O’Donnells J, Mattson CL, et al. Changes in Opioid-Involved Overdose Deaths by Opioid Type and Presence of Benzodiazepines, Cocaine, and Methamphetamine – 25 States, July – December 2017 to January – June 2018. MMWR Morb Mortal Wkly Rep. August 30, 2019;68:737–744.