Improving Pain Management Safety

Title

Improving Pain Management Safety

Description

Percent of households where at least one individual is at risk for adverse opioid event, like overdose or respiratory depression, with naloxone available.

A higher score is better

Rationale

Many individuals are at increased risk for adverse events associated with opioid use. Additionally, many states have implemented standing protocols for naloxone dispensing without prescription to patients or caregivers of patients at risk for adverse opioid events. This measure ensures, at a household level, naloxone is available to any patient.

Logic Model

This measure ensures any household at risk for adverse opioid events is evaluated and provided treatment.

Level of Analysis

Pharmacy (Patient)

Data Source

Pharmacy Data

Denominator Statement

Any household with a patient at risk for adverse opioid event defined as patients prescribed opioids and any of the following:

• ·      ≥50 morphine milligram equivalents per day
• ·      Concomitant use of sedating medications, like benzodiazepines

Denominator Calculation

1.    1. All individuals in the pharmacy

2.   2. All individuals prescribed an opioid

3.   3. All individuals with risk factor (≥50 MME or benzodiazepine)

4.   4. Exclude non-human patients

5.   5. Identify each unique household

Denominator Exclusions

Any non-human patients (e.g., cats, dogs, clinics, office-use, etc)

Denominator Exclusion Rationale

Pharmacies may provide care to pets or other veterinarian needs, or for office-use. This patient profiles should be excluded from the measure calculation.

Numerator Statement

Household from the denominator with a naloxone dispensed during the measurement year

Numerator Calculation

1.     1. Identify all naloxone prescriptions dispensed from the pharmacy

2.    2. Identify each household with a naloxone prescription

3.    3. Households that have a match in the denominator are in the numerator.

Seguridad Measure Specification Process

Data Stratification

The measure rate will be reported as a percent of patients within a single pharmacy.

If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care).

If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate).

Risk adjustment will be applied when available.

Value Sets

The value set Seguridad – Opioids and Seguridad – Opioid Risk Medications will be used to support the exclusion criteria.

Future Iterations

Many pharmacy measures are designed as structure or process. Future goals of this concept include measures focused on appropriate dosing based on renal function and assessment of all patients.

Harmonization¹

Payors: PQA’s Opioid Measure Set

Providers: PQA’s Opioid Measure Set