Expert Panel Nominations

Post new nomination... Cancel

Draft Standards

(0 comments)

Standard 0001: Program routinely uses standardized verbal or written questionnaire screener to identify patients who require clinical intervention related to their substance use beyond routine education about prevention of relapse.

Performance Requirements for 0001

• 0001 - Percent of Patients annually screened for risk of problems due to drinking or substance use (including non-medical use of prescription medications)

Numerator: Eligible patients with medical record documentation of screening for alcohol use with AUDIT-C or full AUDIT and the NIDA one question drug use screener.

Denominator: Adult patients

Scoring: (numerators from both cohorts) added and divided by (the sum of both denominators) multiplied by 100 to convert to a percent.

(0 comments)

Standard 0002: Program routinely provides brief motivational enhancement-oriented counseling for patients who screen positive for unhealthy alcohol or drug use to promote reduced hazardous use of alcohol and other drugs and prevent future complications or dependence.

Performance Requirements for 0002

• 0001 - Percent of adult patients who receive a brief intervention for unhealthy or dependent alcohol use or substance use (including non-medical use of prescription medications).

Numerator: Eligible patients with medical record documentation of brief counseling for unhealthy alcohol and/or drug use.

Denominator: Adult patients.

Scoring: numerator divided by the denominator, multiplied by 100 to convert ot a percent.

Rationale: Brief intervention is a separate procedure from screening. Although the proportion of adults patients who receive a brief intervention depends on the prevalence of unhealthy and dependent alcohol and drug use (including prescription medication misuse) in the base population (e.g., geriatric practices will have lower prevalence than family practices or psychiatric practices), medical records documentation of brief interventions for substance use problems ought not be rare phenomena (~7.5% in routine ambulatory primary care practice)

(0 comments)

Standard 0003: Program monitors substance use and encourges reduction or abstinence.

Performance Requirements for 0003

(0 comments)

Standard 0004: For patients who are medically unstable (e.g., acute trauma, myocardial infarction, and stroke) or psychiatrically unstable (e.g., delirium and imminent risk of harm to self and/or others) or acutely intoxicated, the program makes appropriate referrals for urgent and specialty substance use care or secures substance use consultation to manage the acute episode, and to provide continued care management.

Performance Requirements for 0004

Add new Standard... Cancel

Draft Performance Requirements

(0 comments )
Note: Use the section above to draft a new Standard (or click on the buttons next to an existing draft standard to modify it). When creating or modifying a draft Standard, you may add or modify Performance Requirements associated with that Standard. A Standard represents the basic concept and a Performance Requirement describes the means to assess compliance with the standard.

If you would like to draft a Performance Requirement, but you are unsure about an overarching Standard (i.e., something important to measure but the concept is not yet defined) you can use this section to create the draft Performance Requirement.

Add new Performance Requirement... Cancel

Comments

30 Apr 08 16:49 | CarolGirard said...:
Decades of research show that SBI can reduce repeat hospital visits, save lives, families and communities. Health care providers should not wait until a patient has an obvious addiction to address his or her unhealthy drug or alcohol use. SBI, endorsed by many national and international professional groups, is critical to patient safety and its routine implementation is a sign of basic high quality care. The majority of patients screen negative, so inserting a few questions into the workflow should not create significant problems. When a patient screens positive for risky use, then time should be made to address that risk. Workflows are adjusted when a patient’s blood pressure, cholesterol or glucose levels show high levels of risk. This risk is just as deadly if it’s ignored.

In Massachusetts we are working to establish and sustain SBIRT through both federal and state funded efforts. Our SAMHSA-funded MASBIRT project uses a lay Health Promotion Advocate model in inpatient, ED and clinic settings. Advocates screen and provide brief interventions; a referral coordinator makes referrals when needed. Workflows have been negotiated with each clinical site. Our state-funded Hospital ED project also uses the lay Health Promotion Advocate model. Our Community Health Center project involves 32 Health Centers where Medical Assistants do most of the screening when vital signs are taken, brief interventions are done by nurses or social workers, and referrals are made by social workers or care managers. It would be very helpful to have standards address who can appropriately do SBI. This important practice does not necessarily have to be done by a physician or nurse to be effective – though their participation, support and reinforcement are vital.

30 Apr 08 04:34 | KennethSaffier said...:
Despite the evidence that clearly shows how SBIRT is effective in preventing and decreasing morbidities, there is a tremendous gap between what is known and day to day practice. The 2000 CASA study, Missed Oportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse, (www.casacolumbia.org), showed how patients are not being provided these essential services. When JCAHO requires a standard be met in order for a health care organization to receive a higher rating, our administrators and health care providers, respond to meet these standards. There are very few other incentives that move us to action more than the JCAHO coming to review our work. Given the reality of our societal, professional and individual denial of alcohol and drug problems, our patients who are harmfully involved with alcohol and drugs, especially tobacco/nicotine, and we health professionals, need JCAHO's help. JCAHO can motivate us to regularly include SBIRT and not neglect these highly effective tools. With such a standard, the JCAHO can set in motion a cascade of positive changes in patient care, as well as in medical and other health professional education and training.

29 Apr 08 13:09 | SuzyBibawy said...:
I think SBI should start in the primary care physician office who sometimes is surprized to hear from the ED or the detox unit that his patient whom he has been treating for many years has an alcohol problem.It is time to add this clear question to our history taking practice "how often do you consume more than 2 drinks a day . It is an encouraging way to lead the patient to elaborate more and allow the physician to advice and explain.

29 Apr 08 09:09 | MjsGray said...:
Implementing SBI into any setting can be a challenge. Not once have I heard "Gee, I have plenty of time to do SBI" in the several times I have assisted a practice with implementation. But the key is the how to implement and to value the voices and ideas of those involved (and they all will be involved). Lesson learned: You can have all the administrative support in SBI, but if you don't have those in the front-line/direct-service roles and their supervisors backing it, it will be an uphill battle from the onset. It is key to seek and obtain the feedback from those that work with the patients day-to-day. These are the people that will help determine how to implement and often, you will find someone willing to step-up and become the lead person supporting the effort. This is ideal and will help reinforce doing SBI on a daily basis. This approach helps everyone own the work and something they want to see succeed. And yes, you will feel resistance because it is normal and should be acknowledged. Most importantly, resistance should be heard and appreciated. It will help you get the job done.

26 Apr 08 16:11 | JosephDe said...:
Recovery is a life-long process. Treatment must be evidence based.
Drug abuse, including opioid addiction and polysubstance abuse (benzodiazepines, cocaine, amphetamines, THC, methamphetamine) is not a simple problem with a simple solution. SBI can help to identify afflicted individuals, but treatment modalities must conform to evidence based rather than annecdotal and traditional methods. Troubling statistics tell us that polysubstance abuse is too often supported by uninformed prescribing. Abstinence based approaches work long-term for very few individuals afflicted with opioid addiction. Rapid detox (3-5 days) with sublingual buprenorphine use has well documented and significant failure rates (98% relapse rate within 30 days is frequently reported). Any efforts at SBI as a realistic addition to treating the millions of US citizens afflicted with opioid addiction and/or polysubstance abuse must seriously persue referral to long-term outpatient programs that provide group and individual counseling as well 12-step methodology and pharmacological support through the concommitant use of well monitored suboxone administration.

Many physicians have been offering such programs for long enough periods to have compiled data that conclusively supports the use of medical, psychological, sociological (including 12-step) modalities of treatment as being necessary for outcomes that include long-term sustainable recovery. By long-term sustainable recovery we are speaking to an individual's ability to live a meaningful life with return of responsible behavior and relationships without the use of any drugs of addiction. Such recovery is a life-long process.

Unless SBI begins with this kind of referral perspective it will do nothing to improve the poor US statistics currently noted for successful outcomes in the treatment of opioid addiction and polysubstance abuse.

23 Apr 08 13:04 | JPaulSeale said...:
The evidence base for screening and brief intervention for alcohol misuse has been well established in the scientific literature and endorsed by the US Preventive Services Task Force. Greatest benefit is for patients with risky drinking, and significant benefit for those with alcohol abuse and alcoholism. SBI decreases alcohol consumption and decreases healthcare costs. Alcohol misuse is the 3rd leading cause of death and disability in the U.S. As such, it should be given priority on a level with management of hypertension, diabetes and tobacco abuse. SBI can be implemented in primary care settings without negatively impacting workflow. We have accomplished this in an NIH training proposal in 8 Family Medicine residency programs. The Cutting Back study, which did the same in an HMO setting, demonstrated that brief interventions by MD's and other health professionals, performed in 3 to 5 minutes in an HMO setting, resulted in significant reductions in drinking. Implementation is now feasible and reimbursable with the new 2008 CPT codes. Because many physicians have not been trained in doing brief interventions, dissemination has been slow. A standard from JCAHO would force us to provide this effective preventive service, in the same way that JCAHO standards for tobacco interventions in hospitals have increased this important service.

Please Login or register to post comments.