Vue.component('omp-overview', {
template:
'<div>' +
'<el-row>' +
'<h1 style="text-align: center">Use of Opioids from Multiple Providers in Persons Without Cancer (OMP)</h1>' +
'</el-row>' +
'<el-row>' +
'<h2 id="omp-description" class="scrollspy">Description</h2>' +
'</el-row>' +
'<el-row>' +
'<p>The percentage of individuals ≥18 years of age who received prescriptions for opioids from ≥4 prescribers AND ≥4 pharmacies within ≤180 days.</p>' +
'<p>A lower rate indicates better performance.</p>' +
'</el-row>' +
'<el-row id="omp-add-info" class="scrollspy">' +
'<h2>Additional Information</h2>' +
'</el-row>' +
'<el-row>' +
'<el-col :span="6">' +
'<p><b>Intended Use</b></p>' +
'</el-col>' +
'<el-col :span="18">' +
'<p>Performance measurement for health plans.</p>' +
'</el-col>' +
'</el-row>' +
'<el-row>' +
'<el-col :span="6">' +
'<p><b>Data Sources</b></p>' +
'</el-col>' +
'<el-col :span="18">' +
'<p>Medical and prescription claims data.</p>' +
'</el-col>' +
'</el-row>' +
'<el-row>' +
'<el-col :span="6">' +
'<p><b>Denominator</b></p>' +
'</el-col>' +
'<el-col :span="18">' +
"<p>Individuals ≥18 years of age with ≥2 prescription claims for opioid medications on different dates of service and with a cumulative days' supply ≥15 during the measurement year.</p>" +
'</el-col>' +
'</el-row>' +
'<el-row>' +
'<el-col :span="6">' +
'<p><b>Exclusions</b></p>' +
'</el-col>' +
'<el-col :span="18">' +
'<p>Hospice, cancer, and sickle cell disease.</p>' +
'</el-col>' +
'</el-row>' +
'<el-row>' +
'<el-col :span="6">' +
'<p><b>Numerator</b></p>' +
'</el-col>' +
'<el-col :span="18">' +
'<p>Individuals from the denominator with opioid prescription claims from ≥4 prescribers AND ≥4 pharmacies within ≤180 days during the opioid episode.</p>' +
'</el-col>' +
'</el-row>' +
'</div>'
});
Vue.component('omp-ref-1', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
'<span>CDC. Wide-ranging online data for epidemiologic research (WONDER) [Internet]. Atlanta; GA: CDC; National Center for Health Statistics. 2016 [cited 2016 Dec 6]. Available from: <a href="http://wonder.cdc.gov" target="_blank">http://wonder.cdc.gov</a>.</span>' +
'<sup slot="reference">1</sup>' +
'</el-popover>'
});
Vue.component('omp-ref-2', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
'<span>HHS. National Action Plan for Adverse Drug Event Prevention. Washington, DC; 2014 [cited 2019 May 31]. Available from: <a href="https://health.gov/hcq/pdfs/ADE-Action-Plan-508c.pdf" target="_blank">https://health.gov/hcq/pdfs/ADE-Action-Plan-508c.pdf</a>.</span>' +
'<sup slot="reference">2</sup>' +
'</el-popover>'
});
Vue.component('omp-ref-3', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
'<span>National Drug Control Strategy. 2010 [cited 2016 Dec 6]. Available from: <a href="https://obamawhitehouse.archives.gov/sites/default/files/ondcp/policy-and-research/ndcs2010_0.pdf" target="_blank">https://obamawhitehouse.archives.gov/sites/default/files/ondcp/policy-and-research/ndcs2010_0.pdf</a>.</span>' +
'<sup slot="reference">3</sup>' +
'</el-popover>'
});
Vue.component('omp-ref-4', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
'<span>Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep. 2016 Mar 18;65(1):1-49. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/26987082" target="_blank">26987082</a>.</span>' +
'<sup slot="reference">4</sup>' +
'</el-popover>'
});
Vue.component('omp-ref-5', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
"<span>Interagency Guideline on Prescribing Opioids for Pain: Developed by the Washington State Agency Medical Directors' Group (AMDG) in collaboration with an Expert Advisory Panel, Actively Practicing Providers, Public Stakeholders, and Senior State Officials. 2015 [cited 2019 Jun 4]. Available from: <a href='http://www.agencymeddirectors.wa.gov' target='_blank'>http://www.agencymeddirectors.wa.gov</a>.</span>" +
'<sup slot="reference">5</sup>' +
'</el-popover>'
});
Vue.component('omp-ref-6', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
'<span>Franklin GM, Mai J, Turner J, et al. Bending the prescription opioid dosing and mortality curves: impact of the Washington State opioid dosing guideline. Am J Ind Med. 2012 Apr;55(4):325-31. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/22213274" target="_blank">22213274</a>.</span>' +
'<sup slot="reference">6</sup>' +
'</el-popover>'
});
Vue.component('omp-ref-7', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
'<span>Peirce GL, Smith MJ, Abate MA, et al. Doctor and pharmacy shopping for controlled substances. Med Care. 2012 Jun;50(6):494-500. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/22410408" target="_blank">22410408</a>.</span>' +
'<sup slot="reference">7</sup>' +
'</el-popover>'
});
Vue.component('omp-ref-8', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
'<span>Gwira Baumblatt JA, Wiedeman C, Dunn JR, et al. High-risk use by patients prescribed opioids for pain and its role in overdose deaths. JAMA Intern Med. 2014 May;174(5):796-801. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/24589873" target="_blank">24589873</a>.</span>' +
'<sup slot="reference">8</sup>' +
'</el-popover>'
});
Vue.component('omp-ref-9', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
'<span>Yang Z, Wilsey B, Bohm M, et al. Defining risk of prescription opioid overdose: pharmacy shopping and overlapping prescriptions among long-term opioid users in medicaid. J Pain. 2015; 16(5):445-53. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/25681095" target="_blank">25681095</a>.</span>' +
'<sup slot="reference">9</sup>' +
'</el-popover>'
});
Vue.component('omp-ref-10', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
'<span>Katz N, Panas L, Kim M, et al. Usefulness of prescription monitoring programs for surveillance--analysis of Schedule II opioid prescription data in Massachusetts, 1996-2006. Pharmacoepidemiol Drug Saf. 2010 Feb;19(2):115-23. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/20014166" target="_blank">20014166</a>.</span>' +
'<sup slot="reference">10</sup>' +
'</el-popover>'
});
Vue.component('omp-ref-11', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
'<span>CMS. Analysis fo Proposed Opioid Overutilization Criteria Modifications in Medicare Part D. 2017 [cited 2018 Sep 11]. Available from: <a href="https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Revised-OMS-Criteria-Modification-Analysis.pdf" target="_blank">https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Revised-OMS-Criteria-Modification-Analysis.pdf</a>.</span>' +
'<sup slot="reference">11</sup>' +
'</el-popover>'
});
Vue.component('omp-ref-12', {
template:
'<el-popover placement="top-start" width="400" trigger="hover">' +
'<span>National Center for Injury Prevention and Control. CDC compilation of benzodiazepines, muscle relaxants, stimulants, zolpidem, and opioid analgesics with oral morphine milligram equivalent conversion factors, 2017 version. Atlanta, GA: Centers for Disease Control and Prevention; 2017 [cited 2018 Sep 21]. Available from: <a href="https://www.cdc.gov/drugoverdose/resources/data.html" target="_blank">https://www.cdc.gov/drugoverdose/resources/data.html</a>.</span>' +
'<sup slot="reference">12</sup>' +
'</el-popover>'
});
Vue.component('omp-rationale', {
template:
'<div>' +
'<el-row id="omp-rationale" class="scrollspy">' +
'<h2>Rationale</h2>' +
'</el-row>' +
'<el-row>' +
'<p>Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, as did resultant deaths.' +
'<omp-ref-1></omp-ref-1>' +
' Prescription opioid-related deaths are now considered to be one of the leading preventable public health problems.' +
'<omp-ref-2></omp-ref-2>' +
' In 2010, the US government released its first National Drug Control Strategy stating that opioid overdose is a "growing national crisis".' +
'<omp-ref-3></omp-ref-3>' +
' Most fatal opioid overdoses have been shown to be associated with patients receiving these medications from multiple prescribers and/or patients receiving high total daily opioid dosages.' +
'<omp-ref-4></omp-ref-4>' +
' Therefore, these three related performance measures for use in persons without cancer evaluate opioid use: (a) at high dosage; (b) from multiple providers; and (c) at high-dosage and from multiple providers.</p>' +
/*'<p><strong>High-Dosage.</strong>' +
' According to the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain, the benefits of high-dose opioids for chronic pain are not established and the risks for serious harms increase in a dose-dependent manner.' +
'<omp-ref-4></omp-ref-4>' +
' Higher dosages are associated with increased risks for motor vehicle injury, opioid use disorder, and overdose. Dosages of 50 to <100 morphine milligram equivalents (MME)/day have been found to increase opioid overdose risk by factors of 1.9 to 4.6 compared to dosages of 1 to <20 MME/day. Furthermore, dosages ≥100 MME/day are associated with increased overdose by 2.0 to 8.9 times the risk at 1 to <20 MME/day. Although lower opioid dosages reduce the risk for overdose, a single dosage threshold for safe opioid use has not been identified.' +
'<omp-ref-4></omp-ref-4>' +
'</p>' +
'<p>The CDC prescribing guideline states that clinicians should: use caution when prescribing opioids at any dosage; carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 MME/day; and either avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day (recommendation category: A, evidence type: 3).' +
'<omp-ref-4></omp-ref-4>' +
" The State of Washington's (WA) Agency Medical Director's Group Interagency Guideline (AMDG) on Prescribing Opioids for Pain recommends not escalating chronic opioid analgesic therapy to >120 mg/day MME without first obtaining a consultation from a trained pain specialist who agrees that a high dose is indicated and appropriate." +
'<omp-ref-5></omp-ref-5>' +
" In a retrospective observational study using data from WA state workers' compensation system, the 2007 introduction of the AMDG opioid dosing guideline in WA appeared to be associated temporally with a 26% decline in the average dose for long-acting opioids and a 35% decline in percent of claimants receiving opioid doses of at least 120 MME/day." +
'<omp-ref-6></omp-ref-6>' +
' There was also 50% decrease in opioid-related deaths among injured workers from 2009 to 2010.</p>' +*/
'<p>' + //<strong>Multiple Providers.</strong>' +
' Use of multiple prescribers or pharmacies is associated with an increased risk for potentially fatal overdose, and the risk increases with the number of prescribers and pharmacies.' +
'<omp-ref-4></omp-ref-4><sup>,</sup><omp-ref-7></omp-ref-7><sup>,</sup><omp-ref-8></omp-ref-8><sup>,</sup><omp-ref-9></omp-ref-9>' +
' In a case-control study in West Virginia (2005-2007), subjects classified as doctor shoppers (≥4 prescribers in the previous 6 months) had 2 times the odds (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.6-2.6), and pharmacy shoppers (≥4 pharmacies in the previous 6 months) had 3 times the odds (OR, 3.2; 95% CI, 2.3-4.5) of drug-related death compared with those classified as non-shoppers.' +
'<omp-ref-7></omp-ref-7>' +
' Subjects classified as both doctor and pharmacy shoppers also had increased odds (OR, 3.6; 95% CI, 2.7-4.7) of drug-related death compared with non-shoppers.' +
'<omp-ref-7></omp-ref-7>' +
' Similarly, a matched case-control study among patients prescribed opioids in Tennessee (2008-2011) found an increased risk of opioid-related overdose death with ≥4 prescribers (adjusted OR [aOR], 6.5; 95% CI, 5.1-8.5), with ≥4 pharmacies (aOR, 6.0; 95% CI, 4.4-8.3), and with and average dose of >100 MME/day (aOR, 11.2; 95% CI, 8.3-15.1).' +
'<omp-ref-8></omp-ref-8>' +
'</p>' +
/*'<p>The criterion of ≥4 prescribers and ≥4 pharmacies has been used as an indicator of potential non-medical use and diversion of prescription opioids.' +
'<omp-ref-10></omp-ref-10>' +
' In an analysis of a multistate Medicaid claims database (2008-2010), the diagnostic odds ratio for opioid overdose events was found to be the highest (5.40) using a threshold of ≥4 pharmacies in a 90-day period.' +
'<omp-ref-9></omp-ref-9>' +
' Use of multiple prescribers and pharmacies can be monitored using prescription drug monitoring program (PDMP) data.' +
'<omp-ref-4></omp-ref-4>' +
'</p>' +*/
'<p>' + //<strong>Summary.</strong> These measures were
'This measure was designed for monitoring and improving quality of care across populations of patients and are not intended to guide clinical care for individual patients. Patients with cancer diagnoses and those receiving hospice care are excluded from the measures because of their unique therapeutic goals, ethical considerations, opportunities for medical supervision, and balance of risks and benefits.' +
'<omp-ref-4></omp-ref-4>' +
' When opioids are reduced or discontinued, they should be tapered slowly enough to minimize symptoms and signs of opioid withdrawal (e.g., drug craving, anxiety, insomnia, abdominal pain, vomiting, diarrhea, diaphoresis, mydriasis, tremor, tachycardia, or piloerection).' +
'<omp-ref-4></omp-ref-4>' +
'</p>' +
'</el-row>' +
'</div>'
});
Vue.component('omp-faqs', {
template:
'<div>' +
'<el-row id="omp-faqs" class="scrollspy">' +
'<h2>FAQs</h2>' +
'</el-row>' +
'<el-row>' +
'<el-collapse v-model="active">' +
'<el-collapse-item name="1">' +
"<template slot='title'><span style='font-size: 15px; text-decoration: underline; text-decoration: underline;'>Why is the eligible population limited to individuals with 2 or more fills and ≥ 15 days' supply?</span></template>" +
'<div style="font-size: 15px;">' +
'<p>The purpose is to exclude individuals with only irregular/one-time use of opioids, such as for dental procedures, from the denominator.</p>' +
'</div>' +
'</el-collapse-item>' +
'<el-collapse-item name="2">' +
'<template slot="title"><span style="font-size: 15px; text-decoration: underline;">Why are prescription opioid cold products not included in the measure?</span></template>' +
'<div style="font-size: 15px;">' +
'<p>Prescription opioid cough products are not included in the OHD measure because of the difficulty in accurately calculating daily morphine milligram (MME) equivalents.</p>' +
'</div>' +
'</el-collapse-item>' +
'<el-collapse-item name="3">' +
'<template slot="title"><span style="font-size: 15px; text-decoration: underline;">Why is buprenorphine not included in the medication list?</span></template>' +
"<div style='font-size: 15px;'>" +
'<p>Buprenorphine, as a partial agonist is not expected to be associated with overdose risk in the same dose-dependent manner as for full agonist opioids<omp-ref-12></omp-ref-12>. As a result, buprenorphine products do not have an associated MME conversion factor provided by the CDC for analytic purposes where prescription data are used to calculate MME to inform analyses of risks associated with opioid prescribing for pain.</p>' +
"</div>" +
'</el-collapse-item>' +
'<el-collapse-item name="4">' +
"<template slot='title'><span style='font-size: 15px; text-decoration: underline; text-decoration: underline;'>How are pharmacies and prescribers identified?</span></template>" +
"<div style='font-size: 15px;'>" +
"<p>PQA uses NPIs to identify prescribers. CMS has investigated the use of tax identification numbers (TIN) in the Overutilization Monitoring System (OMS) but did not find a significant impact to the measure rates<omp-ref-11></omp-ref-11>. PQA will consider other identifiers as new standards are adopted by the industry.</p>" +
"</div>" +
'</el-collapse-item>' +
'<el-collapse-item name="5">' +
'<template slot="title"><span style="font-size: 15px; text-decoration: underline;">How did PQA determine the ≥4 prescribers and ≥4 pharmacies threshold?</span></template>' +
"<div style='font-size: 15px;'>" +
'<p>PQA considered and tested various thresholds when the measure initially was developed. Based upon research studies<omp-ref-7></omp-ref-7><sup>,</sup><omp-ref-8></omp-ref-8>, the evidence indicates a strong risk of opioid-related death with ≥4 prescribers and ≥4 pharmacies.</p>' +
'</div>' +
'</el-collapse-item>' +
'<el-collapse-item name="6">' +
'<template slot="title"><span style="font-size: 15px; text-decoration: underline;">What changed about this measure in 2019?</span></template>' +
"<div style='font-size: 15px;'>" +
'<p><strong>Prior to 2019:</strong> The proportion (XX out of 1,000) of individuals from the denominator receiving prescriptions for opioids from ≥4 prescribers AND ≥4 pharmacies.</p>' +
'<p><strong>2019 to Present:</strong> The percentage of individuals ≥18 years of age who received prescriptions for opioids from ≥4 prescribers and ≥4 pharmacies within ≤180 days.</p>' +
'<p><strong>Rationale:</strong> The numerator evaluation period was shortened from the measurement year to ≤180 days in order to reduce false positives. Moreover, this aligns with underlying evidence (studies used 6 months) and recommendations from the CDC and other experts.</p>' +
"<p>The table below summarizes all of the changes to these measures.</p>" +
'<table>' +
'<tr><th>Change</th><th>Impacted Measure(s)</th><th>Rationale</th></tr>' +
'<tr><td>Lower the threshold from >120 to ≥90 MME</td><td>OHD, OHDMP</td><td>A lower MME threshold aligns with the CDC guideline (amount generally suggested to avoid increasing above).</td></tr>' +
"<tr><td>Use average MME rather than ≥90 consecutive days of high MME</td><td>OHD, OHDMP</td><td>By allowing gaps between prescription fills and days' supply in the calculation, the average MME methodology improves identification of individuals who are chronic users of high opioid doses compared to evaluating consecutive days and reduces false positives.</td></tr>" +
'<tr><td>Shorten the numerator evaluation period from 12 months to 6 months</td><td>OMP, OHDMP (only the multiple provider criteria)</td><td>A shortened measurement period better identifies current potential overutilizers, reduces the number of false positives, and aligns with underlying evidence (studies used 6 months) and recommendations from the CDC and other experts.</td></tr>' +
'<tr><td>Rates reported as percent instead of XX out of 1,000 individuals </td><td>OHD, OMP, OHDMP</td><td>Using a percent improves understanding about measure rates.</td></tr>' +
'</table>' +
"</div>" +
'</el-collapse-item>' +
'<el-collapse-item name="7">' +
"<template slot='title'><span style='font-size: 15px; text-decoration: underline; text-decoration: underline;'>Does the PQA's criteria align with CMS' Overutilization Monitoring System (OMS)?</span></template>" +
"<div style='font-size: 15px;'>" +
"<p>After publication of the CDC guideline, CMS revised the OMS criteria/methodology from >120 MME/day for 90 consecutive days, to an average MME/day of ≥90 (for any number of days). The table below highlights the key differences between PQA's measures and OMS.</p>" +
'<table>' +
'<tr><th>Criteria</th><th>PQA</th><th>OMS</th></tr>' +
'<tr><td>Evaluation Period</td><td>Measurement year for high dose and ≤180 days for multiple provider criteria</td><td>Most recent six months for high dose and multiple provider criteria</td></tr>' +
"<tr><td>High Dose</td><td>Average daily dosage of ≥90 morphine milligram equivalents (MME) within ≥90 days</td><td>Average daily morphine equivalent dose (MED) ≥90 mg for any duration</td></tr>" +
'<tr><td>Multiple Providers</td><td>≥4 prescribers and ≥4 pharmacies (prescribers are identified via NPI)</td><td>≥3 prescribers and ≥3 pharmacies, or ≥5 prescribers regardless of the number of pharmacies (prescribers are identified via TIN)</td></tr>' +
'</table>' +
"</div>" +
'</el-collapse-item>' +
'</el-collapse>' +
'</el-row>' +
'</div>',
data: function() {
return {
active: active
}
}
});
Vue.component('omp', {
template:
'<div id="omp" class="search-filter inview">' +
'<omp-overview></omp-overview>' +
'<omp-rationale v-if="rationale"></omp-rationale>' +
'<omp-faqs v-if="faqs"></omp-faqs>' +
'<br><br><br><br>' +
'</div>',
props: {
rationale: {
default: false
},
faqs: {
default: false
}
}
});