PIPMAG Designs Evidence-Based Future of Addiction Medicine

To improve continuously, a specialty must set a baseline from which to measure any advances. The Practice Improvement and Performance Measurement Action Group (PIPMAG) is working to establish that starting point for addiction medicine practice. Learn the latest progress with this endeavor by attending Component Session 7, “Performance Measures and Addiction Medicine” from 8 to 10 a.m., Sunday, in Grand Salon East, Salon B.

Speakers will include PIPMAG Chair Michael M. Miller, M.D., FASAM, FAPA, Associate Clinical Professor, the University of Wisconsin-Madison, and Assistant Clinical Professor, the Department of Psychiatry and Behavioral Medicine, the Medical College of Wisconsin, Milwaukee; Mady Chalk, Ph.D., Director, Center for Policy Research and Analysis, the Treatment Research Institute, Washington, D.C.; and Diane Stollenwerk, M.P.P., Vice President, Community Alliances, National Quality Forum, Washington, D.C.

PIPMAG used its 2011 start-up meeting to wrap its collective arms around defining its exact scope of work, and from there outlining how to secure funding for the group to embrace its charge, Dr. Miller says.

“Our challenge is to describe areas of practice in which physicians offering care for addiction patients can be measured to affirm they are engaging in providing quality care and incorporating appropriate, evidence-based aspects of quality into their practices,” he says. “The challenge we face is that there is not a range of practice guidelines for addiction medicine care from which we can draw. Usually, performance measures are developed using a process that designs a metric or algorithm that will measure if physicians do what established guidelines say they should do. We don’t have those yet, and we may decide that we need to create them.”

PIPMAG’s role is an imperative for ASAM and the specialty itself because all of medicine is moving in the direction of defining best practices, Dr. Miller says.

“To show our patients, the medical establishment, and the government that we are generating the best results, we must collect data on our performance to make sure our physicians are improving,” he says. “We need to measure at a baseline to know that we are moving the needle and offering better care. All of medicine is moving this way—from Maintenance of Certification programs of medical specialty boards, such as ABAM, to state licensure boards.”

Dr. Miller says that the action group will perform a literature review of what guidelines and measures already exist. The measures for Substance Use Disorders treatment and for screening developed by the AMA Physician Consortium on Performance Improvement are known examples. The action group will then outline the specific practice activities where performance measures are needed. In developing these measures, extensive literature reviews will be required, a laborious and time-intensive task.

“ASAM developed three practice guidelines in the mid-1990s, but those focused specifically on managing withdrawal symptoms and detoxification, rather than management of addiction,” he says. “At this point we are trying to delineate specific aspects of addiction medicine practice for which baseline performance can be measured via performance measures.”

Dr. Miller says PIPMAG is also looking at the interface between specialty practice and the clinical work of primary care physicians who will need to carry the bulk of responsibility for meeting the needs of this patient population.

“You can never have enough specialists to treat every patient, so transitions of care (clinical ‘handoffs’) between specialists and generalists is important to most people who evaluate medical quality,” he says. “Health care reform will bring a lot of people into the system who haven’t had coverage and who haven’t been able to self-pay. Up to 40 million people will have some mechanism of coverage under the Affordable Care Act. The people who modeled care under that plan are counting on meeting the need through federally qualified health centers staffed by primary care doctors working with specialty care practitioners, as well as through other Patient Centered Medical Home frameworks.