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Sentinel opioid prescribing measures

The Opioid Prescribing Improvement Program's sentinel measures support the quality improvement arm of the program. These seven measures assess individual provider’s opioid prescribing behavior in the acute, post-acute and chronic pain phases and compare them to the prescribing rates of peers in the same specialty. DHS and the Opioid Prescribing Work Group developed the measures by analyzing Minnesota Medicaid and MinnesotaCare prescription data and considering national measures.

Measure 1: Percent of patients prescribed an index opioid prescription (quality improvement for medical specialties only)

Measure 2: Percent of index opioid prescriptions exceeding the recommended dose (> 100 morphine milligram equivalence for medical specialties; > 200 morphine milligram equivalence for surgical specialties)

Measure 3: Percent of prescriptions exceeding 700 cumulative morphine milligram equivalence during the acute and post-acute pain period (date of index opioid prescription plus 45 days)

Measure 4: Percent of patients with chronic opioid analgesic therapy

Measure 5: Percent of patients on chronic opioid analgesic therapy exceeding 90 morphine milligram equivalence/day (high dose chronic opioid analgesic therapy)

Measure 6: Percent of patients receiving elevated dose chronic opioid analgesic therapy (> 50 morphine milligram equivalence/day) who received a concomitant benzodiazepine prescriptions

Measure 7: Percent of patients on chronic opioid analgesic therapy who receive opioids from multiple providers. 

Measure terminology

Index opioid prescription: The first opioid prescription after at least 90 days of opioid naiveté.

Opioid naïve user: A patient prescribed an opioid medication who does not have an active opioid prescription in the 90 day period prior to the index opioid prescription. 

Morphine milligram equivalence (MME): The equianalgesic of a specific dose and formulation of opioids to parenteral morphine. Standard conversion ratios are used to calculate each opioid’s equianalgesic dose. 

  • Conversion formula for total morphine milligram equivalence (MME) of prescription (total MME of prescription): (Drug Strength)*(Drug Quantity)*(MME Conversion Factor) 
  • Conversion formula for daily MME: (Drug Strength)*(Drug Quantity)*(MME Conversion Factor) / (Days Supply) 

Cumulative morphine milligram equivalence: The sum of the total morphine milligram equivalence of each opioid prescription received in a given timeframe.

Chronic opioid analgesic therapy: ≥ 60 days’ supply of opioids from any number of prescriptions. A ≤ 3 day gap is permissible between prescriptions.

Provider: Clinician licensed to prescribe an opioid and prescribing to Medical Assistance and MinnesotaCare enrollees during the measurement year.

High dose chronic opioid analgesic therapy: ≥ 60 days’ supply of opioids and the daily dose is ≥ 90 morphine milligram equivalence/day.

Elevated dose chronic opioid analgesic therapy: ≥ 60 days’ supply of opioids and the daily dose is ≥ 50 morphine milligram equivalence/day.

Concomitant chronic opioid analgesic therapy and benzodiazepine prescriptions: ≥ 60 days’ supply of opioids and a benzodiazepine prescription that has > 7 days’ supply of overlap with the chronic opioid analgesic therapy during the measurement year.

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