Vue.component('cob-overview', {
	template: 
		'<div>' +
			'<el-row id="cob-title">' +
				'<h1 style="text-align: center">Concurrent Use of Opioids and Benzodiazepines (COB)</h1>' +
			'</el-row>' +
			'<el-row id="cob-description" class="scrollspy">' +
				'<h2>Description</h2>' +
			'</el-row>' +
			'<el-row>' +
				'<p>The percentage of individuals &ge;18 years of age with concurrent use of prescription opioids and benzodiazepines. (NQF #3389)</p>' +
				'<p>A lower rate indicates better performance.</p>' +
			'</el-row>' +
			'<el-row id="cob-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>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 with &ge;2 prescription claims for opioid medications on different dates of service and with a  of &ge;15 cumulative days' supply 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>The number of individuals from the denominator with:</p>' +
					'<ul>' +
						'<li>&ge;2 prescription claims for any benzodiazepines with different dates of service</li>' +
						'<p>-AND-</p>' +
						'<li>Concurrent use of opioids and benzodiazepines for &ge;30 cumulative days</li>' +
					'</ul>' +
				'</el-col>' +
			'</el-row>' +
		'</div>'
});

Vue.component('cob-ref-1', {
	template: '<el-popover placement="top-start" width="400" trigger="hover">' +
		'<span>CDC/NCHS, National Vital Statistics System, Mortality [Internet]. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2018 [cited 2019 Mar 27]. Available from: <a href="https://wonder.cdc.gov" target="_blank">https://wonder.cdc.gov</a>.</span>' +
		'<sup slot="reference">1</sup>' +
		'</el-popover>'
});

Vue.component('cob-ref-2', {
	template: '<el-popover placement="top-start" width="400" trigger="hover">' +
		'<span>Frenk SM, Porter KS, Paulozzi LJ. Prescription opioid analgesic use among adults: United States, 1999-2012 [Internet]. NCHS data brief, no 189. Hyattsville, MD: National Center for Health Statistics. 2015 [cited 2019 Apr 5]. Available from: <a href="https://www.cdc.gov/nchs/data/dataBriefs/db189.pdf" target="_blank">https://www.cdc.gov/nchs/data/dataBriefs/db189.pdf</a>.</span>' +
		'<sup slot="reference">2</sup>' +
		'</el-popover>'
});

Vue.component('cob-ref-3', {
	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; 65:1-49. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/26987082" target="_blank">26987082</a>.</span>' +
		'<sup slot="reference">3</sup>' +
		'</el-popover>'
});

Vue.component('cob-ref-4', {
	template: '<el-popover placement="top-start" width="400" trigger="hover">' +
		'<span>US Food and Drug Administration. FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning [Internet]. 2016 [2016 Nov 9]. Available from: <a href="http://www.fda.gov/Drugs/DrugSafety/ucm518473.htm" target="_blank">http://www.fda.gov/Drugs/DrugSafety/ucm518473.htm</a>.</span>' +
		'<sup slot="reference">4</sup>' +
		'</el-popover>'
});

Vue.component('cob-ref-5', {
	template: '<el-popover placement="top-start" width="400" trigger="hover">' +
		'<span>Gomes T, Mamdani MM, Dhalla IA, et al. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011; 171(7):686-91. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/21482846" target="_blank">21482846</a>.</span>' +
		'<sup slot="reference">5</sup>' +
		'</el-popover>'
});

Vue.component('cob-ref-6', {
	template: '<el-popover placement="top-start" width="400" trigger="hover">' +
		'<span>Dasgupta N, Funk MJ, Proescholdbell S, et al. Cohort Study of the Impact of High-Dose Opioid Analgesics on Overdose Mortality. Pain Med. 2016; 17(1):85-98. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/26333030" target="_blank">26333030</a>.</span>' +
		'<sup slot="reference">6</sup>' +
		'</el-popover>'
});

Vue.component('cob-ref-7', {
	template: '<el-popover placement="top-start" width="400" trigger="hover">' +
		'<span>Jones CM, McAninch JK. Emergency Department Visits and Overdose Deaths From Combined Use of Opioids and Benzodiazepines. Am J Prev Med. 2015; 49(4):493-501. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/26143953" target="_blank">26143953</a>.</span>' +
		'<sup slot="reference">7</sup>' +
		'</el-popover>'
});

Vue.component('cob-ref-8', {
	template: '<el-popover placement="top-start" width="400" trigger="hover">' +
		'<span>Chen LH, Hedegaard H, Warner M. Drug-poisoning Deaths Involving Opioid Analgesics: United States, 1999-2011. NCHS Data Brief. 2014; (166):1-8. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/25228059" target="_blank">25228059</a>.</span>' +
		'<sup slot="reference">8</sup>' +
		'</el-popover>'
});

Vue.component('cob-ref-9', {
	template: '<el-popover placement="top-start" width="400" trigger="hover">' +
		'<span>Park TW, Saitz R, Ganoczy D, et al. Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study. BMJ. 2015; 350:h2698. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/26063215" target="_blank">26063215</a>.</span>' +
		'<sup slot="reference">9</sup>' +
		'</el-popover>'
});

Vue.component('cob-ref-10', {
	template: '<el-popover placement="top-start" width="400" trigger="hover">' +
		'<span>Sun EC, Dixit A, Humphreys K, et al. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ. 2017; 356:j760. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/28292769" target="_blank">28292769</a>.</span>' +
		'<sup slot="reference">10</sup>' +
		'</el-popover>'
});

Vue.component('cob-ref-11', {
	template: '<el-popover placement="top-start" width="400" trigger="hover">' +
		'<span>Hwang CS, Kang EM, Kornegay CJ, et al. Trends in the Concomitant Prescribing of Opioids and Benzodiazepines, 2002-2014. Am J Prev Med. 2016; 51(2):151-160. PMID: <a href="https://www.ncbi.nlm.nih.gov/pubmed/27079639" target="_blank">27079639</a>.</span>' +
		'<sup slot="reference">11</sup>' +
		'</el-popover>'
});

Vue.component('cob-ref-12', {
	template: '<el-popover placement="top-start" width="400" trigger="hover">' +
		'<span>US Food and Drug Administration. FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning [Internet]. 2016 [2016 Nov 9]. Available from: <a href="https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Concurrent-Use-of-Opioids-and-Benzodiazepines-in-a-Medicare-Part-D-Population-CY-2015.pdf" target="_blank">https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Concurrent-Use-of-Opioids-and-Benzodiazepines-in-a-Medicare-Part-D-Population-CY-2015.pdf</a>.</span>' +
		'<sup slot="reference">12</sup>' +
		'</el-popover>'
});

Vue.component('cob-rationale', {
	template: 
		'<div>' +
			'<el-row id="cob-rationale" class="scrollspy">' +
				'<h2>Rationale</h2>' +
			'</el-row>' +
			'<el-row>' +
				'<p>' +
				'Overdose deaths involving prescription opioids were five times higher in 2106 than in 1999, and more than 200,000 people have died in the U.S. from overdoses related to prescription opioids.' +
				'<cob-ref-1></cob-ref-1><sup>,</sup><cob-ref-2></cob-ref-2>' +
				' Scientific research has identified high-risk prescribing practices that have contributed to the opioid overdose epidemic, including overlapping opioid and benzodiazepine prescriptions.' +
				'<cob-ref-3></cob-ref-3>' +
				' Concurrent use of opioids and benzodiazepines, both central nervous system (CNS) depressants, increases the risk for severe respiratory depression, which can be fatal.' +
				'<cob-ref-3></cob-ref-3><sup>,</sup><cob-ref-4></cob-ref-4>' +
				'</p>' +
				'<p>' +
				'According to the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain - United States, 2016, clinicians should avoid concurrent prescribing of opioids and benzodiazepines whenever possible.' +
				'<cob-ref-3></cob-ref-3>' +
				' This is a Category A recommendation (applies to all persons; most patients should receive the recommended course of action) and is based on Type 3 evidence (observational studies or randomized clinical trials with notable limitations). In August 2016, the US Food and Drug Administration added concurrent use of opioids and benzodiazepines as a black box warning to prescription opioids (analgesic and cough medicine) and benzodiazepines.' +
				'<cob-ref-4></cob-ref-4>' +
				'</p>' +
				'<p>' +
				'Several studies indicate that concurrent use of opioids and benzodiazepines puts patients at greater risk for a fatal overdose. Three studies of opioid overdose deaths found evidence of concurrent benzodiazepine use in 31%-61% of cases.' +
				'<cob-ref-5></cob-ref-5><sup>,</sup><cob-ref-6></cob-ref-6><sup>,</sup><cob-ref-7></cob-ref-7>' +
				' In the United States, the number of opioid overdose deaths involving benzodiazepines increased 14% on average for each year from 2006 through 2011. However, the number of opioid overdose deaths not involving benzodiazepines did not change significantly.' +
				'<cob-ref-8></cob-ref-8>' +
				' A case-cohort study found that concurrent use of benzodiazepines among US veterans raised the risk of drug overdose deaths four-fold (hazard ratio, 3.86, 95% confidence interval [CI] 3.49-4.26) compared with patients not using benzodiazepines.' +
				'<cob-ref-9></cob-ref-9>' +
				' In a large sample of privately insured patients from 2001-2013, opioid users who also used benzodiazepines were at substantially higher risk of an emergency department (ED) visit or hospital admission for opioid overdose (adjusted odds ratio 2.14; 95% CI, 2.05-2.24). If this association is causal, elimination of the concurrent use could reduce the population risk of an ED visit or hospitalization for opioid overdose by 15%.' +
				'<cob-ref-10></cob-ref-10>' +
				'</p>' +
				'<p>' +
				'Despite the risks, concurrent prescriptions for opioids and benzodiazepines are common and increasing. From 2001-2013, concurrent prescribing (overlap of at least one day) increased by nearly 80% (from 9% to 17%) among privately insured patients.' +
				'<cob-ref-10></cob-ref-10>' +
				' In one study, approximately half of the patients received both opioid and benzodiazepine prescriptions from the same prescriber on the same day.' +
				'<cob-ref-11></cob-ref-11>' +
				' In a 2015 analysis of Medicare Part D non-cancer and/or non-hospice patients on opioid therapy, the prevalence of benzodiazepine concurrent use was 24%.' +
				'<cob-ref-12></cob-ref-12>' +
				'</p>' +
				'<p>' +
				'The PQA Concurrent Use of Opioids and Benzodiazepines measure evaluates a process that correlates with increased risk of opioid overdose. Efforts to prevent opioid overdose deaths should include a multi-faceted approach, including strategies that focus on monitoring and reducing opioid prescribing that has an unfavorable balance of benefit and harm for most patient populations. The measure excludes patients with cancer and those in hospice due to the unique therapeutic goals, ethical considerations, increased opportunities for medical supervision, and balance of risks and benefits with opioid therapy.' +
				'<cob-ref-3></cob-ref-3>' +
				'</p>' +
			'</el-row>' +
		'</div>'
});

Vue.component('cob-faqs', {
	template: 
		'<div>' +
			'<el-row id="cob-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;'>Should PQA measures be used for clinical decision-making?</span></template>" +
						"<div style='font-size: 15px;'>" +
							"<p>PQA measures are not intended for clinical decision-making. PQA measures evaluate prescribing patterns that correlate with an increased risk of opioid overdose. Efforts to prevent opioid overdose should include a multi-faceted approach, including strategies that focus on monitoring and reducing opioid prescribing that has an unfavorable balance of benefit and harm for most patient populations. These measures are for retrospective evaluation of populations of patients and should not be used to guide clinical decisions for individual patients.</p>" +
						"</div>" +
					'</el-collapse-item>' +
				'</el-collapse>' +
			'</el-row>' +
		'</div>',
	data: function() {
		return {
			active: active
		}
	}
});

Vue.component('cob', {
	template:
		'<div id="cob" class="search-filter inview">' +
			'<cob-overview></cob-overview>' +
            '<cob-rationale v-if="rationale"></cob-rationale>' +
			'<cob-faqs v-if="faqs"></cob-faqs>' +
			'<br><br><br><br>' +
		'</div>',
	props: {
		rationale: {
			default: false
		},
		faqs: {
			default: false
		}
	}
});