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Amaral RAD. Performance measures for alcohol and other drugs services: a commentary. Int Rev Psychiatry 2023; 35:475-485. [PMID: 38299659 DOI: 10.1080/09540261.2023.2249093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/14/2023] [Indexed: 02/02/2024]
Abstract
Alcohol and other drugs treatment includes a wide range of service and personal characteristics, along with expected and unexpected barriers to treatment. To capture the benefits and the gaps of a designed treatment, one needs to consider process-of-care and outcome measurements. Process-of-care measures are mainly developments of the rationale proposed by The Washington Circle and capture all variants in the process-of-care as proportions. Outcome measures are strongly related to different concepts of recovery and described as simple yes/no answers type to wide levels of response, such as in Likert-type scales. According to the studies collected here, more realistic periods of data-collection for process-of-care measures and a more reliable format to capture outcome particularities should be designed.
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Affiliation(s)
- Ricardo Abrantes do Amaral
- Perdizes Institute of the Clinical Hospital of School of Medicine of the University of São Paulo, São Paulo, Brazil
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2
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Gastfriend DR, Mee-Lee D. Thirty Years of TheASAMCriteria: A Report Card. Psychiatr Clin North Am 2022; 45:593-609. [PMID: 36055741 DOI: 10.1016/j.psc.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The American Society of Addiction Medicine Criteria (ASAM) Criteria has profoundly influenced addiction treatment and reimbursement, with its growing toolkit of ASAM CONTINUUM software, ASAM-CARF Level of Care Certification Program, educational programs, and publications. A retrospective accounting shows that the field has made considerable strides, but has far to go. Providers and payers still need to (1) improve consistency in their use of standardized, multidimensional patient assessment; (2) improve flexibility in providing and reimbursing person-centered, individualized services; (3) improve measurement in treatment planning for determination of progress; and (4) focus on outcomes and value in the care they deliver.
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Affiliation(s)
| | - David Mee-Lee
- DML Training and Consulting, 4228 Boxelder Place, Davis, CA 95618, USA
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Williams AR, Johnson KA, Thomas CP, Reif S, Socías ME, Henry BF, Neighbors C, Gordon AJ, Horgan C, Nosyk B, Drexler K, Krawczyk N, Gonsalves GS, Hadland SE, Stein BD, Fishman M, Kelley AT, Pincus HA, Olfson M. Opioid use disorder Cascade of care framework design: A roadmap. Subst Abuse 2022; 43:1207-1214. [PMID: 35657670 PMCID: PMC9577537 DOI: 10.1080/08897077.2022.2074604] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Unintentional overdose deaths, most involving opioids, have eclipsed all other causes of US deaths for individuals less than 50 years of age. An estimated 2.4 to 5 million individuals have opioid use disorder (OUD) yet a minority receive treatment in a given year. Medications for OUD (MOUD) are the gold standard treatment for OUD however early dropout remains a major challenge for improving clinical outcomes. A Cascade of Care (CoC) framework, first popularized as a public health accountability strategy to stem the spread of HIV, has been adapted specifically for OUD. The CoC framework has been promoted by the NIH and several states and jurisdictions for organizing quality improvement efforts through clinical, policy, and administrative levers to improve OUD treatment initiation and retention. This roadmap details CoC design domains based on available data and potential linkages as individual state agencies and health systems typically rely on limited datasets subject to diverse legal and regulatory requirements constraining options for evaluations. Both graphical decision trees and catalogued studies are provided to help guide efforts by state agencies and health systems to improve data collection and monitoring efforts under the OUD CoC framework.
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Affiliation(s)
- Arthur Robin Williams
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | | | - Cindy Parks Thomas
- Brandeis University Schneider Institutes for Health Policy, Brandeis, Massachusetts, USA
| | - Sharon Reif
- Brandeis University Schneider Institutes for Health Policy, Brandeis, Massachusetts, USA
| | - M. Eugenia Socías
- Department of Medicine, University of British Columbia, British Columbia, Canada
| | - Brandy F. Henry
- Pennsylvania State University, State College, Pennsylvania, USA
| | | | - Adam J. Gordon
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Constance Horgan
- Brandeis University Schneider Institutes for Health Policy, Brandeis, Massachusetts, USA
| | - Bohdan Nosyk
- Centre for Health Evaluation & Outcome Sciences, Faculty of Health Sciences, Simon Fraser University, British Columbia, Canada
| | - Karen Drexler
- American Academy of Addiction Psychiatry, East Providence, Rhode Island, USA
| | - Noa Krawczyk
- New York University, New York City, New York, USA
| | | | - Scott E. Hadland
- Massachusetts General Hospital, Harvard University, Cambridge, Massachusetts, USA
| | - Bradley D. Stein
- American Academy of Addiction Psychiatry, East Providence, Rhode Island, USA
| | - Marc Fishman
- Mountain Manor Treatment Centers, Baltimore, Maryland, USA
| | - A. Taylor Kelley
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Harold A. Pincus
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
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Reif S, Stewart MT, Torres ME, Davis MT, Dana BM, Ritter GA. Effectiveness of value-based purchasing for substance use treatment engagement and retention. J Subst Abuse Treat 2021; 122:108217. [PMID: 33509415 PMCID: PMC8380407 DOI: 10.1016/j.jsat.2020.108217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/25/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Many people drop out of substance use disorder (SUD) treatment within the first few sessions, which suggests the need for innovative strategies to address this. We examined the effectiveness of incentive-based contracting for Maine's publicly funded outpatient (OP) and intensive outpatient (IOP) SUD treatment, to determine its potential for improving treatment engagement and retention. METHODS Maine's incentive-based contract with federally block grant-funded OP and IOP treatment agencies created a natural experiment, in which we could compare treatment engagement and retention with a group of state-licensed treatment agencies that were not part of the incentive-based contract. We used administrative data for OP (N = 18,375) and IOP (N = 5986) SUD treatment admissions from FY2005-FY2011 to capture trends prior to and after the FY2008 contract implementation date. We performed multivariable difference-in-difference logistic regression models following propensity score matching of clients. RESULTS Two-thirds (66%) of OP admissions engaged in treatment, defined as 4+ treatment sessions, and 85% of IOP admissions satisfied the similar criteria of 4+ treatment days. About 40-45% of OP admissions reached the threshold for retention, defined as 90 days in treatment. IOP treatment completion was attained by 50-58% of admissions. For OP, the incentive and nonincentive groups had no significant differences in percentages with treatment engagement (AOR = 1.28, DID = 5.9%, p = .19), and 90-day retention was significant in the opposite direction of what we hypothesized (AOR = 0.80, DID = -4.6%, p = .0003). For IOP, the incentive group had a significant, but still small, increase in percentage with treatment engagement (AOR = 1.52, DID = 5.5%, p = .003), but the corresponding increase in treatment completion was not similarly significant (AOR = 1.12, DID = 2.7%, p = .53). In all models, individual-level variables were strong predictors of outcomes. CONCLUSION We found little to no impact of the incentive-based contract on the treatment engagement, retention, and completion measures, adding to the body of evidence that shows few or null results for value-based purchasing in SUD treatment programs. The limited success of such efforts is likely to reflect the bandwidth that providers and programs have to focus on new endeavors, the importance of the incentive funding to their bottom line, and forces beyond their immediate control.
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Affiliation(s)
- Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America.
| | - Maureen T Stewart
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America
| | - Maria E Torres
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America
| | - Margot T Davis
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America
| | - Beth Mohr Dana
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America
| | - Grant A Ritter
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America
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Hadland SE, Yule AM, Levy SJ, Hallett E, Silverstein M, Bagley SM. Evidence-Based Treatment of Young Adults With Substance Use Disorders. Pediatrics 2021; 147:S204-S214. [PMID: 33386323 PMCID: PMC7879425 DOI: 10.1542/peds.2020-023523d] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In summarizing the proceedings of a longitudinal meeting of experts in substance use disorders (SUDs) among adolescents and young adults, in this special article, we review principles of care related to SUD treatment of young adults. SUDs are most commonly diagnosed during young adulthood, but most of the evidence guiding the treatment of this population has been obtained from older adult study participants. Extrapolating evidence from older populations, the expert group asserted the following principles for SUD treatment: It is important that clinicians who work with young adults effectively identify and address SUD to avert long-term addiction and its associated adverse health outcomes. Young adults receiving addiction treatment should have access to a broad range of evidence-based assessment, psychosocial and pharmacologic treatments, harm reduction interventions, and recovery services. These evidence-based approaches should be tailored to young adults' needs and provided in the least restrictive environment possible. Young adults should enter care voluntarily; civil commitment to treatment should be a last resort. In many settings, compulsory treatment does not use evidence-based approaches; thus, when treatment is involuntary, it should reflect recognized standards of care. Continuous engagement with young adults, particularly during periods of relapse, should be considered a goal of treatment and can be supported by care that is patient-centered and focused on the young adult's goals. Lastly, substance use treatments for young adults should be held to the same evidence and quality standards as those for other chronic health conditions.
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Affiliation(s)
- Scott E Hadland
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts;
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Amy M Yule
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Departments of Psychiatry and Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sharon J Levy
- Departments of Psychiatry and Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
- Adolescent Substance Use and Addiction Program and Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; and
| | - Eliza Hallett
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Michael Silverstein
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Sarah M Bagley
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
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6
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Kraemer KL, McGinnis KA, Fiellin DA, Skanderson M, Gordon AJ, Robbins J, Zickmund S, Bryant K, Korthuis PT. Low levels of initiation, engagement, and retention in substance use disorder treatment including pharmacotherapy among HIV-infected and uninfected veterans. J Subst Abuse Treat 2019; 103:23-32. [PMID: 31229189 DOI: 10.1016/j.jsat.2019.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) are common in healthcare settings and contribute to poor outcomes, particularly in patients living with HIV. We assessed initiation, engagement, and retention in SUD treatment and pharmacotherapy following an index SUD episode in a national sample of HIV-infected and uninfected patients receiving care in the Department of Veterans Affairs (VA) healthcare system. METHODS We used electronic national VA data (years 2000-2015) from 52,995 HIV-infected and 111,229 age-, race-, gender-, and region-matched uninfected patients. We defined index SUD episodes as outpatient visits or inpatient/residential admissions with associated primary or secondary ICD-9 codes for substance use in patients without SUD-related services or pharmacotherapy in the preceding 5 months. RESULTS Overall, 57,428 (35%) patients had at least 1 index SUD episode. HIV-infected patients were more likely than uninfected controls to have at least one index SUD episode (35.7% vs. 34.6%; p < .001). Rates of initiation, engagement, and retention in SUD treatment after the index SUD episode were <17% for both groups. In adjusted models, HIV-infected patients were more likely than uninfected patients to be retained in SUD treatment at 6 months (Odds Ratio 1.10; 95% Confidence Interval 1.04-1.16). SUD pharmacotherapy initiation and engagement was uncommon in both HIV-infected and uninfected patients. CONCLUSIONS In this national VA sample, initiation of SUD treatment and pharmacotherapy were uncommon for both HIV-infected and uninfected patients. Interventions to improve initiation, engagement, and retention in the full range of services, including SUD pharmacotherapy, are warranted for all patients with SUD in the VA.
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Affiliation(s)
- Kevin L Kraemer
- Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, United States; VA Pittsburgh Healthcare System, 4100 Allequippa Street, Pittsburgh, PA 15213, United States.
| | - Kathleen A McGinnis
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar Street, Boardman 110, P.O. Box 208056, New Haven, CT 06520-8056, United States
| | - David A Fiellin
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar Street, Boardman 110, P.O. Box 208056, New Haven, CT 06520-8056, United States; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510-2483, United States
| | - Melissa Skanderson
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar Street, Boardman 110, P.O. Box 208056, New Haven, CT 06520-8056, United States
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, United States; Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, United States
| | - Jonathan Robbins
- Division of General Internal Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road L475, Portland, OR 97239-3098, United States
| | - Susan Zickmund
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, United States; Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, United States
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892-6902, United States
| | - P Todd Korthuis
- Division of General Internal Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road L475, Portland, OR 97239-3098, United States
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Wyse J, Robbins JL, McGinnis KA, Edelman EJ, Gordon AJ, Manhapra A, Fiellin DA, Moore BA, Korthuis PT, Gaither JR, Gordon K, Skanderson M, Barry DT, Crystal S, Justice A, Kraemer KL. Predictors of timely opioid agonist treatment initiation among veterans with and without HIV. Drug Alcohol Depend 2019; 198:70-75. [PMID: 30878769 PMCID: PMC6836871 DOI: 10.1016/j.drugalcdep.2019.01.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/02/2019] [Accepted: 01/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) is prevalent among people with HIV (PWH). Opioid agonist therapy (OAT) is the most effective treatment for OUD and is associated with improved health outcomes, but is often not initiated. To inform clinical practice, we identified factors predictive of OAT initiation among patients with and without HIV. METHODS We identified 19,698 new clinical encounters of OUD between 2000 and 2012 in the Veterans Aging Cohort Study (VACS), a national observational cohort of PWH and matched uninfected controls. Mixed effects models examined factors predictive of OAT initiation within 30-days of a new OUD clinical encounter. RESULTS 4.9% of both PWH and uninfected patients initiated OAT within 30 days of a new OUD clinical encounter. In adjusted models, participants with a psychiatric diagnosis (aOR = 0.54, 95% CI 0.47 - 0.62), PWH (aOR = 0.79, 95% CI 0.68-0.92), and rural residence (aOR = 0.56, 95% CI 0.39-0.78) had a lower likelihood of any OAT initiation, while African-American patients (aOR = 1.60, 95% CI 1.34-1.92), those with an alcohol related diagnosis (aOR = 1.76, 95% CI 1.48-2.08), diagnosis year 2005-2008 relative to 2000-2004 (aOR = 1.24, 95% CI 1.05-1.45), and patients with HCV (aOR = 1.50, 95% CI 1.27-1.77) had a greater likelihood of initiating any OAT within 30 days. Predictive factors were similar in the total sample and PWH only models. CONCLUSIONS PWH were less likely to receive timely OAT initiation than demographically similar uninfected patients. Given the health benefits of such treatment, the low rate of OAT initiation warrants focused efforts in both PWH and uninfected populations.
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Affiliation(s)
- Jessica Wyse
- VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA,School of Public Health, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Jonathan L. Robbins
- Division of General Internal Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | | | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Adam J. Gordon
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, USA,VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148, USA
| | - Ajay Manhapra
- Advanced PACT Pain Clinic, Hampton VA Medical Center, 100 Emancipation Dr, Hampton, VA 23667, USA,Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Brent A. Moore
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA
| | - P. Todd Korthuis
- Section of Addiction Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Julie R. Gaither
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Kirsha Gordon
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA
| | - Melissa Skanderson
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA
| | - Declan T. Barry
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA,APT Foundation, Pain Treatment Services, 1 Long Wharf Dr, New Haven, CT 06511, USA
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, 112 Paterson St, New Brunswick, NJ 08901, USA
| | - Amy Justice
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Kevin L. Kraemer
- Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite 933W, Pittsburgh, PA 15213, USA,VA Pittsburgh Healthcare System, 4100 Allequippa St, Pittsburgh, PA 15213, USA
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Rates and Impact of Adherence to Recommended Care for Unhealthy Alcohol Use. J Gen Intern Med 2019; 34:256-263. [PMID: 30484101 PMCID: PMC6374244 DOI: 10.1007/s11606-018-4749-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/21/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Unhealthy alcohol use is a major worldwide health problem. Yet few studies have assessed provider adherence to the alcohol-related care recommended in clinical practice guidelines, nor links between adherence to recommended care and outcomes. OBJECTIVES To describe quality of care for unhealthy alcohol use and its impacts on drinking behavior RESEARCH DESIGN: Prospective observational cohort study of quality of alcohol care for the population of patients screening positive for unhealthy alcohol use in a large Veterans Affairs health system. PARTICIPANTS A total of 719 patients who screened positive for unhealthy alcohol use at one of 11 primary care practices and who completed baseline and 6-month telephone interviews. MAIN MEASURES Using administrative encounter and medical record data, we assessed three composite and 21 individual process-based measures of care delivered across primary and specialty care settings. We assessed self-reported daily alcohol use using telephone interviews at baseline and 6-month follow-up. KEY RESULTS The median proportion of patients who received recommended care across measures was 32.8% (range < 1% for initiating pharmacotherapy to 93% for depression screening). There was negligible change in drinking for the study population between baseline and 6 months. In covariate-adjusted analyses, no composites were significantly associated with changes in heavy drinking days or drinks per week, and just one of nine individual measures tested was significantly associated. In a subsample of patients drinking above recommended weekly limits prior to screening, two of nine individual measures were significantly associated. CONCLUSIONS This study shows wide variability in receipt of recommended care for unhealthy alcohol use. Receipt of recommended interventions for reducing drinking was frequently not associated with decreased drinking. Results suggest deficits in provision of comprehensive alcohol care and in understanding how to improve population-based drinking outcomes.
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Recurrent use of inpatient withdrawal management services: Characteristics, service use, and cost among Medicaid clients. J Subst Abuse Treat 2018; 92:77-84. [PMID: 30032948 DOI: 10.1016/j.jsat.2018.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 11/22/2022]
Abstract
Reducing repeat use of costly inpatient services, such as inpatient withdrawal management, among Medicaid members is a target of healthcare reform. However, characteristics of frequent users of inpatient withdrawal management are understudied. We described the characteristics, service utilization, and costs of New York Medicaid clients who use withdrawal management services by analyzing data from Medicaid records from 2008. We examined follow-up care for individuals with different levels of repeat withdrawal management. We found 32,196 Medicaid withdrawal management patients with a total of 67,073 episodes and we divided patients into low (1 episode, n = 19,602), medium (2-3 episodes, n = 8619) and high (≥4 episodes, n = 3978) use categories. High users had almost 8 times the withdrawal management cost of low users. Similarly, they had 5 times more emergency department visits than low users. High users had high levels of homelessness (75%), 20% had HIV/AIDS, and 40% had Hepatitis. High withdrawal management users were less likely than low users to receive any follow-up treatment services. Medicaid clients with high utilization of inpatient withdrawal management are a small but costly population with poor follow-up rates to subsequent treatment services. They are a socially disenfranchised group that may benefit from targeted services to address their complex clinical needs.
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10
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Williams AR, Nunes EV, Bisaga A, Pincus HA, Johnson KA, Campbell AN, Remien RH, Crystal S, Friedmann PD, Levin FR, Olfson M. Developing an opioid use disorder treatment cascade: A review of quality measures. J Subst Abuse Treat 2018; 91:57-68. [PMID: 29910015 DOI: 10.1016/j.jsat.2018.06.001] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/17/2018] [Accepted: 06/01/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite increasing opioid overdose mortality, problems persist in the availability and quality of treatment for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and naltrexone) have high quality evidence supporting their use, but most individuals with OUD do not receive them and many experience relapse following care episodes. Developing and organizing quality measures under a unified framework such as a Cascade of Care could improve system level practice and treatment outcomes. In this context, a review was performed of existing quality measures relevant to the treatment of OUD and the literature assessing the utility of these measures in community practice. METHODS Systematic searches of two national quality measure clearinghouses (National Quality Forum and Agency for Healthcare Research and Quality) were performed for measures that can be applied to the treatment of OUD. Measures were categorized as structural, process, or outcome measures. Second stage searches were then performed within Ovid/Medline focused on published studies investigating the feasibility, reliability, and validity of identified measures, predictors of their satisfaction, and related clinical outcomes. RESULTS Seven quality measures were identified that are applicable to the treatment of OUD. All seven were process measures that assess patterns of service delivery. One recently approved measure addresses retention in medication-assisted treatment for patients with OUD. Twenty-nine published studies were identified that evaluate the quality measures, primarily focused on initiation and engagement in care for addiction treatment generally. Most measures and related studies do not specifically incorporate the evidence base for the treatment of OUD or assess patient level outcomes such as overdose. CONCLUSION Despite considerable progress, gaps exist in quality measures for OUD treatment. Development of a unified quality measurement framework such as an OUD Treatment Cascade will require further elaboration and refinement of existing measures across populations and settings. Such a framework could form the basis for applying strategies at clinical, organizational, and policy levels to expand access to quality care and reduce opioid-related mortality.
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Affiliation(s)
- Arthur Robin Williams
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States.
| | - Edward V Nunes
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Adam Bisaga
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Harold A Pincus
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States; New York-Presbyterian Hospital, United States
| | - Kimberly A Johnson
- University of South Florida Department of Mental Health Law and Policy, United States
| | - Aimee N Campbell
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Remien H Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University, United States
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers, United States
| | - Peter D Friedmann
- Department of Medicine, University of Massachusetts-Baystate and Baystate Health, United States
| | - Frances R Levin
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Mark Olfson
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
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Paddock SM, Hepner KA, Hudson T, Ounpraseuth S, Schrader AM, Sullivan G, Watkins KE. Association Between Process-Based Quality Indicators and Mortality for Patients With Substance Use Disorders. J Stud Alcohol Drugs 2018; 78:588-596. [PMID: 28728641 DOI: 10.15288/jsad.2017.78.588] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Substance use disorders (SUDs) are associated with elevated rates of mortality. Little is known about whether receiving appropriate care is associated with lower mortality for patients with SUDs. This study examined the association between the receipt of care for SUDs and subsequent 12- and 24-month mortality. METHOD This was a retrospective cohort study of veterans who received care for SUDs paid for by the Veterans Health Administration during October 2006- September 2007 (n = 339,966). Logistic regressions were used to examine the association between quality indicators measuring receipt of care and mortality while controlling for patient characteristics and facility service area. RESULTS There were four quality indicators: SUD treatment initiation, SUD treatment engagement, SUD-related psychosocial treatment, and SUD-related psychotherapy. Outcomes measured were mortality 12 and 24 months after the end of the observation period, through September 2009. Receipt of indicated care ranged from 26.5% to 58.6%, and 12- and 24-month mortality rates were 3% and 6%, respectively. Adjusted odds ratios [95% CI] of 12-month mortality by indicator were: initiation, 0.86 [0.79, 0.93]; engagement, 0.65 [0.58, 0.74]; psychosocial treatment, 0.88 [0.84, 0.92]; and psychotherapy, 0.84 [0.79, 0.89]. For the 24-month mortality outcome, adjusted odds ratios were: initiation, 0.88 [0.84, 0.93]; engagement, 0.78 [0.71, 0.85]; psychosocial treatment, 0.91 [0.88, 0.94]; and psychotherapy, 0.87 [0.83, 0.91]. Results were similar when controlling for facility service area. CONCLUSIONS Receiving appropriate care is associated with lower mortality for patients with SUDs. Significant overall and within-facility service area associations of quality indicators and mortality support their use in encouraging providers to deliver the indicated care. These indicators should be prioritized above others lacking comparably strong process-outcome associations.
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Affiliation(s)
| | | | - Teresa Hudson
- University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Veterans Affairs Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Songthip Ounpraseuth
- University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Veterans Affairs Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Amy M Schrader
- University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Veterans Affairs Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Greer Sullivan
- University of California Riverside School of Medicine, Riverside, California
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12
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Garner BR, Hunter SB, Slaughter ME, Han B, Godley SH. Factors associated with an evidence-based measure of implementation for the Adolescent Community Reinforcement Approach. Drug Alcohol Depend 2017; 180:144-150. [PMID: 28888154 PMCID: PMC6757189 DOI: 10.1016/j.drugalcdep.2017.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND An evidence-based measure of implementation (EBMI) is an implementation outcome measure shown to have predictive validity with one or more future-measured constructs of importance. The current study sought to identify correlates and predictors of an EBMI called procedure exposure. Garner et al. (2016) found procedure exposure to be an EBMI for the Adolescent Community Reinforcement Approach (A-CRA). METHODS The dataset included 76 community-based substance use treatment organizations located across the United States. Organizational-level regression analyses, which were framed within the context of Chaudoir et al. (2013) framework for predicting implementation outcomes, were used to examine predictors of A-CRA procedure exposure RESULTS: The Washington Circle's treatment initiation performance measure (B=5.05 [SE=1.60], p=0.002), as well as session exposure (B=0.18 [SE=0.06], p=0.003), were significant predictors of A-CRA procedure exposure in the backward stepwise regression analysis (Adjusted R-square=0.55). The Washington Circle's treatment engagement performance measure (B=7.93 [SE=0.77], p<0.001), as well as time-to-proficiency (B=-0.04 [SE=0.02], p=0.02), each had significant bivariate relationships with A-CRA procedure exposure but were not retained in the final model. CONCLUSIONS Organizations implementing A-CRA are encouraged to make the following high priorities: (a) scheduling and completing a subsequent treatment session within 14days of their index session (treatment initiation) and (b) providing a targeted number of treatment sessions to each client (session exposure). To the extent organizations do this, they may be more likely to achieve higher levels of A-CRA procedure exposure.
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Affiliation(s)
- Bryan R. Garner
- RTI International, P. O. Box 12194, Research Triangle Park, NC 27709, USA,Corresponding author. (B.R. Garner)
| | | | | | - Bing Han
- RAND Corp, P.O. Box 2138, Santa Monica, CA 90407, USA.
| | - Susan H. Godley
- Chestnut Health Systems, 448 Wylie Dr., Normal, IL 61761, USA
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13
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Hepner KA, Watkins KE, Farmer CM, Rubenstein L, Pedersen ER, Pincus HA. Quality of care measures for the management of unhealthy alcohol use. J Subst Abuse Treat 2017; 76:11-17. [PMID: 28340902 PMCID: PMC5384607 DOI: 10.1016/j.jsat.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 11/14/2016] [Accepted: 11/21/2016] [Indexed: 12/28/2022]
Abstract
There is a paucity of quality measures to assess the care for the range of unhealthy alcohol use, ranging from risky drinking to alcohol use disorders. Using a two-phase expert panel review process, we sought to develop an expanded set of quality of care measures for unhealthy alcohol use, focusing on outpatient care delivered in both primary care and specialty care settings. This process generated 25 candidate measures. Eight measures address screening and assessment, 11 address aspects of treatment, and six address follow-up. These quality measures represent high priority targets for future development, including creating detailed technical specifications and pilot testing them to evaluate their utility in terms of feasibility, reliability, and validity.
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Affiliation(s)
| | | | - Carrie M Farmer
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA 15213, USA.
| | - Lisa Rubenstein
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA; VA Greater Los Angeles at Sepulveda, 16111 Plummer St. (152), North Hills, CA 91343, USA; Department of Medicine and School of Public Health, UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | - Harold Alan Pincus
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA; Department of Psychiatry, Columbia University and New York-Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY 10032, USA.
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14
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Stuart EA, Barry CL, Donohue JM, Greenfield SF, Duckworth K, Song Z, Kouri EM, Ebnesajjad C, Mechanic R, Chernew ME, Huskamp HA. Effects of accountable care and payment reform on substance use disorder treatment: evidence from the initial 3 years of the alternative quality contract. Addiction 2017; 112:124-133. [PMID: 27517740 PMCID: PMC5148657 DOI: 10.1111/add.13555] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/01/2016] [Accepted: 08/11/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Global payment and accountable care reform efforts in the United States may connect more individuals with substance use disorders (SUD) to treatment. We tested whether such changes instituted under an Alternative Quality Contract (AQC) model within the Blue Cross Blue Shield of Massachusetts' (BCBSMA) insurer increased care for individuals with SUD. DESIGN Difference-in-differences design comparing enrollees in AQC organizations with a comparison group of enrollees in organizations not participating in the AQC. SETTING Massachusetts, USA. PARTICIPANTS BCBSMA enrollees aged 13-64 years from 2006 to 2011 (3 years prior to and after implementation) representing 1 333 534 enrollees and 42 801 SUD service users. MEASUREMENTS Outcomes were SUD service use and spending and SUD performance metrics. Primary exposures were enrollment into an AQC provider organization and whether the AQC organization did or did not face risk for behavioral health costs. FINDINGS Enrollees in AQC organizations facing behavioral health risk experienced no change in the probability of using SUD services (1.64 versus 1.66%; P = 0.63), SUD spending ($2807 versus $2700; P = 0.34) or total spending ($12 631 versus $12 849; P = 0.53), or SUD performance metrics (identification: 1.73 versus 1.76%, P = 0.57; initiation: 27.86 versus 27.02%, P = 0.50; engagement: 11.19 versus 10.97%, P = 0.79). Enrollees in AQC organizations not at risk for behavioral health spending experienced a small increase in the probability of using SUD services (1.83 versus 1.66%; P = 0.003) and the identification performance metric (1.92 versus 1.76%; P = 0.007) and a reduction in SUD medication use (11.84 versus 14.03%; P = 0.03) and the initiation performance metric (23.76 versus 27.02%; P = 0.005). CONCLUSIONS A global payment and accountable care model introduced in Massachusetts, USA (in which a health insurer provided care providers with fixed prepayments to cover most or all of their patients' care during a specified time-period, incentivizing providers to keep their patients healthy and reduce costs) did not lead to sizable changes in substance use disorder service use during the first 3 years following its implementation.
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15
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Schwarz AS, Bilberg R, Bjerregaard L, Nielsen B, Søgaard J, Nielsen AS. Relay model for recruiting alcohol dependent patients in general hospitals--a single-blind pragmatic randomized trial. BMC Health Serv Res 2016; 16:132. [PMID: 27080865 PMCID: PMC4832463 DOI: 10.1186/s12913-016-1376-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background A large proportion of the Danish population consumes more than the officially recommended weekly amount of alcohol. Untreated alcohol use disorders lead to frequent contacts with the health care system and can be associated with considerable human and societal costs. However, only a small share of those with alcohol use disorders receives treatment. A referral model to ensure treatment for alcohol dependent patients after discharge is needed. This study evaluates the i) cost-effectiveness ii) efficacy and iii) overall impact on societal costs of the proposed referral model - The Relay Model. Method/Design The study is a single-blind pragmatic randomized controlled trial including patients admitted to the hospital. The study group (n = 500) will receive an intervention, and the control group (n = 500) will be referred to treatment by usual procedures. All patients complete a lifestyle questionnaire with the Alcohol Use Disorders Identification Test embedded as a case identification strategy. The primary outcome of the study will be health care expenditures 12 months after discharge. The secondary outcome will be the percentage of the target group, who 30 days after discharge, reports at the alcohol treatment clinics. In order to analyse both outcomes, difference-in-difference models will be used. Discussion We expect to establish evidence as to whether The Relay Model is either cost-neutral or cost-effective, compared to referral by usual procedures. Trial registration https://register.clinicaltrials.gov/by identifier: RESCueH_Relay NCT02188043 Project Relay Model for Recruiting Alcohol Dependent Patients in General Hospitals (TRN Registration: 07/09/2014)
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Affiliation(s)
- Anne-Sophie Schwarz
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Randi Bilberg
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lene Bjerregaard
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bent Nielsen
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jes Søgaard
- The Danish Cancer Society and Aarhus University, Faculty of Health Science, Institute of Clinical Medicine, Department of Clinical Epidemiology, Copenhagen, Denmark
| | - Anette Søgaard Nielsen
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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16
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Slayter E. Disparities in Substance Abuse Treatment Utilization Among Women with Intellectual Disability. ACTA ACUST UNITED AC 2016; 15:96-115. [PMID: 26958802 DOI: 10.1080/1536710x.2016.1162120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite concerns about health disparities among women with intellectual disabilities, little is known about substance abuse treatment access in this population. Using standardized performance measures, treatment initiation and engagement were examined retrospectively for women aged 18 to 64 (N = 3,752), men with (N = 5,732) and women without intellectual disability (N = 493,446). Logistic regression models of utilization were conducted. Women in the sample were less likely than men in the sample or women without intellectual disability to utilize treatment, suggesting both gender-related and disability-related barriers. Policy and practice implications for improving the health and welfare of women with intellectual disabilities are discussed.
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Affiliation(s)
- Elspeth Slayter
- a Graduate School of Social Work , Salem State University , Salem , Massachusetts , USA
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17
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Myers B, Govender R, Koch JR, Manderscheid R, Johnson K, Parry CDH. Development and psychometric validation of a novel patient survey to assess perceived quality of substance abuse treatment in South Africa. Subst Abuse Treat Prev Policy 2015; 10:44. [PMID: 26545736 PMCID: PMC4636825 DOI: 10.1186/s13011-015-0040-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/02/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A hybrid performance measurement system that combines patient-reported outcome data with administrative data has been developed for South African substance abuse treatment services. This paper describes the development and psychometric validation of one component of this system, the South African Addiction Treatment Services Assessment (SAATSA). METHODS First, a national steering committee identified five domains and corresponding indicators on which treatment quality should be assessed. A decision was made to develop a patient survey to assess several of these indicators. A stakeholder work group sourced survey items and generated additional items where appropriate. The feasibility and face validity of these items were examined during cognitive response testing with 16 patients. This led to the elimination of several items. Next, we conducted an initial psychometric validation of the SAATSA with 364 patients from residential and outpatient services. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted to assess the latent structure of the SAATSA. Findings highlighted areas where the SAATSA required revision. Following revision, we conducted another psychometric validation with an additional sample of 285 patients. We used EFA and CFA to assess construct validity and we assessed reliability using Cronbach's measure of internal consistency. RESULTS The final version of the SAATSA comprised 31 items (rated on a four-point response scale) that correspond to six scales. Four of these scales are patient-reported outcome measures (substance use, quality of life, social connectedness and HIV risk outcomes) that together assess the perceived effectiveness of treatment. The remaining two scales assess patients' perceptions of access to and quality of care. The models for the final revised scales had good fit and the internal reliability of these scales was good to excellent, with Cronbach's α ranging from 0.72 to 0.89. CONCLUSION A lack of adequate measurement tools hampers efforts to improve the quality of substance abuse treatment. Our preliminary evidence suggests that the SAATSA, a novel patient survey that assesses patients' perceptions of the outcomes and quality of substance abuse treatment, is a psychometrically robust tool that can help fill this void.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Rajen Govender
- Department of Sociology, University of Cape Town, Cape Town, South Africa.
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Ron Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington DC, USA.
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Charles D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
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18
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Harris AHS, Rubinsky AD, Hoggatt KJ. Possible Alternatives to Diagnosis-Based Denominators for Addiction Treatment Quality Measures. J Subst Abuse Treat 2015; 58:62-6. [PMID: 26251046 DOI: 10.1016/j.jsat.2015.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 06/03/2015] [Accepted: 06/04/2015] [Indexed: 11/19/2022]
Abstract
Consumers of healthcare quality measures are often unaware of how measured performance may be driven by diagnosing practices rather than the provision of high quality care. Reliance on quality metrics that depend on documented diagnoses can therefore subvert comparisons between clinicians, facilities or systems. In this study, three versions of an alcohol use disorder (AUD) treatment quality measure were calculated: method 1--the usual denominator including all diagnosed patients; method 2--a "population-based" denominator including the entire facility census; and method 3-an epidemiologically-derived denominator comprising the expected prevalence of AUD based on case-mix characteristics and geographic region. Performance rankings under the three specifications were calculated. Changes in percentile rank of up to 30-45% were observed between methods. Therefore, much of the observed between-facility differences on diagnosis-based quality measures may reflect variation in the propensity to diagnose rather than real differences in performance. Stakeholders must decide which of the validity threats produced by these different methods is least worrisome.
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Affiliation(s)
- Alex H S Harris
- Center for Innovation to Implementation and Substance Use Disorder Quality Enhancement Research Initiative, VA Palo Alto Health Care System, Palo Alto, CA, United States.
| | - Anna D Rubinsky
- Center for Innovation to Implementation and Substance Use Disorder Quality Enhancement Research Initiative, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Katherine J Hoggatt
- VA Greater Los Angeles Health Care System and University of California Los Angeles, Los Angeles, CA, USA
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19
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Nielsen AS, Nielsen B. Implementation of a clinical pathway may improve alcohol treatment outcome. Addict Sci Clin Pract 2015; 10:7. [PMID: 25928550 PMCID: PMC4428248 DOI: 10.1186/s13722-015-0031-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/24/2015] [Indexed: 11/23/2022] Open
Abstract
This article describes the design, implementation, and evaluation of a clinical pathway system in a two-cohort quasi-experimental study before and after implementation, controlling for confounders. The main outcome measures were retention in care and sensible alcohol use (defined as abstinent or drinking no more than 21 standard drinks per week). Patients with harmful alcohol use or dependence as their primary problem who were seeking psychosocial treatment at one of four alcohol clinics in Denmark participated in the study. After implementation of the clinical pathway system, which incorporated a structured intake, a referral and independent follow-up system, checklists, audit, and feedback, there was no change in length of stay, but significantly more patients had a good clinical outcome (stopped or moderated their consumption) at the end of treatment (OR = 1.9; 1.2–3.1). The study documents the feasibility of using a clinical pathway framework, incorporating a local monitoring system, checklists, audit, and feedback to enhance treatment quality and improve outcomes for alcohol use disorders.
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Affiliation(s)
- Anette Søgaard Nielsen
- Department of Psychiatry, Odense University Hospital, DK-5000, Odense C, Denmark. .,Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, DK-5000, Odense C, Denmark.
| | - Bent Nielsen
- Department of Psychiatry, Odense University Hospital, DK-5000, Odense C, Denmark. .,Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, DK-5000, Odense C, Denmark.
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20
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Ramchand R, Griffin BA, Hunter SB, Booth MS, McCaffrey DF. Provision of mental health services as a quality indicator for adolescent substance abuse treatment facilities. Psychiatr Serv 2015; 66:41-8. [PMID: 25219932 PMCID: PMC4388191 DOI: 10.1176/appi.ps.201300517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study tested whether adolescents receiving substance abuse treatment at facilities offering full (can treat all psychiatric conditions) or partial (cannot treat severe or persistent mental illness) mental health services have better 12-month substance use and mental health outcomes than youths at facilities with no mental health services. METHODS Data were collected from 3,235 adolescents who were assessed at baseline and at 12 months at one of 50 adolescent treatment facilities. Propensity scores were applied to compare client outcomes from three types of facilities (full, partial, or no mental health services); weighted linear models were estimated to examine outcomes. RESULTS Youths attending facilities offering full or partial mental health services had better substance abuse treatment outcomes than youths attending facilities offering no such services. There was no evidence of a difference in substance use outcomes between facilities offering full versus partial services, nor was there evidence of differences in mental health outcomes. CONCLUSIONS These preliminary findings suggest that the availability of mental health services may be a useful quality indicator for adolescent substance abuse treatment facilities. More research is needed to examine specific types of mental health services offered at different facilities.
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Affiliation(s)
- Rajeev Ramchand
- The authors are with the RAND Corporation. Dr. Ramchand and Dr. Griffin are with the Arlington, Virginia, office, Dr. Hunter and Ms. Booth are in Santa Monica, California, and Dr. McCaffrey is in Pittsburgh. Send correspondence to Dr. Ramchand (e-mail: )
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21
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Upshur C, Weinreb L, Bharel M, Reed G, Frisard C. A randomized control trial of a chronic care intervention for homeless women with alcohol use problems. J Subst Abuse Treat 2014; 51:19-29. [PMID: 25488504 DOI: 10.1016/j.jsat.2014.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 09/26/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
A clinician-randomized trial was conducted using the chronic care model for disease management for alcohol use problems among n = 82 women served in a health care for the homeless clinic. Women with problem alcohol use received either usual care or an intervention consisting of a primary care provider (PCP) brief intervention, referral to addiction services, and on-going support from a care manager (CM) for 6 months. Both groups significantly reduced their alcohol consumption, with a small effect size favoring intervention at 3 months, but there were no significant differences between groups in reductions in drinking or in housing stability, or mental or physical health. However, intervention women had significantly more frequent participation in substance use treatment services. Baseline differences and small sample size limit generalizability, although substantial reductions in drinking for both groups suggest that screening and PCP brief treatment are promising interventions for homeless women with alcohol use problems.
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Affiliation(s)
- Carole Upshur
- Department of Family Medicine and Community Health, University of Massachusetts Medical School.
| | - Linda Weinreb
- Department of Family Medicine and Community Health, University of Massachusetts Medical School
| | - Monica Bharel
- Departments of Medicine, Boston University Medical Center and Massachusetts General Hospital, Boston Health Care for the Homeless Program
| | - George Reed
- Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Christine Frisard
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School
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22
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Lee MT, Horgan CM, Garnick DW, Acevedo A, Panas L, Ritter GA, Dunigan R, Babakhanlou-Chase H, Bidorini A, Campbell K, Haberlin K, Huber A, Lambert-Wacey D, Leeper T, Reynolds M. A performance measure for continuity of care after detoxification: relationship with outcomes. J Subst Abuse Treat 2014; 47:130-9. [PMID: 24912862 DOI: 10.1016/j.jsat.2014.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/21/2014] [Accepted: 04/14/2014] [Indexed: 11/18/2022]
Abstract
Administrative data from five states were used to examine whether continuity of specialty substance abuse treatment after detoxification predicts outcomes. We examined the influence of a 14-day continuity of care process measure on readmissions. Across multiple states, there was support that clients who received treatment for substance use disorders within 14-days after discharge from detoxification were less likely to be readmitted to detoxification. This was particularly true for reducing readmissions to another detoxification that was not followed with treatment and when continuity of care was in residential treatment. Continuity of care in outpatient treatment was related to a reduction in readmissions in some states, but not as often as when continuity of care occurred in residential treatment. A performance measure for continuity of care after detoxification is a useful tool to help providers monitor quality of care delivered and to alert them when improvement is needed.
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Affiliation(s)
- Margaret T Lee
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110.
| | - Constance M Horgan
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | - Deborah W Garnick
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | - Andrea Acevedo
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | - Lee Panas
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | - Grant A Ritter
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | - Robert Dunigan
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | | | - Alfred Bidorini
- Connecticut Department of Mental Health and Addiction Services, Hartford, CT 06134
| | - Kevin Campbell
- Washington State Department of Social and Health Services, The Division of Behavioral Health and Recovery, Olympia, WA 98501
| | - Karin Haberlin
- Connecticut Department of Mental Health and Addiction Services, Hartford, CT 06134
| | - Alice Huber
- Washington State Department of Social and Health Services, The Division of Behavioral Health and Recovery, Olympia, WA 98501
| | - Dawn Lambert-Wacey
- New York State Office of Alcoholism and Substance Abuse Services, Division of Outcome Management and System Investment, Albany, N.Y. 12203
| | - Tracy Leeper
- Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City, OK 73152
| | - Mark Reynolds
- Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City, OK 73152
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Abstract
Little is known about the organizational and environmental factors associated with the employment of nurses in substance abuse treatment programs. Using data collected from the administrators of 250 publicly funded substance abuse treatment programs, this study examined the organizational and environmental correlates of nurse employment in these settings. Negative binomial regression models indicated that the number of nurses employed by treatment programs was positively associated with government ownership, location within a healthcare setting, and the availability of detoxification services. Outpatient-only programs employed fewer nurses than programs with inpatient/residential services. Two environmental factors were associated with nurse employment. Programs that more strongly endorsed a scale of financial barriers employed significantly fewer nurses, whereas programs indicating that funding from state contracts could be used to pay for healthcare providers employed significantly more nurses. These findings suggest that organizational decisions about employing nurses may reflect both the characteristics of the program and the funding environment. Future research should continue to examine the employment of nurses in substance abuse treatment settings, particularly given the shifting environment due to the implementation of healthcare reform.
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24
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Lennox RD, Sternquist MA, Paredes A. A simplified method for routine outcome monitoring after drug abuse treatment. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2013; 7:155-69. [PMID: 24092985 PMCID: PMC3782393 DOI: 10.4137/sart.s12691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The routine collection of drug treatment outcomes to manage quality of care, improve patient satisfaction, and allocate treatment resources is currently hampered by two key difficulties: (1) problems locating clients once they leave treatment; and (2) the prohibitive cost of obtaining meaningful and reliable post-treatment data. This pilot describes precise methods for an economical staff-based routine outcome monitoring (ROM) system using an 18-item core measure telephone survey. As implemented at Narconon™ of Oklahoma, a behavioral and social skills based, residential drug rehabilitation program, the system was psychometrically adequate for aggregate reporting while providing clinically useful information. Standardized procedures for staff training, collecting client contact information, structuring exit interviews and maintaining post-treatment telephone contact produced follow-up rates that improved from 57.6% to 100% over the course of the project. Aggregate data was used to improve program delivery and thereby post-treatment substance use and social outcomes. These methods and use of data may contribute to the discussion on how to best monitor outcomes.
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Affiliation(s)
- Richard D Lennox
- Chestnut Health Systems, 2404 Western Park Lane, Hillsborough, NC 27278, USA
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Boudreaux ED, Abar B, Baumann BM, Grissom G. A randomized clinical trial of the health evaluation and referral assistant (HERA): research methods. Contemp Clin Trials 2013; 35:87-96. [PMID: 23665335 DOI: 10.1016/j.cct.2013.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/26/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
Abstract
The Health Evaluation and Referral Assistant (HERA) is a web-based program designed to facilitate screening, brief intervention, and referral to treatment (SBIRT) for tobacco, alcohol, and drug abuse. After the patient completes a computerized substance abuse assessment, the HERA produces a summary report with evidence-based recommended clinical actions for the healthcare provider (the Healthcare Provider Report) and a report for the patient (the Patient Feedback Report) that provides education regarding the consequences of use, personally tailored motivational messages, and a tailored substance abuse treatment referral list. For those who provide authorization, the HERA faxes the individual's contact information to a substance abuse treatment provider matched to the individual's substance use severity and personal characteristics, like insurance and location of residence (dynamic referral). This paper summarizes the methods used for a randomized controlled trial to evaluate the HERA's efficacy in leading to increased treatment initiation and reduced substance use. The study was performed in four emergency departments. Individual patients were randomized into one of two conditions: the HERA or assessment only. A total of 4269 patients were screened and 1006 participants enrolled. The sample was comprised of 427 tobacco users, 212 risky alcohol users, and 367 illicit drug users. Forty-two percent used more than one substance class. The enrolled sample was similar to the eligible patient population. The study should enhance understanding of whether computer-facilitated SBIRT can impact process of care variables, such as promoting substance abuse treatment initiation, as well as its effect on subsequent substance abuse and related outcomes.
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Affiliation(s)
- Edwin D Boudreaux
- The Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
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Walley AY, Tetrault JM, Friedmann PD. Integration of substance use treatment and medical care: a special issue of JSAT. J Subst Abuse Treat 2012; 43:377-81. [PMID: 23079197 DOI: 10.1016/j.jsat.2012.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 09/07/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, MA 02118, USA
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Rush B, Martin G, Corea L, Rotondi NK. Engaging stakeholders in review and recommendations for models of outcome monitoring for substance abuse treatment. Subst Use Misuse 2012; 47:1293-302. [PMID: 22780842 DOI: 10.3109/10826084.2012.696299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We present an example of a collaborative process designed to review models of outcome monitoring for substance abuse services, with a view to assessing the feasibility of different approaches in Ontario, Canada. A conceptual framework that describes the parameters of an outcome monitoring system and four models of outcome monitoring were identified. Consultations were held with stakeholders (managers, directors, researchers, clinicians, and governmental representatives) about the types of information they would like to obtain from an outcome monitoring system. Our process is useful as a model for collaborative research with respect to performance measurement. The study's implications and limitations are noted.
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Affiliation(s)
- Brian Rush
- Centre for Addiction and Mental Health, Health Systems and Health Equity Research Group, Toronto, Ontario M5S 2S1, Canada.
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Strickler GK, Reif S, Horgan CM, Acevedo A. The Relationship between Substance Abuse Performance Measures and Mutual Help Group Participation after Treatment. ALCOHOLISM TREATMENT QUARTERLY 2012; 30:190-210. [PMID: 22879689 DOI: 10.1080/07347324.2012.663305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We examined the relationship between treatment quality, using during-treatment process measures, and mutual help group (e.g., Alcoholics Anonymous) attendance after outpatient substance use disorder (SUD) treatment for 739 clients in the Alcohol and Drug Services Study. Logistic regression models estimated any and regular mutual help attendance after treatment. Clients referred to mutual help groups were significantly more likely to attend any mutual help after treatment. Results were mixed for facility offered mutual help groups; treatment engagement and retention were not significant. These findings offer treatment providers further evidence of the importance of referring clients to post-treatment mutual help groups, an effective, low-cost option.
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Lauriks S, Buster MC, de Wit MA, Arah OA, Klazinga NS. Performance indicators for public mental healthcare: a systematic international inventory. BMC Public Health 2012; 12:214. [PMID: 22433251 PMCID: PMC3353215 DOI: 10.1186/1471-2458-12-214] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 03/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background The development and use of performance indicators (PI) in the field of public mental health care (PMHC) has increased rapidly in the last decade. To gain insight in the current state of PI for PMHC in nations and regions around the world, we conducted a structured review of publications in scientific peer-reviewed journals supplemented by a systematic inventory of PI published in policy documents by (non-) governmental organizations. Methods Publications on PI for PMHC were identified through database- and internet searches. Final selection was based on review of the full content of the publications. Publications were ordered by nation or region and chronologically. Individual PI were classified by development method, assessment level, care domain, performance dimension, diagnostic focus, and data source. Finally, the evidence on feasibility, data reliability, and content-, criterion-, and construct validity of the PI was evaluated. Results A total of 106 publications were included in the sample. The majority of the publications (n = 65) were peer-reviewed journal articles and 66 publications specifically dealt with performance of PMHC in the United States. The objectives of performance measurement vary widely from internal quality improvement to increasing transparency and accountability. The characteristics of 1480 unique PI were assessed. The majority of PI is based on stakeholder opinion, assesses care processes, is not specific to any diagnostic group, and utilizes administrative data sources. The targeted quality dimensions varied widely across and within nations depending on local professional or political definitions and interests. For all PI some evidence for the content validity and feasibility has been established. Data reliability, criterion- and construct validity have rarely been assessed. Only 18 publications on criterion validity were included. These show significant associations in the expected direction on the majority of PI, but mixed results on a noteworthy number of others. Conclusions PI have been developed for a broad range of care levels, domains, and quality dimensions of PMHC. To ensure their usefulness for the measurement of PMHC performance and advancement of transparency, accountability and quality improvement in PMHC, future research should focus on assessment of the psychometric properties of PI.
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Affiliation(s)
- Steve Lauriks
- Department of Epidemiology, Documentation and Health Promotion EDG, Municipal Health Service Amsterdam, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands.
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Acevedo A, Garnick DW, Lee MT, Horgan CM, Ritter G, Panas L, Davis S, Leeper T, Moore R, Reynolds M. Racial and ethnic differences in substance abuse treatment initiation and engagement. J Ethn Subst Abuse 2012; 11:1-21. [PMID: 22381120 PMCID: PMC3699873 DOI: 10.1080/15332640.2012.652516] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examined variations by race and ethnicity in initiation and engagement, two performance measures of treatment for substance use disorders that focus on the timely receipt of services during the early stage of substance abuse treatment. Administrative data from the Oklahoma Department of Mental Health and Substance Abuse Services were linked with facility-level information from the National Survey of Substance Abuse Treatment Services. We found that Black clients were least likely to initiate treatment, but no race or ethnic differences in treatment engagement were found when compared by race or ethnicity. Most client and facility characteristics' association with initiation or engagement did not differ across racial or ethnic groups. Increased attention is needed to understand what may contribute to the differences and how to address them. This study also offers an approach that state agencies may implement for monitoring treatment quality and examining racial and ethnic disparities in substance abuse treatment services.
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Humphreys K, McLellan AT. A policy-oriented review of strategies for improving the outcomes of services for substance use disorder patients. Addiction 2011; 106:2058-66. [PMID: 21631620 DOI: 10.1111/j.1360-0443.2011.03464.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To inform policy makers on available options for improving the effectiveness of treatments for substance use disorders and to stimulate debate about treatment improvement strategies among public officials, clinical providers, care managers, service users, families and researchers. METHODS We draw on the scientific literature and our public policy experiences in two countries (the United Kingdom and the United States) to give an overview of policies which may improve care for individuals with substance use disorders. We divide such policies into 'process-focused quality improvement strategies' that attempt to change some aspect of treatment (e.g. increased retention, greater use of evidence-based practices) and 'patient-focused strategies' that attempt to reward outcomes directly (e.g. contingency management for patients, payment by results for providers). FINDINGS Many policies of both types are poorly developed, have shown poor results, or both. The evidence is clear that process-focused quality improvement strategies can change what providers do and how treatment programs work, but such changes have thus far demonstrated only minimal impact on patient outcomes. Patient-focused strategies face challenges including treatment providers avoiding hard-to-treat patients or spending inordinate time relocating patients after treatment to assess outcome. However, policies that reward in-treatment outcomes and policies that allow the patient to purchase desired recovery support services show more promise. As policy makers go forward in this endeavor, they can do an enormous service to their countries and the field by embedding careful evaluation studies alongside new treatment outcome improvement initiatives.
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Affiliation(s)
- Keith Humphreys
- Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA, USA.
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Slayter E. Adults With Dual Eligibility for Medicaid and Medicare: Access to Substance Abuse Treatment. ACTA ACUST UNITED AC 2011; 10:67-81. [DOI: 10.1080/1536710x.2011.571482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Garnick DW, Lee MT, Horgan C, Acevedo A, Botticelli M, Clark S, Davis S, Gallati R, Haberlin K, Hanchett A, Lambert-Wacey D, Leeper T, Siemianowski J, Tikoo M. Lessons from five states: public sector use of the Washington Circle performance measures. J Subst Abuse Treat 2011; 40:241-54. [PMID: 21257282 DOI: 10.1016/j.jsat.2010.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 10/20/2010] [Accepted: 11/22/2010] [Indexed: 11/28/2022]
Abstract
Five states (Connecticut, Massachusetts, New York, North Carolina, and Oklahoma) have incorporated the Washington Circle (WC) substance abuse performance measures in various ways into their quality improvement strategies. In this article, we focus on what other states and local providers might learn from these states' experiences as they consider using WC performance measures. Using a case study approach, we report that the use of WC measures differs across these five states, although there are important common themes required for adoption and sustainability of performance measures, which include leadership, evaluation of specification and use of measures over time, state-specific adaptation of the WC measure specifications, collaboration with consultants and partners, inclusion of WC measures in the context of other initiatives, reporting to providers and the public, and data and resource requirements. As additional states adopt some of the WC measures, or adopt other performance measurement approaches, these states' experiences could help them to develop implementations based on their particular needs.
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Affiliation(s)
- Deborah W Garnick
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA02454, USA.
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Thomas CP, Garnick DW, Horgan CM, McCorry F, Gmyrek A, Chalk M, Gastfriend DR, Rinaldo SG, Albright J, Capoccia VA, Harris AHS, Harwood HJ, Greenberg P, Mark TL, Un H, Oros M, Stringer M, Thatcher J. Advancing performance measures for use of medications in substance abuse treatment. J Subst Abuse Treat 2011; 40:35-43. [PMID: 20934836 PMCID: PMC2997925 DOI: 10.1016/j.jsat.2010.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 08/07/2010] [Accepted: 08/11/2010] [Indexed: 11/16/2022]
Abstract
Performance measures have the potential to drive high-quality health care. However, technical and policy challenges exist in developing and implementing measures to assess substance use disorder (SUD) pharmacotherapy. Of critical importance in advancing performance measures for use of SUD pharmacotherapy is the recognition that different measurement approaches may be needed in the public and private sectors and will be determined by the availability of different data collection and monitoring systems. In 2009, the Washington Circle convened a panel of nationally recognized insurers, purchasers, providers, policy makers, and researchers to address this topic. The charge of the panel was to identify opportunities and challenges in advancing use of SUD pharmacotherapy performance measures across a range of systems. This article summarizes those findings by identifying a number of critical themes related to advancing SUD pharmacotherapy performance measures, highlighting examples from the field, and recommending actions for policy makers.
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Affiliation(s)
- Cindy Parks Thomas
- Brandeis University, Institute for Behavioral Health, Heller School for Social Policy and Management, Waltham, MA 02454, USA.
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Rawson RA, Gonzales R, Crèvecoeur-MacPhail D, Urada D, Brecht ML, Chalk M, Kemp J, Cunningham M. Improving the accountability of California's public substance abuse treatment system through the implementation of performance models. J Psychoactive Drugs 2010; Suppl 6:211-4. [PMID: 21138197 DOI: 10.1080/02791072.2010.10400544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Improving the care for individuals with substance use disorders is a national health policy priority. Like other parts of the health care system, the addiction field is under pressure for higher accountability-more efficient use of treatment resources, the delivery of quality services, and the production of positive client outcomes. This introductory article highlights the importance of the collection of articles being published in this special issue as they describe California's efforts toward making the alcohol and drug (AOD) treatment system more accountable and effective.
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Affiliation(s)
- Richard A Rawson
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90025, USA.
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Slayter EM. Demographic and clinical characteristics of people with intellectual disabilities with and without substance abuse disorders in a Medicaid population. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2010; 48:417-431. [PMID: 21166548 DOI: 10.1352/1934-9556-48.6.417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Little is known about the demographic and clinical characteristics of people with intellectual disabilities and substance abuse problems. Drawing on health care billing claims for people with Medicaid coverage aged 12-99 years, the characteristics of people with intellectual disability and a history of substance abuse (N=9,484) were explored and compared with people with intellectual disability but without substance abuse. Age- and/or gender-adjusted odds ratios were derived from logistic regression analyses to consider differences in demographic and clinical diagnoses. People with intellectual disability and substance abuse constituted 2.6% of all people with intellectual disability, most of whom had a diagnosis of mild or moderate intellectual disability. People with intellectual disability and substance abuse problems were, on average, 2 years older than the comparison group and less likely to be White. The sample was more likely than the comparison group to have serious mental illness or depression and substance abuse-related disorders were not prevalent. These data provide a comparison point for existing studies of mental health diagnoses as well as new information about substance abuse disorders. Implications relate to the identification of substance abuse among people with intellectual disabilities as well as the establishment of demographic and clinical correlates.
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Haley SJ, Dugosh KL, Lynch KG. Performance contracting to engage detoxification-only patients into continued rehabilitation. J Subst Abuse Treat 2010; 40:123-31. [PMID: 21094591 DOI: 10.1016/j.jsat.2010.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 09/08/2010] [Accepted: 09/10/2010] [Indexed: 11/18/2022]
Abstract
In 2006, only 18.7% of Delaware's detoxification patients were admitted to continuing recovery-oriented treatment within 30 days after discharge. In response, Delaware established financial contingencies to (1) maintain 90% detoxification occupancy, (2) make receipt of 10% of the facility's monthly reimbursement contingent on 25% of patients entering treatment, and (3) provide a $500 bonus for every patient with three or more prior detoxification visits who was retained in treatment. Under the performance contract, the detoxification provider (1) maintained the 90% occupancy requirement, (2) achieved the 25% treatment entry target for 7 of 12 months, and (3) observed only 8% (27/337) of detoxification completions that met the targeted length of stay. Continuation to and retention in treatment was even more constrained for patients with three or more prior detoxifications. Contrary to the policy intent, the number of patients with three or more detoxifications in fiscal year (FY) 2008 is nearly triple that of FY 2006. The modest gain in the transition rate was achieved without changes in patient access; the FY 2008 patient population reported significantly higher rates of homelessness and a younger age of first use than before the performance contract in FY 2006. Performance contracting may offer promise for improving transition to treatment rates. However, the unique needs of detoxification patients, the treatment capacity of each level of care to meet patient needs, and the structure of the performance contract must be carefully considered. Performance contracting efforts may be strengthened when service contracts across the system are tightly synchronized.
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Affiliation(s)
- Sean J Haley
- Department of Health and Nutrition, Brooklyn College, City University of New York, Brooklyn, NY 11210, USA.
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Amaral RAD, Malbergier A, Andrade AGD. Manejo do paciente com transtornos relacionados ao uso de substância psicoativa na emergência psiquiátrica. BRAZILIAN JOURNAL OF PSYCHIATRY 2010; 32 Suppl 2:S104-11. [PMID: 21140070 DOI: 10.1590/s1516-44462010000600007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e psiquiátricos, atingindo taxas de 28% das ocorrências em prontos-socorros gerais. Todavia, profissionais dos setores de emergência identificam menos que 50% dos casos de problemas relacionados ao álcool. Este artigo visa fornecer base fundamentada em evidências para o tratamento específico a pacientes que preencham os critérios diagnósticos de transtornos por uso de substâncias e que se apresentam ao pronto-socorro em quadros de intoxicação ou abstinência. MÉTODO: Uma revisão sobre o tema foi realizada na base de dados Medline, usando-se os descritores "intoxicação aguda", "abstinência", "álcool", "cocaína", "cannabis", "opioides", "inalantes" e "manejo", tendo o inglês como idioma. RESULTADOS E CONCLUSÃO: O cuidado de pessoas com transtornos por uso de substâncias deve conter: avaliação completa (médica geral e psiquiátrica), tratamento dos quadros diagnosticados (abstinência, intoxicação e quadros clínicos que caracterizem uma emergência), sensibilização do paciente para realizar tratamento, se for necessário, e elaboração de encaminhamento.
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Slayter E. Medicaid-covered alcohol and drug treatment use among people with intellectual disabilities: evidence of disparities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2010; 48:361-374. [PMID: 20973699 DOI: 10.1352/1934-9556-48.5.361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
For some, community inclusion facilitates access to alcohol and drugs and, therefore, the potential for developing substance abuse disorders. However, little is known about substance abuse treatment use among people with intellectual disabilities. Using standardized performance measures, substance abuse treatment utilization was examined for Medicaid-covered people with intellectual disabilities and substance abuse (N=9,484) versus people without intellectual disabilities (N=915,070). The sociobehavioral model of healthcare use guides multivariate logistic regression analyses of substance abuse treatment utilization patterns, revealing disability-related disparities. Factors associated with utilization included being non-White, living in a nonurban area, having a serious mental illness, and living in a state with a generous Medicaid plan for substance abuse treatment. Implications relate to health policy, service delivery patterns, and the need for cross-system collaboration in the use of integrated treatment approaches.
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Affiliation(s)
- Elspeth Slayter
- Salem State University, School of Social Work, Salem, MA 01970, USA.
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Daley M, Shepard DS, Reif S, Dunigan R, Tompkins CP, Perloff J, Siembab L, Horgan CM. Evaluation of Provider Profiling in Public Sector Substance Abuse Treatment. ALCOHOLISM TREATMENT QUARTERLY 2010. [DOI: 10.1080/07347324.2010.512221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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McCarty D, McConnell KJ, Schmidt LA. Priorities for policy research on treatments for alcohol and drug use disorders. J Subst Abuse Treat 2010; 39:87-95. [PMID: 20598828 DOI: 10.1016/j.jsat.2010.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 04/17/2010] [Accepted: 05/03/2010] [Indexed: 11/19/2022]
Abstract
The Robert Wood Johnson Foundation's Substance Abuse Policy Research Program (SAPRP) supported 368 awards for nearly $60 million to complete policy research related to alcohol, tobacco, and illicit drug use and abuse. As part of its closure in 2009, SAPRP commissioned four papers that articulated policy research priorities for tobacco cessation and control, alcohol prevention, drug prevention, and addiction treatment. The papers were released at a Congressional Briefing on October 2, 2009 and are available on the SAPRP Web site (http://www.saprp.org/Research_Agenda.cfm). An abridged version of the treatment policy paper summarizes what we know, what we need to know, and research recommendations. The paper examines five categories of policy concerns that are likely to affect addiction treatment services over the next 5 years: (a) organization and delivery of care, (b) quality of care, (c) evidence-based practices, (d) access to care, and (e) financing, costs, and value of care.
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Affiliation(s)
- Dennis McCarty
- Oregon Health & Science University, Portland, OR 97239, USA.
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Wisdom JP, Ford JH, McCarty D. The Use of Health Information Technology in Publicly-Funded U. S. Substance Abuse Treatment Agencies. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/009145091003700207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug and alcohol treatment agencies are challenged to improve their infrastructure to meet growing technological and organizational demands. Health care reform and increased emphasis on performance monitoring in the United States are leading to improvements in health information technology. We assess literature to: (1) survey opportunities for health information technology for publicly-funded substance abuse treatment; (2) describe the use of electronic medical records in U.S. substance use treatment programs; (3) identify barriers and facilitators to implementing technology in substance abuse treatment programs; and (4) discuss applications of these concepts to private and international substance abuse treatment. Although these technologies hold promise to improve outcomes in the areas of cost-effectiveness, provider time savings, and quality improvement, substantial barriers exist to implementing health information technology in substance abuse treatment programs. Increased incentives, evidence, and implementation guidance can facilitate health information technology infrastructure improvement in substance abuse treatment to increase competitiveness in the U.S. health care market and improve the quality of care.
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Development of a model and measure of process-oriented quality of care for substance abuse treatment. J Behav Health Serv Res 2010; 37:4-24. [PMID: 19462245 DOI: 10.1007/s11414-009-9180-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The development of a detailed model of substance-abuse treatment (SAT) staff performance is described. The model describes the key behaviors of SAT staff. Specifically, researchers used the critical incident technique to develop the model, which includes a total of 15 dimensions, nested under four meta-dimensions: providing clinical services, employee citizenship behaviors, providing clinical support, and managerial behavior. Development and validation of a measure based on the model are also described. More than 600 SAT staff members in 51 SAT agencies completed the new measure. Factor analyses supported the measure's hypothesized dimensional structure; high internal consistency reliabilities were observed for all scales; and interrater agreement metrics indicated an acceptable level of within-agency agreement. Moreover, the measure correlated in expected and theoretically consistent ways with measures of job satisfaction and other job-related opinions.
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Harris AHS, Humphreys K, Bowe T, Tiet Q, Finney JW. Does meeting the HEDIS substance abuse treatment engagement criterion predict patient outcomes? J Behav Health Serv Res 2010; 37:25-39. [PMID: 18770044 DOI: 10.1007/s11414-008-9142-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examines the patient-level associations between the Health Plan Employer Data and Information Set (HEDIS) substance use disorder (SUD) treatment engagement quality indicator and improvements in clinical outcomes. Administrative and survey data from 2,789 US Department of Veterans Affairs SUD patients were used to estimate the effects of meeting the HEDIS engagement criterion on improvements in Addiction Severity Index Alcohol, Drug, and Legal composite scores. Patients meeting the engagement indicator improved significantly more in all domains than patients who did not engage, and the relationship was stronger for alcohol and legal outcomes for patients seen in outpatient settings. The benefit accrued by those who engaged was statistically significant but clinically modest. These results add to the literature documenting the clinical benefits of treatment entry and engagement. Although these findings only indirectly support the use of the HEDIS engagement measure for its intended purpose-discriminating quality at the facility or system level-they confirm that the processes of care captured by the measure are associated with important patient outcomes.
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Affiliation(s)
- Alex H S Harris
- Center for Health Care Evaluation, Department of Veterans Affairs, Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, CA 94025, USA.
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Dausey DJ, Pincus HA, Herrell JM. Performance measurement for co-occurring mental health and substance use disorders. Subst Abuse Treat Prev Policy 2009; 4:18. [PMID: 19828034 PMCID: PMC2770527 DOI: 10.1186/1747-597x-4-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 10/14/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Co-occurring mental health and substance use disorders (COD) are the norm rather than the exception. It is therefore critical that performance measures are developed to assess the quality of care for individuals with COD irrespective of whether they seek care in mental health systems or substance abuse systems or both. METHODS We convened an expert panel and asked them to rate a series of structure, process, and outcomes measures for COD using a structured evaluation tool with domains for importance, usefulness, validity, and practicality. RESULTS We chose twelve measures that demonstrated promise for future pilot testing and refinement. The criteria that we applied to select these measures included: balance across structure, process, and outcome measures, quantitative ratings from the panelists, narrative comments from the panelists, and evidence the measure had been tested in a similar form elsewhere. CONCLUSION To be successful performance measures need to be developed in such a way that they align with needs of administrators and providers. Policymakers need to work with all stakeholders to establish a concrete agenda for developing, piloting and implementing performance measures that include COD. Future research could begin to consider strategies that increase our ability to use administrative coding in mental health and substance use disorder systems to efficiently capture quality relevant clinical data.
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Affiliation(s)
- David J Dausey
- Carnegie Mellon University, Pittsburgh PA 15213, USA
- RAND Corporation, Pittsburgh PA 15213, USA
| | - Harold A Pincus
- RAND Corporation, Pittsburgh PA 15213, USA
- College of Physicians and Surgeons, Columbia University, and New York Presbyterian Hospital and Irving Center for Clinical and Translational Research, New York NY 10032, USA
| | - James M Herrell
- Substance Abuse and Mental Health Services Administration (SAMHSA)/Center for Substance Abuse Treatment (CSAT), Rockville, MD 20850, USA
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Maclean Slayter E. Not Immune: Access to Substance Abuse Treatment Among Medicaid-Covered Youth With Mental Retardation. JOURNAL OF DISABILITY POLICY STUDIES 2009. [DOI: 10.1177/1044207309341373] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Youth with mental retardation* (MR) have experienced increasing levels of participation in community life over the last 30 years. This freedom has facilitated access to community life beyond school settings; it has also created the potential for alcohol and drug use and for the development of substance abuse (SA). Little is known about access to SA treatment for youth with MR—an especially vulnerable population. Through the application of a set of standardized performance measures, this study examines SA treatment access among youth aged 12 to 21 with and without MR ( N = 150,009). Guided by Andersen’s sociobehavioral model of health care utilization, multivariate logistic regression analyses modeled SA treatment initiation and engagement. Youth with MR and SA were less likely to initiate or engage in treatment. Engagement among youth with MR and SA was associated with being male and/or non-White. Implications relate to a need for improved treatment access for youth with MR and SA through cross-system collaboration.
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Stein BD, Kogan JN, Sorbero M. Substance abuse detoxification and residential treatment among Medicaid-enrolled adults: rates and duration of subsequent treatment. Drug Alcohol Depend 2009; 104:100-6. [PMID: 19481884 PMCID: PMC2818065 DOI: 10.1016/j.drugalcdep.2009.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 04/08/2009] [Accepted: 04/08/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Substance use disorders are chronic disorders with substantial public health significance, yet the treatment provided is often episodic despite ongoing need. Among the more severely ill individuals requiring detoxification or residential treatment, little empirical information is available about rates and predictors of subsequent engagement in necessary subsequent treatment. METHODS Using administrative data from the largest Medicaid managed behavioral health organization in a large mid-Atlantic state, we used multivariate regression to examine rates and predictors of subsequent treatment engagement and retention following new episodes of detoxification or residential substance abuse treatment among 5670 Medicaid-enrolled adults during 2004-2006. RESULTS Slightly less than half (49%) of the sample received follow-up care within 30 days of discharge. Rates of follow-up were significantly higher in individuals with a serious mental illness, and significantly lower in African-American individuals, males, individuals with disabilities, and those who received detoxification without residential treatment. The mean duration of follow-up treatment was 84 days, and was longer among individuals with a serious mental illness and Caucasians. Even after controlling for individuals' sociodemographic and clinical characteristics, there was substantial variation in follow-up rates among discharging providers. CONCLUSION The relatively low rates of follow-up care and relatively brief duration of treatment for many of those who received such follow-up care are concerning in a population receiving substance abuse detoxification or residential treatment. The markedly lower rates among those receiving detoxification alone without subsequent residential treatment and among those without a comorbid serious mental illness suggest that efforts specifically targeting those individuals may be of particular benefit.
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Affiliation(s)
- Bradley D. Stein
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 Ohara St., Pittsburgh, Pennsylvania 15213,Community Care Behavioral Health Organization, One Chatham Center, 112 Washington Place, Pittsburgh, Pennsylvania 15219
| | - Jane N. Kogan
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 Ohara St., Pittsburgh, Pennsylvania 15213,Community Care Behavioral Health Organization, One Chatham Center, 112 Washington Place, Pittsburgh, Pennsylvania 15219
| | - Mark Sorbero
- Community Care Behavioral Health Organization, One Chatham Center, 112 Washington Place, Pittsburgh, Pennsylvania 15219
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48
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Monitoring and Evaluation of Substance Abuse Services in South Africa: Implications for Policy and Practice. Int J Ment Health Addict 2009. [DOI: 10.1007/s11469-009-9232-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Garner BR, Godley MD, Funk RR, Lee MT, Garnick DW. The Washington Circle continuity of care performance measure: predictive validity with adolescents discharged from residential treatment. J Subst Abuse Treat 2009; 38:3-11. [PMID: 19553067 DOI: 10.1016/j.jsat.2009.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 05/12/2009] [Accepted: 05/21/2009] [Indexed: 11/18/2022]
Abstract
This study examined the predictive validity of the Washington Circle (WC) continuity of care after long-term residential treatment performance measure, as well as the impact of assertive continuing care interventions on achieving continuity of care. This measure is a process measure that focuses on timely delivery of a minimal floor of services that are necessary to provide sufficient quality of treatment but should not be construed to be the optimal continuity of care after residential treatment for any specific adolescent. Participants included 342 adolescents who were admitted to long-term residential treatment and randomly assigned to either standard continuing care or an assertive continuing care condition. Overall, results provide initial support for the WC continuity of care after residential treatment performance measure as a useful predictor of 3-month recovery status. In addition, assignment to an assertive continuing care condition was found to significantly increase the likelihood of achieving continuity of care.
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Vandivort R, Teich JL, Cowell AJ, Chen H. Utilization of substance abuse treatment services under Medicare, 2001–2002. J Subst Abuse Treat 2009; 36:414-9. [DOI: 10.1016/j.jsat.2008.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 08/22/2008] [Accepted: 08/23/2008] [Indexed: 10/21/2022]
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