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BACKGROUND/RATIONALE:
In order to evaluate the quality and effectiveness of care, health care systems increasingly rely on process measures of treatment provision constructed from administrative data. The OQP Continuity of Care measure is the primary metric through which VA SUD specialty care quality is insentivized. The HEDIS performance measures of substance use disorder (SUD) care (Initiation and Engagement) have been widely adopted by many state and private health care agencies to evaluate the quality of their SUD treatment performance. Further, as the VA Mental Health Strategic Plan approved by the Secretary recommends greater use of these measures, greater analysis of them has high VA policy relevance. However, two important aspects of the validity of these measures have not been evaluated: 1) The extent to which meeting these process-based criteria are associated with other quality measures, such as patient clinical outcomes, and 2) The extent to which the criteria as specified accurately index bonafide SUD care.
OBJECTIVE(S):
Aim1: To determine the degree of association between meeting the process of care criteria (i.e., OQP Continuity of Care measure, HEDIS Initiation and Engagement) at the patient level with outcome quality measures (i.e., change in patient symptoms).
Aim2: To determine the degree of association between facility-level rates of meeting the process of care measures with outcome quality measures (e.g., average patient outcomes), structural quality measures (e.g.,
number of SUD beds, patient-to-staff ratios) and other process measures (e.g., adherence to clinical practice guidelines).
Aim 3: To evaluate the extent to which the specifications for process measures of quality accurately index bonafide SUD care. Subsidiary Aims: Determine the sensitivity of the findings in Aims 1-3 to different specifications of the three process-of- care measures. Examine whether these relationships are moderated by patient characteristics (e.g., male vs. female, stratified by age) or setting (inpatient vs. outpatient).
METHODS:
Method Aims 1 and 2: We will examine three pre-existing samples of VA SUD patients (N = 5,723, 3,450, and 340,000 respectively) and evaluate the degree of association between the three process-of care quality measures and outcome quality measures (e.g., SUD symtom and psychosocial improvement) and structural quality measures (e.g., patient to staff ratios, number of SUD beds). Method Aim 3: Receipt of SUD care as determined by the HEDIS specifications (using CPT, DRG, and ICD9 –CM codes) will be compared to receipt of SUD care as determined by the specialty treatment codes available in the SAS Medical Datasets (e.g., clinic stop, bedsection). The HEDIS coding system for identifying SUD care and the clinic stop/ bedsection approach utilized in the OQP COC measure, will be evaluated by calculating thier concordance with eachother and SUD care documented in progress notes.
Method Subsidiary Aims: By manipulating the various parameters of the OQP and HEDIS measures (e.g., number of visits, duration of engagement, subsets of procedure and diagnoses codes), we will determine the optimal specifications for
various purposes, such as maximizing correspondence with clinical outcomes. We will also determine the previously described relationships separately for men and women, and stratified by age (<30, 30-49, 50-65, >66).
FINDINGS/RESULTS:
The results of the validation studies of the HEDIS and VA Continuity of Care Quality Measures have been submitted for publication and presentation.
IMPACT:
Anticipated Impacts on VA Patient Care:
Improving substance use disorder (SUD) care requires that quality can be defined and measured. By evaluating the concurrent and predictive validity of VA Office of Quality and Performance (OQP) Continuity of Care (COC) measure and the widely adopted HEDIS quality measures, the results from this project will
either constitute an empirical basis for their use, highlight important caveats or limitations, or suggest possible refinements to improve their validity.
We had deseminated our initial findings regarding the VA Continuity of Care performance measure to the SUD QUERI Continuity of Care Workgroup.
PUBLICATIONS:
None at this time.
DRA:
Substance Abuse, Addictive Disorders
DRE:
Quality of Care
Keywords:
none
MeSH Terms:
none
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