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2015 HSR&D/QUERI National Conference Abstract

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1006 — Continuing Care after Residential Substance Use Disorder Treatment in the VA Health Care System: Facilitators, Challenges, and Performance Measurement

Rubinsky AD, VA Puget Sound Health Care System; Ellerbe L, VA Puget Sound Health Care System; Gupta S, VA Puget Sound Health Care System; Phelps T, VA Puget Sound Health Care System; Bowe T, VA Puget Sound Health Care System; Harris AH, VA Puget Sound Health Care System;

Objectives:
Residential treatment programs are a vital part of VA care for substance use disorders (SUDs) but are resource-intensive and highly variable on many processes of care. Outpatient continuing care can improve treatment outcomes. This study aimed to (1) develop continuing care metrics for VA SUD Residential Rehabilitation Treatment Programs (RRTPs) based on administrative data, and (2) obtain information from SUD RRTP managers and front-line staff about program structure and processes that might contribute to variability in performance on these metrics.

Methods:
VA administrative data from fiscal year 2012 were used to calculate the proportion of patients discharged from each SUD RRTP who had at least one outpatient SUD or mental health (MH) visit within 7 days and 30 days, and at least one outpatient SUD visit within 30 days. Program managers and front-line staff from 97 identified programs (63 SUD-centered RRTPs and 34 MH RRTPs with a SUD track) were invited to participate in a telephone interview to discuss program performance on these metrics.

Results:
Among SUD-centered RRTPs, the mean rate of SUD/MH continuing care was 59% within 7 days and 80% within 30 days, and the mean rate of SUD continuing care was 63% within 30 days. Among MH RRTPs with a SUD track, these rates were 56%, 75% and 36%, respectively. There was substantial variability in continuing care rates across the programs: 21-93% for SUD/MH care within 7 days, 36-100% for SUD/MH care within 30 days and 4-91% for SUD care within 30 days. Fifty-nine interviews representing 44 programs revealed several common facilitators of continuing care: emphasizing its importance from day 1, connecting patients with continuing care providers pre-discharge, pre-discharge scheduling, persistent follow-up by program staff, and accessibility. Key challenges included poor program staffing, lack of program accountability, and poor accessibility.

Implications:
Administrative data-based metrics can identify variability in SUD RRTP rates of continuing care. Several structural and process factors were common to programs with high continuing care rates; many of these same factors were lacking in programs with low rates. Overall, SUD-centered RRTPs were far better at providing SUD-specific continuing care than MH RRTPs with a SUD track.

Impacts:
Administrative data-based metrics could be useful for monitoring SUD RRTP continuing care and identifying low performers that may be high-value targets for quality improvement.