Study Develops Candidate Quality Measures for VA Alcohol Use Disorder Treatment
Improving healthcare is contingent upon having valid measures of quality; however, it is often difficult to translate and operationalize clinical evidence or treatment guidelines into a quality measure that predicts patient outcomes. For example, recent research found that VA's current substance use disorder (SUD) treatment quality measures are not positively associated with facility-level outcomes and only modestly related to patient-level outcomes in some patient subgroups. The goal of this study was to identify patterns of VA care that are associated with both facility- and patient-level outcomes in order to develop a new process-of-care measure for VA outpatient alcohol use disorder (AUD) treatment quality. As part of this process, investigators sought to develop a list of candidate quality measures that could be operationalized, and to identify which quality measures had significant facility- and patient-level associations with outcomes. Quality measures included intensity and duration of care, as well as provider continuity. Outcome and process data were analyzed for 2701 VA patients who had started a new episode of care at 71 different VA (outpatient) SUD treatment programs from 2001-2003.
Findings show that nine candidate process measures of outpatient AUD treatment quality can predict facility-level and patient-level improvement. The candidate measures with the strongest association with improvement in outcomes focused on Veterans who received 3 to 6 outpatient visits in the first month of care. Results also showed that while the literature indicates that longer duration of care should produce better patient outcomes, the investigators found no such link with overall outcomes. The authors suggest that their "pre-validated" quality measures require additional steps, such as verifying the association between these measures and outcomes in other datasets, as well as having expert panels (e.g., policymakers, stakeholders) determine whether they make sense clinically and meet other design requirements.
Harris A, Kivlahan D, Bowe T, Finney J, and Humphreys K. Developing and Validating Process Measures of Health Care Quality: An Application to Alcohol Use Disorder Treatment. Medical Care December 2009;47(12):1244-1250.
This study was funded by HSR&D. All authors except for Dr. Bowe are part of the VA/HSR&D Substance Use Disorders Quality Enhancement Research Initiative (SUD-QUERI). All authors except Dr. Kivlahan are part of HSR&D's Center for Health Care Evaluation in Palo Alto, CA.