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Predictive Validity of Outpatient Follow-up After Detoxification as a Quality Measure.

Schmidt EM, Gupta S, Bowe T, Ellerbe LS, Phelps TE, Finney JW, Humphreys K, Trafton J, Vanneman ME, Harris AHS. Predictive Validity of Outpatient Follow-up After Detoxification as a Quality Measure. Journal of addiction medicine. 2017 May 1; 11(3):205-210.

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OBJECTIVES: Care coordination for substance use disorder (SUD) treatment is a persistent challenge. Timely outpatient follow-up after detoxification from alcohol and opiates is associated with improved outcomes, leading some care systems to attempt to measure and incentivize this practice. This study evaluated the predictive validity of a 7-day outpatient follow-up after detoxification quality measure used by the Veterans Health Administration (VHA). METHODS: A national sample of patients who received detoxification from alcohol or opiates (N? = 25,354) was identified in VHA administrative data. Propensity score-weighted mixed-effects regressions modeled associations between receiving an outpatient follow-up visit within 7 days of completing detoxification and patient outcomes, controlling for facility-level performance and clustering of patients within facilities. RESULTS: Baseline differences between patients who did (39.6%) and did not (60.4%) receive the follow-up visit were reduced or eliminated with propensity score weighting. Meeting the quality measure was associated with significantly more outpatient treatment for SUD (b? = 1.07 visits) and other mental health conditions (b? = 0.58 visits), and higher inpatient utilization for SUD (b? = 0.75 admissions) and other mental health conditions (b? = 0.76 admissions). Notably, meeting the quality measure was associated with 53.3% lower odds of 2-year mortality (P? < 0.001 for all). CONCLUSIONS: These findings support the predictive validity of 7-day follow-up after detoxification as a care coordination measure. Well-coordinated care may be associated with higher outpatient and inpatient utilization, and such engagement in care may be protective against mortality in people who receive detoxification from alcohol or opiates.

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