Continuity of Care Performance Measure Not Associated with Improved Outcomes for Veterans with Substance Use Disorders
VA currently incentivizes two quality measures related to Veterans' substance use care: 1) annual alcohol misuse screening in all primary care medical settings, and 2) Continuity of Care (CoC) for Veterans in new episodes of specialty substance use disorder (SUD) treatment. The CoC performance measure specifies that patients should receive at least two SUD outpatient visits in each of the three consecutive 30-day periods after they qualify as new SUD patients. This study evaluated the link between patient outcomes and the CoC performance measure in 1,850 randomly selected Veterans from 109 SUD treatment programs at 73 VA facilities. Investigators assessed data that included demographics and medical/psychiatric comorbidities, in addition to a self-administered questionnaire focusing on Veterans' Addiction Severity Index (ASI) composite scores. Facility-level analyses also were conducted using the ASI alcohol and drug composites, as well as facility rates of meeting the CoC performance measure.
Findings show that meeting the CoC performance measure was not associated with patient-level improvements in the ASI alcohol or drug composites, days of alcohol intoxication, or days of substance-related problems. Higher facility-level rates of CoC were negatively associated with improvements in ASI alcohol and drug composites - and were not associated with follow-up abstinence rates. Overall, authors suggest that these findings indicate that researchers and quality managers will need to determine if changes in performance on new criteria are associated with changes in average patient outcomes.
Harris A, Humphreys K, Bowe T, Kivlahan D, and Finney J. Measuring the quality of substance use disorder treatment: Evaluating the validity of the VA continuity of care performance measure. Journal of Substance Abuse Treatment April 2009;36(3):294-305.
This study was funded by HSR&D and VA/HSR&D's 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; Dr. Kivlahan is part of SUD-QUERI.