Study Questions Validity of HEDIS Quality Measures for SUD Specialty Care
Healthplan Employer Data and Information Set (HEDIS) is the most widely used set of quality measures, thus many healthcare systems now track HEDIS measures of Initiation and Engagement in Alcohol and Other Drug Dependence Treatment. “Initiation” refers to the percentage of patients diagnosed with a substance use disorder (SUD) with: 1) at least a 60-day SUD service-free period, and 2) either an inpatient/residential admission with an SUD diagnosis, or both an initial SUD-related outpatient visit and an additional SUD-related visit within 14 days. “Engagement” refers to the percentage of outpatients with diagnosed SUDs that 1) meet the Initiation criteria, and 2) receive two additional SUD-related visits within 30 days following Initiation. Using VA data, this study identified 320,238 Veterans who received at least one of the HEDIS-specified SUD diagnoses during FY06. Investigators then developed a Markov model to determine their progression through Initiation and Engagement, with a focus on clinical setting and care specialty.
Findings show that Veterans who have contact with SUD specialty treatment have higher rates of advancing from diagnosis to Initiation – and from Initiation to Engagement – compared to Veterans who are diagnosed with substance use disorders in psychiatric or other medical locations. For example, outpatients who were diagnosed in SUD specialty treatment settings were much more likely to “initiate” than those who were diagnosed in psychiatric and other specialty settings (44%, 15%, and 9%, respectively). Results also showed that 85% of the Veterans who received an SUD diagnosis in FY06 (n=271,411), did so first in an outpatient setting, and that more than 40% of “engagement” occurred outside of SUD specialty care. Therefore, the usual combining of inpatient and outpatient performance on these measures into overall facility scores may affect measurement and interpretation. The authors suggest that these particular quality measures be considered measures of facility performance rather than measures of the quality of SUD specialty care.
Harris A, Bowe T, Finney J, and Humphreys K. HEDIS initiation and engagement quality measures of substance use disorder care: Impacts of setting and health care specialty. Population Health Management August 2009;12(4):191-96.
This study was funded by HSR&D. Drs. Harris, Finney and Humphreys are part of HSR&D’s Center for Health Care Evaluation: Improving Clinical Decision-Making and Treatment Effectiveness, located in Palo Alto, CA.