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Drug Alcohol Depend. 2017 Aug 1;177:307-314. doi: 10.1016/j.drugalcdep.2017.03.033. Epub 2017 Jun 27.

Association between process measures and mortality in individuals with opioid use disorders.

Author information

1
RAND Corporation,1776 Main Street, Santa Monica, CA, 90407, USA. Electronic address: kwatkins@rand.org.
2
RAND Corporation,1776 Main Street, Santa Monica, CA, 90407, USA. Electronic address: paddock@rand.org.
3
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA; Division of Health Services Research, University of Arkansas for Medical Sciences,4301 W. Markham St., #554, Little Rock, AR, 72205, USA. Electronic address: Teresa.Hudson@va.gov.
4
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA; College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., #820, Little Rock, AR, 72205, USA. Electronic address: stounpraseuth@uams.edu.
5
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA; College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., #820, Little Rock, AR, 72205, USA. Electronic address: amschrader@uams.edu.
6
RAND Corporation,1776 Main Street, Santa Monica, CA, 90407, USA. Electronic address: hepner@rand.org.
7
RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA; University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261, USA. Electronic address: stein@rand.org.

Abstract

BACKGROUND:

Individuals with opioid use disorders have high rates of mortality relative to the general population. The relationship between treatment process and mortality is unknown.

AIM:

To examine the association between 7 process measures and 12- and 24-month mortality.

METHODS:

Retrospective cohort study of patients with opioid use disorders who received care from the Veterans Administration between October 2006 and September 2007. Logistic regression models were used to examine the association between 12 and 24-month mortality and 7 patient-level process measures, while risk-adjusting for patient characteristics. Process measures included quarterly physician visits, any opioid use disorder pharmacotherapy, continuous pharmacotherapy, psychosocial treatment, Hepatitis B/C and HIV screening, and no prescriptions for benzodiazepines or opioids. We conducted sensitivity analyses to examine the robustness of our findings to an unobserved confounder.

RESULTS:

Among individuals with opioid use disorders, not being prescribed opioids or benzodiazepines, receipt of any psychosocial treatment and quarterly physician visits were significantly associated with lower mortality at both 12 and 24 months, but Hepatitis and HIV screening, and measures related to opioid use disorder pharmacotherapy were not. Sensitivity analyses indicated that the difference in the prevalence of an unobserved confounder would have to be unrealistically large given the observed data, or there would need to be a large effect of the confounder, to render these findings non-significant.

CONCLUSIONS AND RELEVANCE:

This is the first study to show an association between process measures and mortality in patients with opioid use disorders and provides initial evidence for their use as quality measures.

KEYWORDS:

Measure validation; Mortality; Opioid use disorders; Process measures; Quality improvement; Quality of care

PMID:
28662975
PMCID:
PMC5557034
DOI:
10.1016/j.drugalcdep.2017.03.033
[Indexed for MEDLINE]
Free PMC Article

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