Format

Send to

Choose Destination
Subst Abus. 2019 Jan 24:1-10. doi: 10.1080/08897077.2018.1545726. [Epub ahead of print]

The association between medical comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) measures of treatment initiation and engagement for alcohol and other drug use disorders.

Author information

1
a Institute for Health Research , Kaiser Permanente Colorado , Denver , Colorado , USA.
2
b Colorado Permanente Medical Group , Aurora , Colorado , USA.
3
c Division of General Internal Medicine , University of Colorado School of Medicine , Aurora , Colorado , USA.
4
d Henry Ford Health System , Detroit , Michigan , USA.
5
e Division of Research , Kaiser Permanente Northern California , Oakland , California , USA.
6
f Essentia Institute of Rural Health, Essentia, Essentia Health , Duluth , Minnesota , USA.
7
g Department of Research and Evaluation , Kaiser Permanente Southern California , Pasadena , California , USA.
8
h Department of Population Health , New York University School of Medicine , New York , New York , USA.
9
i Center for Health Research , Kaiser Permanente Northwest , Portland , Oregon , USA.
10
j Department of Psychiatry, Weill Institute for Neurosciences , University of California San Francisco, San Francisco , California , USA.
11
k Kaiser Permanente Washington Health Research Institute , Seattle , Washington , USA.
12
l Department of Health Services , University of Washington School of Public Health , Seattle , Washington , USA.

Abstract

BACKGROUND:

Medical comorbidity may influence treatment initiation and engagement for alcohol and other drug (AOD) use disorders. We examined the association between medical comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) treatment initiation and engagement measures.

METHODS:

We used electronic health record and insurance claims data from 7 US health care systems to identify patients with AOD use disorders between October 1, 2014, and August 15, 2015 (N = 86,565). Among patients identified with AOD use disorders in outpatient and emergency department (ED) settings, we examined how Charlson/Deyo comorbidity index scores and medical complications of AOD use were associated with treatment initiation. Among those who initiated treatment in inpatient and outpatient/ED settings, we also examined how comorbidity and AOD use-related medical complications were associated with treatment engagement. Analyses were conducted using generalized estimating equation logistic regression modeling.

RESULTS:

Among patients identified as having an AOD diagnosis in outpatient and ED settings (n = 69,965), Charlson/Deyo comorbidity index scores of 2 or more were independently associated with reduced likelihood of initiation (risk ratio [RR] = 0.80, 95% confidence interval [CI] = 0.74, 0.86; reference score = 0), whereas prior-year diagnoses of cirrhosis (RR = 1.25, 95% CI = 1.12, 1.35) and pancreatic disease (RR = 1.34, 95% CI = 1.15, 1.56) were associated with greater likelihood of initiation. Among those who were identified in outpatient/ED settings and initiated, higher comorbidity scores were associated with lower likelihood of engagement (score 1: RR = 0.85, 95% CI = 0.76, 0.94; score 2+: RR = 0.61, 95% CI = 0.53, 0.71).

CONCLUSION:

Medical comorbidity was associated with lower likelihood of initiating or engaging in AOD treatment, but cirrhosis and pancreatic disease were associated with greater likelihood of initiation. Interventions to improve AOD treatment initiation and engagement for patients with comorbidities are needed, such as integrating medical and AOD treatment.

KEYWORDS:

Alcohol-induced disorders; comorbidity; complications and therapy; health care; health services research; quality indicators; substance-related disorders

Supplemental Content

Full text links

Icon for Taylor & Francis
Loading ...
Support Center