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Subst Abus. 2019 Jan 24:1-11. doi: 10.1080/08897077.2018.1545728. [Epub ahead of print]

Factors associated with Healthcare Effectiveness Data and Information Set (HEDIS) alcohol and other drug measure performance in 2014-2015.

Author information

1
a Division of Research , Kaiser Permanente Northern California , Oakland , California , USA.
2
b Department of Psychiatry, Weill Institute for Neurosciences , University of California , San Francisco , California , USA.
3
c Center for Health Research , Kaiser Permanente Northwest , Portland , Oregon , USA.
4
d Kaiser Permanente Washington Health Research Institute , Seattle , Washington , USA.
5
e Institute for Health Research, Kaiser Permanente Colorado , Aurora , Colorado , USA.
6
f Colorado Permanente Medical Group , Aurora , Colorado , USA.
7
g Department of Research and Evaluation , Kaiser Permanente Southern California , Pasadena , California , USA.
8
h Center for Health Policy & Health Services Research and Behavioral Health Services, Henry Ford Health System , Detroit , Michigan , USA.
9
i Essentia Institute of Rural Health, Essentia Health , Duluth , Minnesota , USA.
10
j Oregon Health Sciences University Portland , Oregon , USA.

Abstract

BACKGROUND:

Only 10% of patients with alcohol and other drug (AOD) disorders receive treatment. The AOD Initiation and Engagement in Treatment (AOD-IET) measure was added to the national Healthcare Effectiveness Data and Information Set (HEDIS) to improve access to care. This study identifies factors related to improving AOD-IET rates.

METHODS:

We include data from 7 health systems with differing geographic, patient demographic, and organizational characteristics; all used a common Virtual Data Warehouse containing electronic health records and insurance claims data. Multilevel logistic regression models examined AOD-IET among adults (18+).

RESULTS:

A total of 86,565 patients had an AOD diagnosis qualifying for the HEDIS denominator. Initiation rates varied from 26% to 46%; engagement rates varied from 14% to 29%. Women versus men (odds ratio [OR] = 0.81, 95% confidence interval [CI] = 0.76-0.86); Hispanics (OR = 0.85, 95% CI = 0.79-0.91), black/African Americans (OR = 0.82, 95% CI = 0.75-0.90), and Asian Americans (OR = 0.83, 95% CI = 0.72-0.95) versus whites; and patients aged 65+ versus 18-29 (OR = 0.82, 95% CI = 0.74-0.90) had lower odds of initiation. Patients aged 30-49 versus 18-29 (OR = 1.11, 95% CI = 1.04-1.19) and those with prior psychiatric (OR = 1.26, 95% CI = 1.18-1.35) and medical (OR = 1.18, 95% CI = 1.10-1.26) conditions had higher odds of engagement. Identification in primary care versus other departments was related to lower odds of initiation (emergency department [ED]: OR = 1.55, 95% CI = 1.45-1.66; psychiatry/AOD treatment: OR = 3.58, 95% CI = 3.33-3.84; other outpatient: OR = 1.19, 95% CI = 1.06-1.32). Patients aged 30-49 versus 18-29 had higher odds of engagement (OR = 1.26, 95% CI = 1.10-1.43). Patients aged 65+ versus 18-29 (OR = 0.51, 95% CI = 0.43-0.62) and black/African Americans versus whites (OR = 0.64, 95% CI = 0.53-0.77) had lower odds. Those initiating treatment in psychiatry/AOD treatment versus primary care (OR = 7.02, 95% CI = 5.93-8.31) had higher odds of engagement; those in inpatient (OR = 0.40, 95% CI = 0.32-0.50) or other outpatient (OR = 0.73, 95% CI = 0.59-0.91) settings had lower odds.

DISCUSSION:

Rates of initiation and engagement varied but were low. Findings identified age, race/ethnicity, co-occurring conditions, and department of identification as key factors associated with AOD-IET. Focusing on these could help programs develop interventions that facilitate AOD-IET for those less likely to receive care.

KEYWORDS:

Alcohol and drug; performance measures

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