Measuring the quality of substance use disorder treatment: Evaluating the validity of the Department of Veterans Affairs continuity of care performance measure

• Published in: Journal of substance abuse treatment 2009-04, Vol.36 (3), p.294-305
• Main Authors: Harris, Alex H.S., Ph.D, Humphreys, Keith, Ph.D, Bowe, Thomas, Ph.D, Kivlahan, Daniel R., Ph.D, Finney, John W., Ph.D
• Format: Article
• Language: English
• Subjects: Alcohol use; Analysis of Variance; Biological and medical sciences; Care delivery; Cohort Studies; Continuing care; Continuity of care; Continuity of Patient Care - standards; Continuity of Patient Care - statistics & numerical data; Desintoxication. Drug withdrawal; Drug use; Health care delivery; Humans; Medical sciences; Mental health; Organization of mental health. Health systems; Performance measurement; Performance measures; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality Assurance, Health Care - methods; Quality of care; Social psychiatry. Ethnopsychiatry; Standards of quality; Street Drugs; Studies; Substance abuse disorders; Substance abuse treatment; Substance Abuse Treatment Centers; Substance use disorder services; Substance-Related Disorders - rehabilitation; Treatment Outcome; Treatments; United States; United States Department of Veterans Affairs; Veterans
• ISSN: 0740-5472; 1873-6483
• DOI: 10.1016/j.jsat.2008.05.011

Abstract This study examined the patient- and facility-level associations between the continuity of care performance measure adopted by the Department of Veterans Affairs (VA) and improvements in self-administered Addiction Severity Index (ASI) composites and other indicators of problematic substance use. Up to 50 patients from each of a nationally representative sample of 109 VA substance use disorder (SUD) treatment programs at 73 VA facilities were assessed at intake and posttreatment. The continuity of care 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. In analyses adjusting for baseline characteristics, meeting the continuity of care 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. Facility-level rates of continuity of care were negatively associated with improvements in ASI alcohol and drug composites. The continuity of care performance measure derived from prior patient-level evidence did not discriminate facility-level performance as predicted. Translating research into process-of-care quality measures requires postconstruction validation.