The Veterans Health Administration (VA) Health Care for Reentry Veterans (HCRV) program links veterans exiting prison with treatment. Among veterans served by HCRV, national VA clinical data were used to describe contact with VA health care, and mental health and substance use disorder diagnoses and treatment use. Of veterans seen for an HCRV outreach visit, 56% had contact with VA health care. Prevalence of mental health disorders was 57%; of whom 77% entered mental health treatment within a month of diagnosis. Prevalence of substance use disorders was 49%; of whom 37% entered substance use disorder treatment within a month of diagnosis. For veterans exiting prison, increasing access to VA health care, especially for rural veterans, and for substance use disorder treatment, are important quality improvement targets.
The Veterans Justice Outreach (VJO) program of the U.S. Veterans Health Administration has a primary mission of linking military veterans in jails, courts, or in contact with law enforcement to mental health and substance use disorder treatment. National data of veterans with VJO contact were used to describe demographic characteristics, and mental health and substance use disorder diagnoses and treatment use and test correlates of treatment entry and engagement using multi-level logistic regression models. Of the 37,542 VJO veterans, treatment entry was associated with being homeless and having a mental health disorder or both a mental health and a substance use disorder versus a substance use disorder only. Being American Indian/Alaskan Native was associated with lower odds of treatment entry. Engagement was associated with female gender, older age, Asian race, urban residence, and homeless status. Increased utilization of substance use disorder treatment, especially pharmacotherapy, is an important quality improvement target.
We examined if patient or setting characteristics predict subsequent addiction treatment involvement in a sample of 270,877 Veteran Administration (VA) patients identified with substance use disorders (SUD). Patient characteristics (e.g., gender, age, marital status) and treatment specialty of the unit where the SUD was identified (SUD, Psychiatric, or Other) were used to predict two aspects of treatment involvement, specifically the HEDIS Initiation and Engagement quality indicators (National Committee for Quality Assurance, 2006). Overall, patients who were female, not married, younger, and had their SUDs identified in SUD or Psychiatric treatment units initiated and engaged in treatment at significantly higher rates. For example, a younger, single patient who was identified with an SUD in an SUD specialty unit had a predicted probability of meeting the Initiation criteria of 0.54 compared to 0.14 for an older married patient identified in a general medical setting. This research facilitates the identification of patients with lower likelihoods of initiation and engagement in treatment and may inform intervention efforts to improve rates of initiation and engagement in targeted groups and settings.
Background: The U.S. is facing an opioid epidemic, but despite mandates for pharmacotherapy for opioid use disorder to be available at Veterans Health Administration (VHA) facilities, the majority of veterans with opioid use disorder do not receive these medications. In implementation research, facilities are often targeted for qualitative inquiry or quality improvement efforts based on quality measure performance during a one-year period. However, sites that experience quality performance changes from one year to the next may be highly informative because mechanisms that impact facility change may be more discoverable. The current study examined changes in receipt of pharmacotherapy for opioid use disorder in a national healthcare system to determine the extent to which sites fluctuated in performance over a two-year period and illustrate how changes in quality measures over time may be useful for implementation research and healthcare surveillance of quality measures. Methods: Using national VHA data from Fiscal Years (FY) 2016 and 2017, we calculated quality measure performance as the number of patients who received pharmacotherapy for opioid use disorder (i.e., methadone, buprenorphine, and naltrexone) divided by the number of patients with a current non-remitted opioid use disorder diagnosis for each FY at each facility (n=129) and examined change from FY16 to FY17. Results: The mean rate of receipt of pharmacotherapy for opioid use disorder was 38% (facility range = 3% to 74%) in FY16 and 41% (facility range = 2% to 76%) in FY17. The average facility-level change in performance was 3% and ranged from –19% to 26%. There were 32 facilities that decreased in provision of pharmacotherapy, 12 facilities with no change, and 85 facilities that increased. Conclusions: For facilities with average or high performance, it was difficult to maintain their performance over time. Identifying and learning from facilities with recent fluctuations may be more informative to guide the design of future quality improvement efforts than studying facilities with stable high or low performance.
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