Establishing the feasibility of measuring performance in use of addiction pharmacotherapy

Abstract

This paper presents the rationale and feasibility of standardized performance measures for use of pharmacotherapy in the treatment of substance use disorders (SUD), an evidence-based practice and critical component of treatment that is often underused. These measures have been developed and specified by the Washington Circle, to measure treatment of alcohol and opioid dependence with FDA-approved prescription medications for use in office-based general health and addiction specialty care. Measures were pilot tested in private health plans, the Veterans Health Administration (VHA), and Medicaid. Testing revealed that use of standardized measures using administrative data for overall use and initiation of SUD pharmacotherapy is feasible and practical. Prevalence of diagnoses and use of pharmacotherapy varies widely across health systems. Pharmacotherapy is generally used in a limited portion of those for whom it might be indicated. An important methodological point is that results are sensitive to specifications, so that standardization is critical to measuring performance across systems.

Developing an opioid use disorder treatment cascade: A review of quality measures

“…However, among the 7 included measures (Table 1), only the 2 HEDIS measures of Initiation and Engagement were directly studied in the published literature. The remaining 5 measures were not assessed across any of the 29 articles, although 4 articles (Mattke, Predmore, Sloss, Wilks, & Watkins, 2017; Thomas, Garnick, Horgan, et al, 2011; Thomas, Garnick, Horgan, et al, 2013; Watkins, Paddock, Hudson, et al, 2017) pertained to expanding HEDIS Initiation and Engagement measure specification to include MAT as a qualifying treatment service or additionally investigated outcomes with continuous use of MAT as a process measure.…”

“…Across the 29 studies, only 4 addressed OUD specifically (Mattke, Predmore, Sloss, Wilks, & Watkins, 2017; Thomas, Garnick, Horgan, et al., 2011; Thomas, Garnick, Horgan, et al, 2013). The other 25 studies assessed measure development or outcomes for SUDs generally.…”

“…For the included measures, studies demonstrated the feasibility, reliability, and importance of the HEDIS measures (see Table 2) among managed, private, Medicaid, and Veterans Health Administration (VHA) plans (Garnick, Lee, Chalk, et al, 2002; Garnick, Lee, Horgan, et al, 2011; Thomas, Garnick, Horgan, et al, 2013), although reliability was generally found to be better in specialty settings than in non-specialty settings (Harris et al, 2015; Harris, Reeder, Ellerbe, & Bowe, 2011). However, measure specification (i.e.…”

“…However, measure specification (i.e. technical definition for population of interest and qualifying treatment criteria) produced differing results based on payers (Garnick, Lee, Horgan, et al, 2011; Thomas, Garnick, Horgan, et al., 2011) as there can be great variation across settings in patient characteristics and population-based analyses (Thomas, Garnick, Horgan, et al, 2013). Studies specific to assessing pharmacologic measures consistently showed the feasibility of measures assessing use of MAT as a performance measure in systems with robust electronic health record systems (Thomas, Garnick, Horgan, et al, 2011; Thomas, Garnick, Horgan, et al, 2013; Watkins, Paddock, Hudson, et al, 2016).…”

Access to Addiction Pharmacotherapy in Private Health Plans

“…Less than 2.5% of alcohol-dependent patients in the VA received a prescription for oral naltrexone or another medication for alcohol dependence (Harris et al, 2010; Iheanacho et al, 2013). Despite rapid increases in addiction medication sales in the 2000s (Mark et al, 2009), the number of patients prescribed addiction medications still represents a small proportion of the population that would likely benefit (Harris et al, 2010; Mark et al, 2009; Thomas et al, 2013). …”