Predictive validity of a quality measure for intensive substance use disorder treatment
Predictive validity of a quality measure for intensive substance use disorder treatment
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DOI：
10.1080/08897077.2016.1212779
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发表时间：
2017-01-01
期刊：
影响因子：
3.5
通讯作者：
Harris, Alex H. S.
中科院分区：
文献类型：
--
作者：
Schmidt, Eric M.;Gupta, Shalini;Harris, Alex H. S.
背景：物质使用障碍（SUD）治疗质量的测量是提高治疗效果的重要工具。退伍军人健康管理局（VHA）为SUD制定了一项访问和参与强化门诊项目（IOPs）的措施。然而，预测有效性，或该测量与治疗结果之间的关联，尚未得到检验。方法：退伍军人患SUD的数据来自3个样本：结局监测项目（N = 5436）、全国VHA心理健康服务评估（N = 339,887）和接受戒毒服务的患者（N = 23,572）。倾向评分加权混合效应回归模拟了接受至少1周IOP治疗与患者预后之间的关联，控制了医院水平的表现和医院的随机效应。结果：倾向评分加权减少或消除了患者组之间可观察到的基线差异。获得IOPs的患者与未获得IOPs的患者相比，酒精和药物相关症状严重程度显著降低，过去一个月饮酒天数显著减少（b = 1.83, P < .001），过去一个月醉酒天数显著减少（b = 1.55, P < .001）。戒毒后接受IOP治疗的患者6个月SUD门诊使用率较高（b = 2.09, P < .001），后续戒毒次数较多（b = 0.25, P < .001）， 2年死亡率较低（优势比[OR] = 0.68, 95%可信区间[CI]: 0.61-0.75; P < .001）。结论：在IOP中接受至少1周的SUD治疗与更高的随访利用率、改善的健康结果和降低的死亡率相关。这些关联为VHA IOP质量测量的预测有效性提供了支持。未来的研究应该集中在VHA之外的测量可行性和效度，以及一旦将这种质量测量与绩效激励联系起来，是否保持预测效度。
Background: Measures of substance use disorder (SUD) treatment quality are essential tools for performance improvement. The Veterans Health Administration (VHA) developed a measure of access to and engagement in intensive outpatient programs (IOPs) for SUD. However, predictive validity, or associations between this measure and treatment outcomes, has not been examined. Methods: Data on veterans with SUD came from 3 samples: the Outcomes Monitoring Project (N = 5436), a national evaluation of VHA mental health services (N = 339,887), and patients receiving detoxification services (N = 23,572). Propensity score-weighted mixed-effects regressions modeled associations between receiving at least 1 week of IOP treatment and patient outcomes, controlling for facility-level performance and a random effect for facility. Results: Propensity score weighting reduced or eliminated observable baseline differences between patient groups. Patients who accessed IOPs versus those who did not reported significantly reduced alcohol-and drug-related symptom severity, with significantly fewer past-month days drinking alcohol (b = 1.83, P < .001) and fewer past-month days intoxicated (b = 1.55, P < .001). Patients who received IOP after detoxification services had higher 6-month utilization of SUD outpatient visits (b = 2.09, P < .001), more subsequent detoxification episodes (b = 0.25, P < .001), and lower odds of 2-year mortality (odds ratio [OR] = 0.68, 95% confidence interval [CI]: 0.61-0.75; P < .001). Conclusions: Receiving at least 1 week of SUD treatment in an IOP was associated with higher follow-up utilization, improved health outcomes, and reduced mortality. These associations lend support to the predictive validity of VHA's IOP quality measure. Future research should focus on measure feasibility and validity outside of VHA, and whether predictive validity is maintained once this quality measure is tied to performance incentives.