Specifying and Pilot Testing Quality Measures for the American Society of Addiction Medicine's Standards of Care.
Specifying and Pilot Testing Quality Measures for the American Society of Addiction Medicine's Standards of Care.
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DOI：
10.1097/adm.0000000000000203
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发表时间：
2016-05
影响因子：
5.5
通讯作者：
Thomas CP
中科院分区：
文献类型：
--
作者：
Harris AH;Weisner CM;Chalk M;Capoccia V;Chen C;Thomas CP
2013年，美国成瘾医学协会（ASAM）批准了他们的成瘾专科医生护理标准。随后，ASAM绩效评估小组确定并优先考虑将标准应用到绩效评估中。本文的目标是描述将其中三个标准转化为质量措施的操作过程，并介绍在大型医疗保健系统中对这些措施进行试点测试的初步措施规范和结果。通过展示过程而不仅仅是最终结果，我们希望阐明度量开发过程，以便进行教育，并激发对所做决定的辩论。每一项措施都被分解成主要的概念。然后使用常用的管理数据源对每个概念进行操作。检查了备选规格并进行了敏感性分析，以告知平衡准确性、临床细微差别和简单性的决策。使用美国退伍军人健康管理局（VHA）的数据，计算了119个VHA设施的总体表现和表现变化。实施和试点测试了三项措施：酒精使用障碍的药物治疗、阿片类药物使用障碍的药物治疗以及药物管理戒断后的及时随访（又名戒毒）。每一项措施都可以根据现有数据进行计算，显示出足够的改进空间（没有天花板效应）和广泛的设施水平可变性。接下来的步骤包括在其他卫生保健系统和其他环境中进行可行性和试点测试，例如独立的成瘾治疗计划，以及研究这些措施的规格和预测有效性。
In 2013, American Society of Addiction Medicine (ASAM) approved their Standards of Care for the Addiction Specialist Physician. Subsequently, an ASAM Performance Measures Panel identified and prioritized the standards to be operationalized into performance measures. The goal of this paper is to describe the process of operationalizing three of these standards into quality measures, and to present the initial measure specifications and results of pilot testing these measures in a large health care system. By presenting the process rather than just the end results, we hope to shed light on the measure development process in order to educate, as well as stimulate debate about the decisions that were made. Each measure was decomposed into major concepts. Then each concept was operationalized using commonly available administrative data sources. Alternative specifications examined and sensitivity analyses were conducted to inform decisions that balanced accuracy, clinical nuance, and simplicity. Using data from the US Veterans Health Administration (VHA), overall performance and variation in performance across 119 VHA facilities were calculated. Three measures were operationalized and pilot tested: pharmacotherapy for alcohol use disorder, pharmacotherapy for opioid use disorder, and timely follow-up after medically managed withdrawal (aka detoxification). Each measure was calculable with available data, showed ample room for improvement (no ceiling effects) and wide facility-level variability. Next steps include conducting feasibility and pilot testing in other health care systems and other contexts such as standalone addiction treatment programs, as well as to study the specification and predictive validity of these measures.