Quality Metrics and Systems Transformation: Are We Advancing Alcohol and Drug Screening in Primary Care?
Quality Metrics and Systems Transformation: Are We Advancing Alcohol and Drug Screening in Primary Care?
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DOI：
10.1111/1475-6773.12716
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发表时间：
2018-06-01
影响因子：
3.4
通讯作者：
McConnell, K. John
中科院分区：
文献类型：
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作者：
Rieckmann, Traci;Renfro, Stephanie;McConnell, K. John
目的探讨俄勒冈州的协调护理组织（CCO）和按绩效付费激励模式对完成筛查和简短干预（SBI）以及物质使用障碍（SUD）治疗服务的利用的影响。数据来源/研究设置对2012年至2015年医疗补助遭遇数据进行二次分析，并对CCO中的利益相关者进行半年一次的定性访谈。研究设计纵向混合方法设计，同时收集数据数据收集/提取方法定性访谈在 ATLAS.ti 中进行记录、转录和编码。定量数据包括 CCO 实施前 30 个月、6 个月的过渡期以及 CCO 实施后 30 个月的医疗补助遭遇。数据按半年汇总，分析仅限于参加 CCO、不符合医疗保险覆盖或医疗补助扩展资格的 18-64 岁医疗补助接受者。主要发现定量分析记录了与 CCO 实施同时发生的 SBI 率显着增加（0.1% 至 4.6%）。完成 SBI 与 SUD 诊断开始治疗的增加无关。定性分析强调了调整激励措施、重新设计工作流程和领导力以促进全州 SBI 的重要性。结论结果为使用绩效指标来扩大初级保健中的 SBI 提供了适度的支持。未来的研究应该考察增加 SUD 治疗的发起和参与的医疗改革努力。
ObjectiveTo examine the influence of Oregon's coordinated care organizations (CCOs) and pay-for-performance incentive model on completion of screening and brief intervention (SBI) and utilization of substance use disorder (SUD) treatment services.Data Sources/Study SettingSecondary analysis of Medicaid encounter data from 2012 to 2015 and semiannual qualitative interviews with stakeholders in CCOs.Study DesignLongitudinal mixed-methods design with simultaneous data collection with equal importance.Data Collection/Extraction MethodsQualitative interviews were recorded, transcribed, and coded in ATLAS.ti. Quantitative data included Medicaid encounters 30months prior to CCO implementation, a 6-month transition period, and 30months following CCO implementation. Data were aggregated by half-year with analyses restricted to Medicaid recipients 18-64years of age enrolled in a CCO, not eligible for Medicare coverage or Medicaid expansion.Principal FindingsQuantitative analysis documented a significant increase in SBI rates coinciding with CCO implementation (0.1 to 4.6 percent). Completed SBI was not associated with increased initiation in treatment for SUD diagnoses. Qualitative analysis highlighted importance of aligning incentives, workflow redesign, and leadership to facilitate statewide SBI.ConclusionsResults provide modest support for use of a performance metric to expand SBI in primary care. Future research should examine health reform efforts that increase initiation and engagement in SUD treatment.