Multi-level Influences of Alcohol Based Quality and Outcome Measures

项目摘要 不健康的饮酒仍然是一个严重的问题， 2001-2002年和2012-2013年。过度饮酒是可预防死亡的第三大原因， 慢性疾病、生产力损失和卫生系统的直接成本。基于证据的做法是 预防和治疗不健康的酒精使用及其有害后果。为促进吸收 这些做法，卫生系统使用质量措施，以确定各方面的护理正在做得很好，并监测 需要改进的地方。国家质量论坛已经批准了几项针对不健康的护理质量措施， 酒精使用，这已被卫生系统用于日常决策。其中包括指标 开始和参与酒精和其他药物（AOD）滥用或依赖治疗（相当于 物质使用障碍），以及对AOD滥用或 依赖建议更广泛采用的另一个领域是普遍筛查不健康的酒精使用。 尽管卫生系统采用了这五项措施，但这些与酒精有关的质量的普遍性 措施尚未完全确立。这包括缺乏对预期变异性的了解， 在卫生系统的不同级别测量的质量的可靠性（例如，诊所、供应商）。此外，有限 有关于改进绩效的有意义驱动因素的信息，以指导卫生系统的质量 改进的努力。本研究旨在通过以下两个方面来解决这些科学证据差距 具体目标：1）检查不健康酒精使用的护理质量措施的可变性和可靠性，以及2） 确定与不健康酒精使用的护理质量相关的多层次因素。五种品质的每一种 重点的措施，分层建模将被应用于表征的可变性和可靠性在四个级别 卫生保健服务提供：病人，提供者，诊所和社区。目标2中的假设生成分析将 从目标1扩展层次模型，并检查一组扩展的解释变量的影响 在概念上与接受指南一致性护理有关。所有目标的研究都将在 Kaiser Permanente华盛顿（KPWA）卫生系统，这是最大的非营利医疗保健之一的一部分， 系统在美国。KPWA是一个理想的设置，因为它的层次结构和广泛的行政和 电子健康记录数据，以衡量质量和护理质量的多层次决定因素。一起，科学 从这项研究中获得的见解将为质量指标的衡量提供最佳做法，并提高 传播高质量信息的报告工具。这将支持研究小组的长期目标， 提高战略业绩报告的有效性，以加快努力， 不健康的饮酒为了实现这一目标，研究团队将与KPWA交付系统领导者合作， 根据研究结果编制报告卡原型，介绍提供者的质量业绩， 以一种易于解释并提供可操作见解的方式为诊所提供服务。

Project Summary Unhealthy use of alcohol remains a critical problem with high-risk drinking increasing by almost 30% between 2001-2002 and 2012-2013. Excessive alcohol use is the third leading cause of preventable death, and is linked to chronic medical conditions, lost productivity and direct cost to health systems. Evidence-based practices are available to prevent and treat unhealthy alcohol use and its detrimental consequences. To facilitate uptake of these practices, health systems use quality measures to identify aspects of care being done well and monitor areas for improvement. The National Quality Forum has endorsed several care quality measures for unhealthy alcohol use, which have been adopted for routine decision-making by health systems. These include indicators for initiation and engagement in treatment for alcohol and other drug (AOD) abuse or dependence (equivalent to substance use disorder), as well as follow-up after an emergency department visit for AOD abuse or dependence. Another area proposed for broader adoption is universal screening for unhealthy alcohol use. Despite adoption of these five measures by health systems, the generalizability of these alcohol-related quality measures has not been fully established. This includes the lack of knowledge on the expected variability and reliability of quality measured at different levels of a health system (e.g., clinics, providers). In addition, limited information exists on the meaningful drivers of improved performance to guide health systems with quality improvement efforts. This study seeks to address these scientific evidence gaps through the following two specific aims: 1) examine the variability and reliability of care quality measures for unhealthy alcohol use, and 2) identify multi-level factors associated with care quality for unhealthy alcohol use. For each of the five quality measures of focus, hierarchical modeling will be applied to characterize the variability and reliability at four levels of health care delivery: patient, provider, clinic and community. Hypothesis generating analyses in Aim 2 will extend hierarchical models from Aim 1 and examine the influence of an expansive set of explanatory variables conceptually related to receipt of guideline concordant care. Research in all aims will be conducted within the Kaiser Permanente Washington (KPWA) Health System, which is part of one of the largest nonprofit healthcare systems in the US. KPWA is an ideal setting given its hierarchical structure and extensive administrative and electronic health record data to measure quality and multi-level determinants of care quality. Together, scientific insights gained from this study will provide best practices for the measurement of quality indicators and enhance reporting tools that disseminate quality information. This will support the study team's long-term goal of increasing the effectiveness of strategic performance reporting to accelerate efforts to improve care quality for unhealthy alcohol use. To achieve this goal, the study team will partner with KPWA delivery system leaders to develop prototype report cards informed by study findings that present the quality performance of providers and clinics in a manner that is easily interpretable and offer actionable insights.