Multi-level Influences of Alcohol Based Quality and Outcome Measures

项目摘要 酒精的不健康使用仍然是一个严重的问题，高风险饮酒在以下几年间增加了近30% 2001-2002年和2012-2013年。过量饮酒是可预防的死亡的第三大原因，而且与 由于慢性疾病、生产力下降和卫生系统的直接成本。循证实践是 可用于预防和治疗不健康的酒精使用及其有害后果。为了促进对 这些做法，卫生系统使用质量措施来确定做好护理的各个方面，并监测 需要改进的地方。国家质量论坛通过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。这些指标包括 开始并参与酒精和其他药物滥用或依赖的治疗(相当于 药物使用障碍)，以及在急诊科就诊后因AOD滥用或 依赖。另一个被提议更广泛采用的领域是对不健康饮酒的普遍筛查。 尽管卫生系统采取了这五项措施，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和 在卫生系统的不同级别(例如，诊所、提供者)衡量的质量可靠性。此外，有限的 有关于改进绩效的有意义的驱动因素的信息，以指导高质量的卫生系统 改进的努力。这项研究试图通过以下两个方面来解决这些科学证据的差距 具体目标：1)检查不健康饮酒护理质量指标的可变性和可靠性；2) 确定与不健康饮酒护理质量相关的多层次因素。对于五种质量中的每一种 重点测量，分层建模将在四个水平上表征变异性和可靠性 卫生保健服务的提供方式：患者、提供者、诊所和社区。在目标2中生成分析的假设将 从目标1扩展层次模型，并检验一组可扩展的解释变量的影响 概念上与接受指南的一致性护理有关。所有AIMS的研究将在 Kaiser Permanente Washington(KPWA)健康系统，它是最大的非营利性医疗保健之一的一部分 美国的系统。KPWA是一个理想的环境，因为它的等级结构和广泛的行政和 衡量医疗质量和医疗质量的多层次决定因素的电子健康记录数据。合在一起，科学 从这项研究中获得的见解将为衡量质量指标提供最佳做法，并增强 传播质量信息的报告工具。这将支持研究小组的长期目标 提高战略绩效报告的有效性，以加快提高护理质量的努力 不健康的饮酒行为。为了实现这一目标，研究小组将与KPWA交付系统负责人合作，以 根据研究结果开发原型报告卡，展示供应商的质量表现，并 以一种易于理解的方式提供可操作的见解。

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.