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Improving the Quality of Addiction Treatment Quality Measurement

提高成瘾治疗质量测量的质量

基本信息

批准号：
8597287
负责人：
Alex Sox-Harris
金额：
--
依托单位：
VETERANS ADMIN PALO ALTO HEALTH CARE SYS
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-01-01 至 2013-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8597287
关键词：
Aftercare Caring Clinic Clinical Code Continuity of Patient Care Current Procedural Terminology Codes Data Deterioration Diagnosis Diagnostic Drug Metabolic Detoxication Elements Evaluation Funding Guidelines Health Planning Health care facility Healthcare Light Link Measurement Measures Medical Records Mental Health Mental Health Services Methods Metric Modeling Modification Monitor Outcome Outcome Measure Patient Care Patients Pattern Patterns of Care Performance Policies Policy Maker Process Program Evaluation Quality Indicator Quality of Care Relative (related person)Research Sampling Services Source Structure Subgroup Substance Use Disorder Sum Surveys Symptoms Testing Time Validation Veterans Washington Weight addiction base expectation experience handbook health administration health care quality improved operation validation studies

项目摘要

DESCRIPTION (provided by applicant): Background and Anticipated Impacts on VA Patient Care: Our recently completed HSR&D-funded research (IIR 07-092-1) revealed three serious problems with the validity of Veterans Health Administration (VHA) and Health Plan Employer Data and Information Set (HEDIS) measures of addiction treatment quality: First, the presumed associations between established process quality measures and outcomes are weak or non-existent. Second, the validity of underlying strategies used at VHA and HEDIS for identifying health care encounters in the medical record is generally poor and varies substantially by setting and facility. Third, currently utilized addiction treatment quality measures focus exclusively on process and do not adequately capture other important domains of quality (e.g., structure, access, patient experiences, and outcomes). All VHA stakeholders benefit from the existence and proper use of valid healthcare quality measures. In light of the now recognized need to improve and expand addiction-related quality measurement, the proposed study has the following objectives. Aim 1. Evaluate the Associations between Currently Proposed, High-Profile Measures of Addiction Treatment Quality and Outcomes (predictive validity): Predictive validity refers to the strength of association between access or process quality measures and subsequent patient outcomes. We identified three sources of 41 newly developed, but unvalidated, addiction treatment quality measures: 18 VA Unform Mental Health Services Handbook Metrics, 18 from the recently completed congressionally-mandated RAND/Altarum evaluation of VA mental health services; and 5 newly developed metrics from the Washington Circle policy group. Our aim is to evaluate the associations between these measures and outcomes, in four samples of patients for whom we have pre-existing outcome data. Aim 2. Examine the Associations Among Contemporaneously Measured Quality Indictors and Investigate the Validity of Underlying Care Identification Strategies (Concurrent Validity). According to Donabedian, quality indicators should be associated to other contemporaneously measured indicators of the underlying construct. If the association between theoretically linked quality indicators is strong, this is evidence that the method of assessment is strong and the subsequent inferences are valid. Conversely if the expected relationships between indicators are weak, this suggests problems with the quality or measurement model. Therefore, we will assess the associations between contemporaneously measured, theoretically linked quality measures. Another aspect of concurrent validity is the extent to which quality measure specifications accurately identify the targeted processes and patients in available data (termed specification strategy). Our previous HSR&D-funded research found several problems in the specification strategies used in both the VHA Continuity of Care measure (based on VHA clinic stop codes), and the 2006 version of HEDIS Initiation and Engagement measures (based on diagnosis/CPT code combinations). We propose to conduct a similar validation study of the substantially different 2010 HEDIS specification strategy, as well as specification strategies used in the new OMHS metrics. Secondary Aim1. Evaluate the Impact of Diagnostic and Setting Factors that May Moderate Predictive or Concurrent Validity. Given the finding by our team and others that relationships between patterns of care and outcomes vary by diagnostic and setting factors, we will evaluate these potential moderators of the predictive and concurrent validity examined in Aims 1 and 2. Secondary Aim 2. Evaluate Methods to Combine Validated Quality Metrics into Information that is Clinically and Operationally Meaningful. We propose to explore various means of combining the quality metrics into composite measures, and then evaluate the association of these composites with outcomes.

描述（由申请人提供）：