Improving the Quality of Addiction Treatment Quality Measurement

描述(由申请人提供)： 背景和对退伍军人患者护理的预期影响：我们最近完成的HSR&D资助的研究(IIR 07-092-1)揭示了退伍军人健康管理局(VHA)和健康计划雇主数据和信息集(HEDIS)对成瘾治疗质量的衡量标准的有效性存在三个严重问题：第一，已建立的过程质量衡量标准与结果之间的假定关联很弱或根本不存在。其次，VHA和HEDIS用来识别医疗记录中的卫生保健遭遇的基本策略的有效性通常很差，而且因环境和设施的不同而有很大差异。第三，目前 所采用的成瘾治疗质量衡量标准完全侧重于过程，而没有充分涵盖其他重要的质量领域(例如，结构、途径、患者体验和结果)。VHA的所有利益相关者都受益于有效的医疗质量衡量标准的存在和正确使用。鉴于现在认识到需要改进和扩大与成瘾有关的质量测量，拟议的研究有以下目标。目的1.评估目前建议的、备受瞩目的成瘾治疗质量和结果之间的相关性(预测有效性)：预测有效性指的是 获取或过程质量测量与后续患者结果之间的关联。我们确定了41项新开发但未经验证的成瘾治疗质量衡量标准的三个来源：18个VA Unform精神健康服务手册指标，18个来自最近完成的国会授权的RAND/Altarum对VA精神健康服务的评估；以及5个来自华盛顿圈政策小组的新制定的指标。我们的目的是评估这些措施与结果之间的关联，在我们已有现有结果数据的四个患者样本中。目的2.检查同时测量的质量指标之间的关联，并调查潜在护理识别策略的有效性(同时有效性)。根据多纳贝迪安的说法，质量指标应与基础结构的其他同时测量的指标相关联。如果理论上联系在一起的质量指标之间的关联性很强，这就证明了评估方法是强有力的，随后的推论是有效的。相反，如果指标之间的预期关系较弱，则表明质量或衡量模式存在问题。因此，我们将评估同时测量的、理论上相关联的质量测量之间的关联。同时有效性的另一个方面是质量测量规范在多大程度上准确地识别可用数据中的目标过程和患者(称为规范策略)。我们之前由HSR&D资助的研究发现，在VHA连续性护理措施(基于VHA诊所停止代码)和2006版HEDIS启动和参与措施(基于诊断/CPT代码组合)中使用的规范策略存在几个问题。我们建议对完全不同的2010年HEDIS规范策略以及新的OMHS指标中使用的规范策略进行类似的验证研究。次要目标1.评估诊断和设定因素的影响，这些因素可能会影响预测或并发效度。考虑到我们团队和其他人的发现，护理模式和结果之间的关系因诊断和设置因素而异，我们将评估这些潜在的调节因素，这些因素是AIMS 1和2.次级目标2中检查的预测性和并发有效性。评估将经过验证的质量指标结合到具有临床和操作意义的信息中的方法。我们建议探索将质量度量组合成组合度量的各种方法，然后评估这些组合与结果的关联。

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.