Excessive alcohol use, including alcohol misuse, dependence and abuse, is a major public health problem in the United States. Alcohol use disorders (AUD) are associated with functional impairment, poor health outcomes, and significant economic consequences. Yet few individuals with alcohol use problems receive adequate treatment. Improving treatment outcomes through better quality of care for AUDs is the major, overarching alcohol-related priority facing the health system today. To improve the quality of care for AUDs, it is first necessary to develop AUD quality measures and validate these measures by linking processes of care (e.g. specific components of high-quality treatment) to outcomes. Current quality measures for AUD treatment are inadequate, focusing primarily on the number of visits rather than the actual quality of care provided. In addition, most current AUD quality measures are specific to specialty care treatment, rather than primary care where the vast majority of individuals with alcohol use problems seek treatment. The goal of this project is to produce quality measures for the range of alcohol use disorders seen in both primary and specialty mental health care settings that can be used to guide quality improvement efforts. To do this, this project will employ an expert panel process to modify and improve existing AUD quality measures to include care for alcohol misuse and score additional variability in quality to better capture the clinical complexity of care provided to patients detected in primary care settings (Aim 1). Second, this project will enroll nearly 1000 newly-detected veterans with probable alcohol misuse and will use the revised AUD quality measures to describe quality of care they receive in both primary and specialty care settings in the Veterans Health Administration (VHA), and will identify the areas in greatest need of quality improvement (Aim 2). The VHA is the ideal environment for developing and evaluating new quality measures because of their long experience with electronic medical records, clinical reminders and universal screening for alcohol misuse. Finally, this project will develop a comprehensive index of guideline concordant care for AUDs by combining all quality measures, and will evaluate the predictive validity of the index by relating it to clinical outcomes (Aim 3). By conducting a prospective study to validate clinical practice guidelines, and by identifying important clinical and policy leverage points for improving outcomes, this research will not only be a major advance for alcohol-specific research and patient care, but will advance treatment research more broadly. The products of this research - validated AUD quality measures - have the potential to improve outcomes through the transformation of care. By linking AUD quality measures with outcomes, we can illustrate the clinical importance and relevance of quality measurement for AUD and support policy decisions to improve the quality of AUD care.

Public Health Relevance

Alcohol use disorders (AUD) are associated with poor health outcomes, decreased quality of life, and significant economic consequences. To improve outcomes, it is necessary to improve the quality of AUD care by developing appropriate quality measures. The proposed research will modify, improve, and estimate the predictive validity of current AUD quality measures for the range of alcohol use disorders seen in both primary and specialty mental health care settings, and will use these measures to evaluate the quality of AUD care received by nearly 1,000 newly-detected patients with problem alcohol use.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Health Services Research Review Subcommittee (AA)
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Huebner, Robert B
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Rand Corporation
Santa Monica
United States
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Watkins, Katherine E; Farmer, Carrie M; De Vries, David et al. (2015) The Affordable Care Act: an opportunity for improving care for substance use disorders? Psychiatr Serv 66:310-2