The proposed secondary data analysis is the first step in an innovative research agenda to develop relevant and feasible QIs supported by the strongest level of evidence. Developing relevant, feasible and valid QIs is a key public policy priority, and nowhere is the need for quality measures greater than in substance abuse treatment. Of the 615 National Quality Forum endorsed standards, only one is specific to substance use. There are no measures for co-occurring MH&SA disorders (MCOD) or co-occurring physical health and SA disorders (PCOD), despite the prevalence of both types of co-morbidity. We propose a secondary data analysis to identify potential QIs for substance use disorders (SUDs) and M/P CODs with the best-performing indicator characteristics. We will use a unique data set (consisting of a rich combination of administrative data, patient surveys, and surveys of service system administrators) developed for the Program Evaluation of the Veterans Health Administration by our research team. This data set contains over 60 QIs created through a collaborative effort of researchers, clinicians, and policy makers, as well as data on indicator reliability and feasibility. While each of these 60 candidate QIs has carefully developed specifications, it would be inefficient and costly to test all of them in a prospective cohort stud. This secondary analysis will allow us to winnow down the set of possible measures to the most promising and robust candidates that can be rigorously tested on a broader population in subsequent studies. Therefore, this secondary data analysis represents a critical first step, which will provide a foundation for a prospective validation study in a broad range of public and private service systems. We also use innovative methods to develop composite QIs to characterize the quality of all care provided patients with SUDs, as not all processes apply to all patients, and high-quality care is best described as the sum of many individual processes.
Our specific aims are:
Aim 1 :. To evaluate the association between individual QIs and outcomes for individuals with SUDs and to identify the QIs with the best-performing indicator characteristics.
Aim 2 :. To evaluate the association between individual QIs and outcomes for individuals with M/P CODs and to identify QIs with the best- performing indicator characteristics.
Aim 3 :. To characterize the quality of all MH/SA treatment provided to patients using a composite QI and to evaluate its association with outcomes. To our knowledge, this secondary data analysis is the first to propose a comprehensive analysis of process outcome links for over 60 QIs across a broad range of outcomes in order to identify the most promising candidate QIs with the strongest indicator properties. It is the first step in an innovative research agenda to develop relevant and feasible QIs supported by the strongest level of evidence.
The Institute of Medicine has identified serious problems with the quality of mental health and substance abuse care in the United States and has identified improving quality and treatment outcomes as critical public health and public policy objectives. Developing quality measures is a public policy priority, and nowhere is the need for quality measures greater than in substance abuse treatment. We propose a secondary data analysis to identify potential quality measure with the best-performing characteristics. It represents a criticl first step that will provide a foundation for a future prospective-validation study.