Multi-level Influences of Alcohol Based Quality and Outcome Measures

酒精质量的多层次影响和结果测量

• 批准号: 10704144
• 负责人: Joseph Edwin Glass
• 金额: $ 23.15万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-13 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10704144
• 关键词: Acceleration; Address; Adopted; Adoption; Alcohol consumption; Alcohols; Area; Caring; Characteristics; Chronic; Clinic; Clinical; Communities; Data; Decision Making; Dependence; Development; Direct Costs; Drug abuse; Drug usage; Effectiveness; Electronic Health Record; Emergency department visit; Ensure; Evidence based practice; Feedback; Fetal Alcohol Spectrum Disorder; Foundations; Future; Goals; Guidelines; Health Status; Health system; Healthcare Systems; Individual; Influentials; Knowledge; Link; Measurement; Measures; Medical; Mental Health; Modeling; Monitor; National Committee for Quality Assurance; Outcome Measure; Patients; Performance; Phase; Positioning Attribute; Productivity; Property; Provider; Public Health; Quality Indicator; Quality of Care; Reporting; Research; Severities; Structure; Substance Use Disorder; System; Testing; United States Centers for Medicare and Medicaid Services; Variant; Washington; Work; alcohol abuse therapy; alcohol and other drug; alcohol misuse; alcohol screening; care delivery; data visualization; follow-up; health care delivery; high risk drinking; hospital readmission; improved; innovation; insight; organizational structure; prevent; preventable death; prototype; screening; substance use treatment; tool; uptake

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.

项目概要 不健康饮酒仍然是一个严重问题，高风险饮酒者增加了近 30% 2001-2002 年和 2012-2013 年。过量饮酒是可预防死亡的第三大原因，并且与 慢性疾病、生产力损失以及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饮酒及其有害后果。为了促进吸收 在这些做法中，卫生系统使用质量措施来确定护理工作中做得好的方面并进行监测 有待改进的地方。国家质量论坛批准了多项针对不健康人群的护理质量措施 酒精使用，已被卫生系统用于日常决策。这些包括指标 开始并参与酒精和其他药物 (AOD) 滥用或依赖的治疗（相当于 物质使用障碍），以及因 AOD 滥用或急诊科就诊后的随访 依赖性。提议更广泛采用的另一个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，但这些与酒精相关的质量的普遍性 措施尚未完全制定。这包括缺乏对预期变化的了解和 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 存在关于改善绩效的有意义驱动因素的信息，以指导卫生系统提高质量 改进努力。本研究旨在通过以下两个方面来解决这些科学证据差距 具体目标：1) 检查不健康饮酒护理质量措施的可变性和可靠性，以及 2) 确定与不健康饮酒护理质量相关的多层次因素。对于五种品质中的每一种 将应用焦点度量、分层建模来表征四个级别的可变性和可靠性 医疗保健服务提供者：患者、提供者、诊所和社区。目标 2 中的假设生成分析将 从目标 1 扩展层次模型并检查一组广泛的解释变量的影响 从概念上讲，与接受指南一致护理相关。所有目标的研究将在 华盛顿凯撒医疗机构 (KPWA) 医疗系统，是最大的非营利医疗保健机构之一的一部分 美国的系统。鉴于其层级结构和广泛的行政和管理，KPWA 是一个理想的环境。 电子健康记录数据用于衡量护理质量的质量和多层次决定因素。一起，科学 从这项研究中获得的见解将为测量质量指标提供最佳实践，并增强 传播高质量信息的报告工具。这将支持研究团队的长期目标 提高战略绩效报告的有效性，以加快改善护理质量的努力 不健康的饮酒。为了实现这一目标，研究团队将与 KPWA 交付系统领导者合作， 开发基于研究结果的原型报告卡，展示提供者的质量绩效和 以易于解释并提供可行见解的方式进行诊所。