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）：对 VA 患者护理的背景和预期影响：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) 措施有效性的三个严重问题成瘾治疗质量的影响：首先，既定过程质量措施与结果之间的假定关联很弱或不存在。其次，VHA 和 HEDIS 使用的用于识别病历中医疗保健遭遇的基本策略的有效性通常较差，并且因环境和设施的不同而存在很大差异。三、目前所使用的成瘾治疗质量衡量标准仅关注过程，而没有充分捕捉其他重要的质量领域（例如结构、可及性、患者体验和结果）。所有 VHA 利益相关者都受益于有效医疗质量措施的存在和正确使用。鉴于现在认识到需要改进和扩大成瘾相关的质量测量，拟议的研究有以下目标。目标 1. 评估目前提出的、引人注目的成瘾治疗质量和结果之间的关联（预测有效性）：预测有效性是指访问或过程质量测量与随后的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指标的三个来源：18 项 VA 统一心理健康服务手册指标，18 项来自最近完成的国会授权的 RAND/Altarum 对 VA 心理健康服务的评估；以及华盛顿圈政策小组新制定的 5 个指标。我们的目的是在我们已有结果数据的四个患者样本中评估这些措施与结果之间的关联。目标 2. 检查同时测量的质量指标之间的关联并调查基础护理识别策略的有效性（同时有效性）。根据 Donabedian 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。如果理论上关联的质量指标之间的关联性很强，则证明评估方法很强并且随后的推论是有效的。相反，如果指标之间的预期关系较弱，则表明质量或测量模型存在问题。因此，我们将评估同时测量的、理论上相关的质量测量之间的关联。并发有效性的另一个方面是质量测量规范在可用数据中准确识别目标流程和患者的程度（称为规范策略）。我们之前由 HSR&D 资助的研究发现，VHA 护理连续性措施（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一些问题。我们建议对截然不同的 2010 HEDIS 规范策略以及新 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.评估可能调节预测或并发有效性的诊断和设置因素的影响。鉴于我们的团队和其他人发现护理模式和结果之间的关系因诊断和设置因素而异，我们将评估目标 1 和 2 中检查的预测和并发有效性的这些潜在调节因素。次要目标 2. 评估组合方法验证质量指标为具有临床和操作意义的信息。我们建议探索将质量指标组合成综合指标的各种方法，然后评估这些综合指标与结果的关联。