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: 10590820
• 负责人: Joseph Edwin Glass
• 金额: $ 20.6万
• 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/10590820
• 关键词: Address; Adopted; Adoption; Alcohol consumption; Alcohols; Area; Caring; Characteristics; Chronic; Clinic; Clinical; Communities; Data; Decision Making; Development; Direct Costs; Drug Addiction; 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; Patient Care; Patients; Performance; Phase; Positioning Attribute; Productivity; Property; Provider; Public Health; Quality Indicator; Quality of Care; Reporting; Research; Severities; Structure; Substance Use Disorder; Suggestion; System; Testing; United States Centers for Medicare and Medicaid Services; Variant; Washington; Work; alcohol abuse therapy; alcohol and other drug; alcohol misuse; alcohol screening; base; 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; Address; Adopted; Adoption; Alcohol consumption; Alcohols; Area; Caring; Characteristics; Chronic; Clinic; Clinical; Communities; Data; Decision Making; Development; Direct Costs; Drug Addiction; 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; Patient Care; Patients; Performance; Phase; Positioning Attribute; Productivity; Property; Provider; Public Health; Quality Indicator; Quality of Care; Reporting; Research; Severities; Structure; Substance Use Disorder; Suggestion; System; Testing; United States Centers for Medicare and Medicaid Services; Variant; Washington; Work; alcohol abuse therapy; alcohol and other drug; alcohol misuse; alcohol screening; base; 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.

项目摘要 不健康的酒精使用仍然是一个关键问题，高风险饮酒之间增加了几乎30％ 2001-2002和2012-2013。过度使用饮酒是可预防死亡的第三主要原因，并且是联系的 对于慢性医疗状况，生产力失去了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。促进吸收 这些实践，卫生系统采用质量措施来确定护理的各个方面并进行监控 改进领域。国家质量论坛已认可了不健康的几项护理质量措施 饮酒，卫生系统已用于常规决策。这些包括指标 启动和参与酒精和其他药物（AOD）滥用或依赖的治疗（相当于 药物使用障碍），以及急诊科访问AOD滥用或 依赖。提出更广泛采用的另一个领域是对不健康的饮酒的普遍筛查。 尽管通过卫生系统采用了这五项措施，但这些与酒精有关的质量的普遍性 措施尚未完全确立。这包括缺乏有关预期可变性的知识和 在卫生系统的不同水平（例如诊所，提供者）处测量质量的可靠性。另外，有限 有关提高性能的有意义驱动因素的信息，以指导质量的卫生系统 改进工作。这项研究旨在通过以下两个来解决这些科学证据差距 具体目的：1）检查不健康饮酒的护理质量度量的可变性和可靠性，以及2） 确定与护理质量相关的多层次因素，以供不健康的饮酒。对于五个质量中的每一个 焦点，分层建模将应用于四个级别的可变性和可靠性 医疗保健提供：患者，提供者，诊所和社区。在AIM 2中生成分析的假设将 从AIM 1扩展层次模型，并检查一组扩展的解释变量的影响 从概念上讲，与收到指南协调护理有关。所有目标的研究都将在 Kaiser Permanente Washington（KPWA）卫生系统，该系统是最大的非营利性医疗保健之一 美国的系统。鉴于其层次结构和广泛的行政结构，KPWA是理想的环境 电子健康记录数据以衡量护理质量的质量和多层决定因素。在一起，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 报告传播质量信息的工具。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 不健康的酒精使用。为了实现这一目标，研究团队将与KPWA交付系统领导者合作 开发由研究结果告知的原型成绩单，呈现提供者和 诊所以容易解释并提供可行的见解的方式。