Table 4.
Article | Measure | Setting | Data source | Sample size | Primary outcome | Results | Specific to OUD? |
---|---|---|---|---|---|---|---|
Clinical outcomes and substance use | |||||||
Harris, Humphreys, & Finney, 2007 | HEDIS initiation and engagement | VHA, 110 SUD treatment programs across 73 facilities | Self-administered ASI | N = 5723 patients | ASI composite drug and alcohol scores at the facility level approximately 7 months after patient intake | Patients receiving care at facilities with higher rates of Initiation has modestly greater improvements in ASI drug (but not alcohol) composite scores when adjusting for facility case-mix characteristics | No |
Harris, Humphreys, Bowe, Tiet, & Finney, 2008 | HEDIS engagement | VHA | Administrative and survey data | N = 2789 patients | ASI composite drug, alcohol, and legal scores at patient level | Patients who engaged had statistically significant but clinically modest gains in all scores, with greater effects for alcohol and legal outcomes for patients seen in outpatient settings | No |
Garnick, Lee, O’Brien, et al., 2012 | HEDIS engagement | Outpatient multisite pilot study across 12 states; adolescents | Secondary data, 28 outpatient clinics | N = 1491 patients | Substance use outcomes | Adolescents who engaged reported had lower risk of substance use (AOR 0.60 95% CI 0.41, 0.87), alcohol use (AOR 0.63 95% CI 0.45, 0.87), heavy alcohol use (AOR 0.53 95% CI 0.33, 0.86), or marijuana use (AOR 0.64 95% CI 0.45, 0.93) | No |
Acevedo, Garnick, Ritter, Lundgren, & Horgan, 2016 | HEDIS engagement | AOD outpatient treatment facilities in Massachusetts | Administrative data | N = 11,591 patients | Detoxification admissions | Engaged patients had lower detoxification admission in year following index outpatient visit (HR = 0.87, p < .01) among clients in AOD treatment | No |
Criminal justice | |||||||
Garnick, Horgan, Lee, et al., 2007 | HEDIS initiation and engagement | Oklahoma, publicly funded outpatient treatment | Administrative data, client self-report | N = 5328 clients | Criminal justice outcomes | Engagement, but not initiation, was associated with lower risk (HR: 0.73 95% CI 0.62, 0.87) of subsequent arrest and incarceration | N |
Garnick, Horgan, Acevedo, et al., 2014 | HEDIS engagement | Public sector AOD treatment centers in 4 states | Administrative linked with criminal justice data | N = 106,662 patients | Criminal justice outcomes | Those who engaged had significantly lower risk of any arrest in all four states studied (HR range 0.73–0.83) | No |
Employment | |||||||
Dunigan, Acevedo, Campbell, et al., 2014 | HEDIS Engagement | Public sector outpatient treatment in Washington state | Administrative, employment, and criminal justice data including self-report | N = 7570 patients | Employment outcomes | For clients with prior criminal justice involvement, engagement was associated with both greater employment (44.7% vs. 38.8%. p < .01) and higher wages ($12,537 vs. $11,338) in the year following treatment | No |
Mortality | |||||||
Watkins, Paddock, Hudson, et al., 2016 | HEDIS initiation and engagement | Cohort study of VHA patients with co-occurring disorders (COD) | Administrative data | N = 144,045 patients | 12 and 24 month mortality | Initiation associated with 15% decrease and engagement associated with 31% decrease in 12-month mortality. Increasing numbers of visits associated with further reductions in mortality. | No |
Paddock, Hepner, Hudson, et al., 2017 | HEDIS initiation and engagement | VHA, inpatient and outpatient | Administrative data | N = 339,966 patients | 12 and 24 month mortality | AOR of 12-month mortality with initiation = 0.86, p = .001 and engagement = 0.65, p < .001; and 24-month mortality with initiation = 0.88, p = .005 and engagement = 0.78, p < .001 | No |
Watkins, Paddock, Hudson, et al., 2017 | MAT continuity (3 months) | VHA, retrospective cohort study | Administrative data | N = 31,016 patients | 12 and 24 month mortality among patients with OUD | MAT continuity was not associated with decreased mortality however not being prescribed opioids or benzodiazepines, receipt of any psychosocial treatment, and quarterly physician visits were significantly associated with lower mortality at both 12 and 24 months | Yes |
Patient satisfaction | |||||||
Hepner, Paddock, Watkins, et al., 2017 | HEDIS initiation and engagement | VHA | Administrative data and phone survey | N = 2074 patients | Self-reported perceived improvement on the ECHO | Engagement, but not Initiation, was associated with perceived improvement (Coeff 0.25, p = .006) | No |
VHA = Veterans Health Administration; ASI = Addiction Severity Index; AOD = Alcohol or other drug; TAU = Treatment as usual; AOR = Adjusted odds ratio; CI = Confidence interval; ECHO = Experience of Care and Health Outcomes; HEDIS=Healthcare Effectiveness Data Information Set.