Table 4.

Outcomes among patients satisfying quality measures.

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.