Table 2.

Determination Categories of Incident OUD Diagnoses Based on Chart Review of Documented Clinical Course

Categories	Description	Examples
Likely accurate diagnosis	Sufficient documentation of OUD diagnostic criteria or clinical course internally consistent with diagnosis	Veteran admitted for opioid overdose, seen by addiction psychiatry and started on MOUD
Potentially inaccurate diagnosis
Likely inaccurate: Administrative errors	Documentation consistent with likely inaccurate diagnosis that was not intended by clinician	- Veteran admitted for alcohol use disorder. Diagnosis placed during group visit for naloxone training. - OUD diagnosis applied for lab medicine encounter. No other documentation consistent with OUD.
Likely inaccurate: Clinical errors	Documentation consistent with likely inaccurate diagnosis that was intended, but misapplied, by clinician	- Veteran receiving LTOT from non-VA provider. Diagnosis placed after PMP review. No subsequent taper or naloxone/MOUD provided or discussed. - Veteran receiving high dose LTOT (> 100 MEQ). No discussion of problematic behaviors and no taper or MOUD provided.
Indeterminate	Documentation of opioid use with problematic behaviors not meeting criteria for OUD and no clinical decision consistent with OUD diagnosis	- LTOT discontinued for hostile behavior. No OUD diagnostic criteria documented. No SUD referral or MOUD provided or discussed.