Quality of care measures for the management of unhealthy alcohol use

Hepner, Kimberly A.; Watkins, Katherine E.; Farmer, Carrie M.; Rubenstein, Lisa V.; Pedersen, Eric R.; Pincus, Harold Alan

doi:10.1016/j.jsat.2016.11.006

Cited by 8 publications

(14 citation statements)

References 57 publications

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“…Still, even among existing mental health process measures that could be reported, not all have been validated 25,26,[33][34][35][36][37][38][39] .…”

Section: Current State Of Measuring Mental Health Care Qualitymentioning

confidence: 99%

Measuring and improving the quality of mental health care: a global perspective

et al. 2018

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Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient-centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement-based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.

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“…Still, even among existing mental health process measures that could be reported, not all have been validated 25,26,[33][34][35][36][37][38][39] .…”

Section: Current State Of Measuring Mental Health Care Qualitymentioning

confidence: 99%

Measuring and improving the quality of mental health care: a global perspective

et al. 2018

Self Cite

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“…Several other NQF-endorsed treatment performance measures are related to screening for tobacco use in inpatient settings. In addition, an expert panel convened by the RAND Corporation has suggested that detailed specification development and pilot testing would be appropriate for a potential AUD-related quality measure on screening for substance use, including tobacco use, in individuals with an Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score of greater than or equal to 5 (Hepner et al 2017). The American Society of Addiction Medicine also has proposed a measure on screening for tobacco use disorder (American Society of Addiction Medicine 2014).…”

Section: Quality Measurement Considerationsmentioning

confidence: 99%

“…Brief counseling is described as at least one session of "a minimum of 5-15 minutes, which may include: feedback on alcohol use and harms; identification of high risk situations for drinking and coping strategies; increased motivation and the development of a personal plan to reduce drinking" (National Quality Measures Clearinghouse 2016). An expert panel convened by the RAND Corporation has suggested a number of potential AUD-related quality measures that would be appropriate for detailed specification development and pilot testing; many of these use specific threshold scores on the AUDIT-C as a method for identifying individuals who are appropriate for the use of the measure (Hepner et al 2017).…”

Section: Quality Measurement Considerationsmentioning

confidence: 99%

“…These would be useful to review before considering development of a new measure. In addition, an expert panel convened by the RAND Corporation has suggested screening for liver disease in individuals with an AUD diagnosis or an AUDIT-C score of greater than or equal to 8 (Hepner et al 2017), and the American Society of Addiction Medicine has proposed a measure on documenting diagnoses of co-occurring psychiatric disorders (American Society of Addiction Medicine 2014). With the increasing use of electronic medical record systems and associated recording of problems and diagnoses using structured terminology, it may be possible to develop electronic measures from this recommendation that could be used for process-focused internal or health system-based quality improvement initiatives.…”

Section: Quality Measurement Considerationsmentioning

confidence: 99%

“…Among individuals who were identified with AUD via screening in general ambulatory settings, only a small fraction received any information about treatment (Glass et al 2016). Some specific elements of a comprehensive treatment plan, including counseling about treatment options, offer of psychotherapy, receipt of AUD pharmacotherapy, referral to community-based recovery support, and integrated treatment of co-occurring disorders, have been suggested for detailed development of quality measure specifications and pilot testing by an expert panel convened by the RAND Corporation on AUD-related quality measures (Hepner et al 2017). Nevertheless, an overarching performance measure derived from this recommendation is not recommended because of the associated burdens and practical challenges.…”

Section: Quality Measurement Considerationsmentioning

confidence: 99%

See 2 more Smart Citations

The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

2018

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Alcohol-Related Nurse Care Management in Primary Care

et al. 2018

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IMPORTANCE Experts recommend that alcohol use disorders (AUDs) be managed in primary care, but effective approaches are unclear.OBJECTIVE To test whether 12 months of alcohol care management, compared with usual care, improved drinking outcomes among patients with or at high risk for AUDs. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted at 3 Veterans Affairs (VA) primary care clinics. Between October 11, 2011, and September 30, 2014, the study enrolled 304 outpatients who reported heavy drinking (Ն4 drinks per day for women and Ն5 drinks per day for men).INTERVENTIONS Nurse care managers offered outreach and engagement, repeated brief counseling using motivational interviewing and shared decision making about treatment options, and nurse practitioner-prescribed AUD medications (if desired), supported by an interdisciplinary team (CHOICE intervention). The comparison was usual primary care. MAIN OUTCOMES AND MEASURESPrimary outcomes, assessed by blinded telephone interviewers at 12 months, were percentage of heavy drinking days in the prior 28 days measured by timeline follow-back interviews and a binary good drinking outcome, defined as abstinence or drinking below recommended limits in the prior 28 days (according to timeline follow-back interviews) and no alcohol-related symptoms in the past 3 months as measured by the Short Inventory of Problems. RESULTSOf 304 participants, 275 (90%) were male, 206 (68%) were white, and the mean (SD) age was 51.4 (13.8) years. At baseline, both the CHOICE intervention (n = 150) and usual care (n = 154) groups reported heavy drinking on 61% of days (95% CI, 56%-66%). During the 12-month intervention, 137 of 150 patients in the intervention group (91%) had at least 1 nurse visit, and 77 of 150 (51%) had at least 6 nurse visits. A greater proportion of patients in the intervention group than in the usual care group received alcohol-related care: 42% (95% CI, 35%-49%; 63 of 150 patients) vs 26% (95% CI, 19%-35%; 40 of 154 patients). Alcohol-related care included more AUD medication use: 32% (95% CI, 26%-39%; 48 of 150 patients in the intervention group) vs 8% (95% CI, 5%-13%; 13 of 154 patients in the usual care group). No significant differences in primary outcomes were observed at 12 months between patients in both groups. The percentages of heavy drinking days were 39% (95% CI, 32%-47%) and 35% (95% CI, 28%-42%), and the percentages of patients with a good drinking outcome were 15% (95% CI, 9%-22%; 18 of 124 patients) and 20% (95 % CI, 14%-28%; 27 of 134 patients), in the intervention and usual care groups, respectively (P = .32-.44). Findings at 3 months were similar. CONCLUSIONS AND RELEVANCEThe CHOICE intervention did not decrease heavy drinking or related problems despite increased engagement in alcohol-related care.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01400581

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Quality of care measures for the management of unhealthy alcohol use

Cited by 8 publications

References 57 publications

Measuring and improving the quality of mental health care: a global perspective

Measuring and improving the quality of mental health care: a global perspective

The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

Alcohol-Related Nurse Care Management in Primary Care

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