title: Veterans Affairs facility performance on Washington Circle indicators and casemix-adjusted effectiveness.
abstract: Self-administered Addiction Severity Index (ASI) data were collected on 5,723 patients who received substance abuse treatment in 1 of 110 programs located at 73 Veterans Affairs facilities. The associations between each of three Washington Circle (WC) performance indicator scores (identification, initiation, and engagement) and their casemix-adjusted facility-level improvement in ASI drug and alcohol composites 7 months after intake were estimated. Higher initiation rates were not associated with facility-level improvement in ASI alcohol composite scores but were modestly associated with greater improvements in ASI drug composite scores. Identification and engagement rates were unrelated to 7-month outcomes. WC indicators focused on the early stages of treatment may tap necessary but insufficient processes for patients with substance use disorder to achieve good posttreatment outcomes. Ideally, the WC indicators would be supplemented with other measures of treatment quality.
authors.affiliation: Center for Health Care Evaluation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA. Alexander.Harris2@va.gov
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.forename: Keith
authors.initials: K
authors.lastname: Humphreys
authors.forename: John W
authors.initials: JW
authors.lastname: Finney
mesh_terms: D000437:Alcoholism / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care; D020379:Risk Adjustment; D012720:Severity of Illness Index; D016320:Substance Abuse Treatment Centers / Q000592:standards*; D019966:Substance-Related Disorders / Q000628:therapy*; D014728:Veterans