title: Predictive validity of two process-of-care quality measures for residential substance use disorder treatment.
abstract: BACKGROUND
  In order to monitor and ultimately improve the quality of addiction treatment, professional societies, health care systems, and addiction treatment programs must establish clinical practice standards and then operationalize these standards into reliable, valid, and feasible quality measures. Before being implemented, quality measures should undergo tests of validity, including predictive validity. Predictive validity refers to the association between process-of-care quality measures and subsequent patient outcomes. This study evaluated the predictive validity of two process quality measures of residential substance use disorder (SUD) treatment.
  
  
  METHODS
  Washington Circle (WC) Continuity of Care quality measure is the proportion of patients having an outpatient SUD treatment encounter within 14 days after discharge from residential SUD treatment. The Early Discharge measure is the proportion of patients admitted to residential SUD treatment who discharged within 1 week of admission. The predictive validity of these process measures was evaluated in US Veterans Health Administration patients for whom utilization-based outcome and 2-year mortality data were available. Propensity score-weighted, mixed effects regression adjusted for pre-index imbalances between patients who did and did not meet the measures' criteria and clustering of patients within facilities.
  
  
  RESULTS
  For the WC Continuity of Care measure, 76 % of 10,064 patients had a follow-up visit within 14 days of discharge. In propensity score-weighted models, patients who had a follow-up visit had a lower 2-year mortality rate [odds ratio (OR) = 0.77, p = 0.008], but no difference in subsequent detoxification episodes relative to patients without a follow-up visit. For the Early Discharge measure, 9.6 % of 10,176 discharged early and had significantly higher 2-year mortality (OR = 1.49, p < 0.001) and more subsequent detoxification episodes.
  
  
  CONCLUSIONS
  These two measures of residential SUD treatment quality have strong associations with 2-year mortality and the Early Discharge measure is also associated with more subsequent detoxification episodes. These results provide initial support for the predictive validity of residential SUD treatment quality measures and represent the first time that any SUD quality measure has been shown to predict subsequent mortality.
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA. Alexander.Harris2@va.gov.
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA. Shalini.Gupta2@va.gov.
authors.forename: Shalini
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA. Thomas.Bowe@va.gov.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bowe
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA. Laura.Ellerbe@va.gov.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Ellerbe
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA. Tyler.Phelps@va.gov.
authors.forename: Tyler E
authors.initials: TE
authors.lastname: Phelps
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA. Anna.Rubinsky@va.gov.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Rubinsky
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA. John.Finney@va.gov A.
authors.forename: John W
authors.initials: JW
authors.lastname: Finney
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA. Steven.Asch@va.gov.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA. Keith.Humphreys@va.gov.
authors.forename: Keith
authors.initials: K
authors.lastname: Humphreys
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA. Jodie.Trafton@va.gov.
authors.forename: Jodie
authors.initials: J
authors.lastname: Trafton
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010351:Patient Discharge; D057216:Propensity Score; D019984:Quality Indicators, Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000458:organization & administration; D015203:Reproducibility of Results; D012114:Residential Treatment / Q000592:standards*; D012720:Severity of Illness Index; D016320:Substance Abuse Treatment Centers / Q000592:standards*; D014481:United States; D014493:United States Department of Veterans Affairs