title: Predictive validity of a quality measure for intensive substance use disorder treatment.
abstract: Measures of substance use disorder (SUD) treatment quality are essential tools for performance improvement. The Veterans Health Administration (VHA) developed a measure of access to and engagement in intensive outpatient programs (IOPs) for SUD. However, predictive validity, or associations between this measure and treatment outcomes, has not been examined.
  
  
  
  Data on veterans with SUD came from 3 samples: the Outcomes Monitoring Project (N = 5436), a national evaluation of VHA mental health services (N = 339,887), and patients receiving detoxification services (N = 23,572). Propensity score-weighted mixed-effects regressions modeled associations between receiving at least 1 week of IOP treatment and patient outcomes, controlling for facility-level performance and a random effect for facility.
  
  
  
  Propensity score weighting reduced or eliminated observable baseline differences between patient groups. Patients who accessed IOPs versus those who did not reported significantly reduced alcohol- and drug-related symptom severity, with significantly fewer past-month days drinking alcohol (b = 1.83, P < .001) and fewer past-month days intoxicated (b = 1.55, P < .001). Patients who received IOP after detoxification services had higher 6-month utilization of SUD outpatient visits (b = 2.09, P < .001), more subsequent detoxification episodes (b = 0.25, P < .001), and lower odds of 2-year mortality (odds ratio [OR] = 0.68, 95% confidence interval [CI]: 0.61-0.75; P < .001).
  
  
  
  Receiving at least 1 week of SUD treatment in an IOP was associated with higher follow-up utilization, improved health outcomes, and reduced mortality. These associations lend support to the predictive validity of VHA's IOP quality measure. Future research should focus on measure feasibility and validity outside of VHA, and whether predictive validity is maintained once this quality measure is tied to performance incentives.
authors.affiliation: a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.|b Center for Health Policy/Primary Care and Outcomes Research (CHP/PCOR) and the Division of General Medical Disciplines , Stanford , California , USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Schmidt
authors.affiliation: a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: Shalini
authors.initials: S
authors.lastname: Gupta
authors.affiliation: a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bowe
authors.affiliation: a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Ellerbe
authors.affiliation: a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: Tyler E
authors.initials: TE
authors.lastname: Phelps
authors.affiliation: a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Finney
authors.affiliation: a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.affiliation: a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Humphreys
authors.affiliation: a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.|c Program Evaluation and Resource Center , Office of Mental Health Operations, VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: Jodie
authors.initials: J
authors.lastname: Trafton
authors.affiliation: a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.|b Center for Health Policy/Primary Care and Outcomes Research (CHP/PCOR) and the Division of General Medical Disciplines , Stanford , California , USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Vanneman
authors.affiliation: a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.
authors.forename: Alex H S
authors.initials: AHS
authors.lastname: Harris
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000379:methods*; D015203:Reproducibility of Results; D019966:Substance-Related Disorders / Q000628:therapy; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: Access to care; intensive outpatient programs; mortality; patient participation; quality indicators; substance-related disorders