Differences across race and ethnicity in the quality of antidepressant medication management.

Objective: To illustrate the importance of a multidimensional view of disparities in quality of antidepressant medication management (AMM), as well as discriminating "within-facility" disparities from disparities that exist between facilities.

Data Sources And Study Setting: We used data from the Veterans Health Administration's (VA) Corporate Data Warehouse (CDW) which contains clinical and administrative data from VA facilities nationally.

Study Design: CDW data were used to measure five indicators of AMM quality, including the HEDIS Effective Acute-Phase and Effective Continuation-Phase measures.

Progress toward a performance measure for mental health based on a generic patient- reported outcome measure: Findings from the Veterans Outcome Assessment survey.

We report on studies conducted to develop outcome-based performance measures (PROM-PMs) based on generic patient-reported outcome measures (PROMs) that could support strategies for quality improvement applicable to all patients in a mental health system. Data were from the Veterans Outcome Assessment Survey at baseline and three months for the Mental Component Score (MCS-12), a widely used measure of mental health-related quality of life, for 15,540 outpatients beginning treatment in General Mental Health clinics in 140 Veterans Affairs (VA) facilities. Mental health diagnoses from medical records were coded using hierarchical categories.

Surveying the Landscape of Quality-of-Care Measures for Mental and Substance Use Disorders.

Objective: Quality measures that are used to evaluate health care services have a central role in monitoring and incentivizing quality improvement and the provision of evidence-based treatment. This systematic scan aimed to catalog quality-of-care measures for mental and substance use disorders and assess gaps and redundancies to inform efforts to develop and retire measures.

Methods: Quality measure inventories were analyzed from six organizations that evaluate health care quality in the United States.

Evaluating and Improving Engagement in Care After High-Intensity Stays for Mental or Substance Use Disorders.

Objective: This interrupted time-series analysis examined whether activating a quality measure, supported by education and a population management tool, was associated with higher postdischarge engagement (PDE) in outpatient care after inpatient and residential stays for mental or substance use disorder care.

Methods: Discharges from October 2016 to May 2019 were identified from national Veterans Health Administration (VHA) records representing all 140 VHA health care systems. Engagement was defined as multiple mental or substance use disorder outpatient visits in the 30 days postdischarge.

Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration.

Background: Potential protective effects of nonpharmacological treatments (NPT) against long-term pain-related adverse outcomes have not been examined.

Objective: To compare active duty U.S.

Patient and Health Care Factors Associated With Long-term Diabetes Complications Among Adults With and Without Mental Health and Substance Use Disorders.

Importance: Among people with diabetes, co-occurring mental health (MH) or substance use (SU) disorders increase the risk of medical complications. Identifying how to effectively promote long-term medical benefits for at-risk populations, such as people with MH or SU disorders, is essential. Knowing more about how health care accessed before the onset of diabetes is associated with health benefits after the onset of diabetes could inform treatment planning and population health management.

Four Decades after War: Incident Diabetes among Women Vietnam-Era Veterans in the HealthViEWS Study.

Objectives: We analyzed long-term differences in incident diabetes associated with military service in a warzone among women who served during the Vietnam War era.

Methods: For HealthViEWS, the largest later-life study of women Vietnam War-era U.S.

Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System.

Purpose: To evaluate facility-level variation in the use of services for patients with carpal tunnel syndrome (CTS) receiving care in the Veterans Health Administration (VHA).

Methods: A national cohort of VHA patients diagnosed with CTS during fiscal year 2013 was divided into nonsurgical and operative treatment groups for comparison. We assessed the use of 5 types of CTS-related services (electrodiagnostic studies [EDS], imaging, steroid injection, oral steroids, and therapeutic modalities) in the prediagnosis and postdiagnosis periods before any operative intervention at the patient and facility levels.

Barriers and Facilitators to Implementation of Pharmacotherapy for Opioid Use Disorders in VHA Residential Treatment Programs.

Objective: Despite evidence of effectiveness, pharmacotherapy-methadone, buprenorphine, or naltrexone-is prescribed to less than 35% of Veterans Health Administration (VHA) patients diagnosed with opioid use disorder (OUD). Among veterans whose OUD treatment is provided in VHA residential programs, factors influencing pharmacotherapy implementation are unknown. We examined barriers to and facilitators of pharmacotherapy for OUD among patients diagnosed with OUD in VHA residential programs to inform the development of implementation strategies to improve medication receipt.

Potentially Preventable Medical Hospitalizations and Emergency Department Visits by the Behavioral Health Population.

This study investigated geographic variation in potentially preventable medical outcomes that might be used to monitor access to high-quality medical care in the behavioral health population. Analyzing public and non-public data sources from California on adults admitted between 2009 and 2011 to all non-federal licensed medical inpatient (N = 6,603,146) or emergency department units (N = 21,011,958) revealed that 33.6% of nearly 1 million potentially preventable hospitalizations and 9.

Predictive Validity of Outpatient Follow-up After Detoxification as a Quality Measure.

Objectives: Care coordination for substance use disorder (SUD) treatment is a persistent challenge. Timely outpatient follow-up after detoxification from alcohol and opiates is associated with improved outcomes, leading some care systems to attempt to measure and incentivize this practice. This study evaluated the predictive validity of a 7-day outpatient follow-up after detoxification quality measure used by the Veterans Health Administration (VHA).

Using organizational and clinical performance data to increase the value of mental health care.

U.S. health systems, policy makers, and patients increasingly demand high-value care that improves health outcomes at lower cost.

Measurement-based management of mental health quality and access in VHA: SAIL mental health domain.

We outline the development of a Mental Health Domain to track accessibility and quality of mental health care in the United States Veterans Health Administration (VHA) as part of a broad-based performance measurement system. This domain adds an important element to national performance improvement efforts by targeting regional and facility leadership and providing them a concise yet comprehensive measure to identify facilities facing challenges in their mental health programs. We present the conceptual framework and rationale behind measure selection and development.

Predictive validity of a quality measure for intensive substance use disorder treatment.

Background: 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.

Assessment of a novel hybrid Delphi and Nominal Groups technique to evaluate quality indicators.

Objective: To test the implementation of a novel structured panel process in the evaluation of quality indicators.

Data Source: National panel of 64 clinicians rating usefulness of indicator applications in 2008-2009.

Study Design: Hybrid panel combined Delphi Group and Nominal Group (NG) techniques to evaluate 81 indicator applications.