Development and validation of a claim-based provider-level measurement of use of medications to treat opioid use disorder.

Objective: Medication for opioid use disorder (MOUD) is effective but underused. Measuring the percentage of a provider's patients with an opioid use disorder (OUD) who receive MOUD may drive quality improvement and stimulate greater use of medications. This study introduces and tests a provider-level measure of MOUD receipt.

Methods: The study used claims and enrollment data from 32 states in the 2014 Medicaid Analytic Extract to measure the proportion of a provider's patients who received MOUD within 30 days of their OUD diagnosis. The research team assessed measure reliability with several tests to establish the effect of provider on MOUD receipt; and assessed the validity by correlation with a measure of emergency department visits or hospitalizations related to substance use.

Results: The sample included 434,484 individuals treated for OUD by one or more of 9398 providers. The mean provider score was 38 %, indicating that 38 % of the average provider's patients received an MOUD within 30 days of an OUD diagnosis (44 % for clinicians [N = 5344] and 31 % for facilities [N = 4054]). Provider performance varied considerably. The interquartile ranges were 11 %-79 % and 9 %-45 % among clinicians and facilities, respectively. The measure reliably distinguished between lower- and higher-performing providers and demonstrated convergent validity, as indicated by a significant and moderately sized negative correlation between MOUD receipt and substance use-related hospitalizations or emergency department visits.

Conclusions: The measure may help to improve access to MOUD and OUD outcomes by identifying providers who could benefit from technical assistance, quality improvement initiatives, and resources to expand MOUD prescribing.