Katherine E Watkins1, Susan M Paddock2, Teresa J Hudson3, Songthip Ounpraseuth4, Amy M Schrader5, Kimberly A Hepner6, Greer Sullivan7. 1. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA,. Electronic address: kwatkins@rand.org. 2. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA,. Electronic address: Paddock@rand.org. 3. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA,; Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 W. Markham St., #554, Little Rock, AR, 72205, USA. Electronic address: Teresa.Hudson@va.gov. 4. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA,; College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., #820, Little Rock, AR, 72205, USA,. Electronic address: stounpraseuth@uams.edu. 5. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA,; College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., #820, Little Rock, AR, 72205, USA,. Electronic address: amschrader@uams.edu. 6. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA,. Electronic address: hepner@rand.org. 7. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA,; University of California, Riverside, School of Medicine, 2608 School of Medicine Education Building, 900 University Ave., Riverside, CA 92521, USA. Electronic address: greer.sullivan@ucr.edu.
Abstract
IMPORTANCE: Individuals with co-occurring mental and substance use disorders have increased rates of mortality relative to the general population. The relationship between measures of treatment quality and mortality for these individuals is unknown. OBJECTIVE: To examine the association between 5 quality measures and 12- and 24-month mortality. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study of patients with co-occurring mental illness (schizophrenia, bipolar disorder, post-traumatic stress disorder and major depression) and substance use disorders who received care for these disorders paid for by the Veterans Administration between October 2006 and September 2007. Logistic regression models were used to examine the association between 12 and 24-month mortality and 5 patient-level quality measures, while risk-adjusting for patient characteristics. Quality measures included receipt of psychosocial treatment, receipt of psychotherapy, treatment initiation and engagement, and a measure of continuity of care. We also examined the relationship between number of diagnosis-related outpatient visits and mortality, and conducted sensitivity analyses to examine the robustness of our findings to an unobserved confounder. MAIN OUTCOMES MEASURE: Mortality 12 and 24 months after the end of the observation period. RESULTS: All measures except for treatment engagement at 24 months were significantly associated with lower mortality at both 12 and 24 months. At 12 months, receiving any psychosocial treatment was associated with a 21% decrease in mortality; psychotherapy, a 22% decrease; treatment initiation, a 15% decrease, treatment engagement, a 31% decrease; and quarterly, diagnosis-related visits a 28% decrease. Increasing numbers of visits were associated with decreasing mortality. Sensitivity analyses indicated that the difference in the prevalence of an unobserved confounder would have to be unrealistically large given the observed data, or there would need to be a large effect of an unobserved confounder, to render these findings non-significant. CONCLUSIONS AND RELEVANCE: This is the first study to show an association between process-based quality measures and mortality in patients with co-occurring mental and substance use disorders, and provides initial support for the predictive validity of the measures. By devising strategies to improve performance on these measures, health care systems may be able to decrease the mortality of this vulnerable population.
IMPORTANCE: Individuals with co-occurring mental and substance use disorders have increased rates of mortality relative to the general population. The relationship between measures of treatment quality and mortality for these individuals is unknown. OBJECTIVE: To examine the association between 5 quality measures and 12- and 24-month mortality. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study of patients with co-occurring mental illness (schizophrenia, bipolar disorder, post-traumatic stress disorder and major depression) and substance use disorders who received care for these disorders paid for by the Veterans Administration between October 2006 and September 2007. Logistic regression models were used to examine the association between 12 and 24-month mortality and 5 patient-level quality measures, while risk-adjusting for patient characteristics. Quality measures included receipt of psychosocial treatment, receipt of psychotherapy, treatment initiation and engagement, and a measure of continuity of care. We also examined the relationship between number of diagnosis-related outpatient visits and mortality, and conducted sensitivity analyses to examine the robustness of our findings to an unobserved confounder. MAIN OUTCOMES MEASURE: Mortality 12 and 24 months after the end of the observation period. RESULTS: All measures except for treatment engagement at 24 months were significantly associated with lower mortality at both 12 and 24 months. At 12 months, receiving any psychosocial treatment was associated with a 21% decrease in mortality; psychotherapy, a 22% decrease; treatment initiation, a 15% decrease, treatment engagement, a 31% decrease; and quarterly, diagnosis-related visits a 28% decrease. Increasing numbers of visits were associated with decreasing mortality. Sensitivity analyses indicated that the difference in the prevalence of an unobserved confounder would have to be unrealistically large given the observed data, or there would need to be a large effect of an unobserved confounder, to render these findings non-significant. CONCLUSIONS AND RELEVANCE: This is the first study to show an association between process-based quality measures and mortality in patients with co-occurring mental and substance use disorders, and provides initial support for the predictive validity of the measures. By devising strategies to improve performance on these measures, health care systems may be able to decrease the mortality of this vulnerable population.
Authors: Christy K Scott; Michael L Dennis; Alexandre Laudet; Rodney R Funk; Ronald S Simeone Journal: Am J Public Health Date: 2011-02-17 Impact factor: 9.308
Authors: Layla Parast; Brian Doyle; Cheryl L Damberg; Kanaka Shetty; David A Ganz; Neil S Wenger; Paul G Shekelle Journal: J Gen Intern Med Date: 2015-01-07 Impact factor: 5.128
Authors: Laurel A Copeland; John E Zeber; Chen-Pin Wang; Michael L Parchman; Valerie A Lawrence; Marcia Valenstein; Alexander L Miller Journal: BMC Health Serv Res Date: 2009-07-26 Impact factor: 2.655
Authors: Margaret T Lee; Constance M Horgan; Deborah W Garnick; Andrea Acevedo; Lee Panas; Grant A Ritter; Robert Dunigan; Hermik Babakhanlou-Chase; Alfred Bidorini; Kevin Campbell; Karin Haberlin; Alice Huber; Dawn Lambert-Wacey; Tracy Leeper; Mark Reynolds Journal: J Subst Abuse Treat Date: 2014-05-02
Authors: Meredith G Harris; Chrianna Bharat; Meyer D Glantz; Nancy A Sampson; Ali Al-Hamzawi; Jordi Alonso; Ronny Bruffaerts; José Miguel Caldas de Almeida; Alfredo H Cia; Giovanni de Girolamo; Silvia Florescu; Oye Gureje; Josep Maria Haro; Hristo Hinkov; Elie G Karam; Georges Karam; Sing Lee; Jean-Pierre Lépine; Daphna Levinson; Victor Makanjuola; John McGrath; Zeina Mneimneh; Fernando Navarro-Mateu; Marina Piazza; José Posada-Villa; Charlene Rapsey; Hisateru Tachimori; Margreet Ten Have; Yolanda Torres; Maria Carmen Viana; Somnath Chatterji; Alan M Zaslavsky; Ronald C Kessler; Louisa Degenhardt Journal: Addiction Date: 2019-06-02 Impact factor: 6.526
Authors: Katherine E Watkins; Susan M Paddock; Teresa J Hudson; Songthip Ounpraseuth; Amy M Schrader; Kimberly A Hepner; Bradley D Stein Journal: Drug Alcohol Depend Date: 2017-06-27 Impact factor: 4.492
Authors: Audrey L Jones; Maria K Mor; Gretchen L Haas; Adam J Gordon; John P Cashy; James H Schaefer; Leslie R M Hausmann Journal: J Gen Intern Med Date: 2018-06-08 Impact factor: 5.128
Authors: Beth Ann Griffin; Lynsay Ayer; Joseph Pane; Brian Vegetabile; Lane Burgette; Daniel McCaffrey; Donna L Coffman; Matthew Cefalu; Rod Funk; Mark D Godley Journal: J Subst Abuse Treat Date: 2020-07-06
Authors: Amy M Kilbourne; Kathryn Beck; Brigitta Spaeth-Rublee; Parashar Ramanuj; Robert W O'Brien; Naomi Tomoyasu; Harold Alan Pincus Journal: World Psychiatry Date: 2018-02 Impact factor: 49.548
Authors: Andrea H Kline-Simon; Scott P Stumbo; Cynthia I Campbell; Ingrid A Binswanger; Constance Weisner; Irina V Haller; Rulin C Hechter; Brian K Ahmedani; Gwen T Lapham; Amy M Loree; Stacy A Sterling; Bobbi Jo H Yarborough Journal: Subst Abus Date: 2019-01-31 Impact factor: 3.716
Authors: Amy M Loree; Hsueh-Han Yeh; Derek D Satre; Andrea H Kline-Simon; Bobbi Jo H Yarborough; Irina V Haller; Cynthia I Campbell; Gwen T Lapham; Rulin C Hechter; Ingrid A Binswanger; Constance Weisner; Brian K Ahmedani Journal: Subst Abus Date: 2019-01-25 Impact factor: 3.716
Authors: Margaret T Lee; Andrea Acevedo; Deborah W Garnick; Constance M Horgan; Lee Panas; Grant A Ritter; Kevin M Campbell Journal: Psychiatr Serv Date: 2018-04-26 Impact factor: 3.084