Andrea K Finlay1, Ingrid A Binswanger2, Christine Timko3, David Smelson4, Matthew A Stimmel5, Mengfei Yu6, Tom Bowe7, Alex H S Harris8. 1. Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. Electronic address: Andrea.Finlay@va.gov. 2. Institute for Health Research, Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237-8066, USA; Division of General Internal Medicine, University of Colorado School of Medicine 12631 E. 17(th) Ave., Academic Office One, Campus Box B180, Aurora, CO 80045, USA. Electronic address: Ingrid.A.Binswanger@kp.org. 3. Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA. Electronic address: ctimko@stanford.edu. 4. Center for Organization and Implementation Science, Edith Nourse Rogers VA Medical Center, 200 Springs, Bedford, MA 01730, USA. Electronic address: David.Smelson@va.gov. 5. Veterans Justice Outreach Program, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. Electronic address: Matthew.Stimmel@va.gov. 6. Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. Electronic address: Mengfei.Yu@va.gov. 7. Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. Electronic address: Thomas.Bowe@va.gov. 8. Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Surgery, Stanford University School of Medicine, Alway Building, Room M121, 300 Pasteur Drive, Stanford, CA 94305-2200, USA. Electronic address: Alexander.Harris2@va.gov.
Abstract
BACKGROUND: The U.S. is facing an opioid epidemic, but despite mandates for pharmacotherapy for opioid use disorder to be available at Veterans Health Administration (VHA) facilities, the majority of veterans with opioid use disorder do not receive these medications. In implementation research, facilities are often targeted for qualitative inquiry or quality improvement efforts based on quality measure performance during a one-year period. However, sites that experience quality performance changes from one year to the next may be highly informative because mechanisms that impact facility change may be more discoverable. The current study examined changes in receipt of pharmacotherapy for opioid use disorder in a national healthcare system to determine the extent to which sites fluctuated in performance over a two-year period and illustrate how changes in quality measures over time may be useful for implementation research and healthcare surveillance of quality measures. METHODS: Using national VHA data from Fiscal Years (FY) 2016 and 2017, we calculated quality measure performance as the number of patients who received pharmacotherapy for opioid use disorder (i.e., methadone, buprenorphine, and naltrexone) divided by the number of patients with a current non-remitted opioid use disorder diagnosis for each FY at each facility (n = 129) and examined change from FY16 to FY17. RESULTS: The mean rate of receipt of pharmacotherapy for opioid use disorder was 38% (facility range = 3% to 74%) in FY16 and 41% (facility range = 2% to 76%) in FY17. The average facility-level change in performance was 3% and ranged from -19% to 26%. There were 32 facilities that decreased in provision of pharmacotherapy, 12 facilities with no change, and 85 facilities that increased. CONCLUSIONS: For facilities with average or high performance, it was difficult to maintain their performance over time. Identifying and learning from facilities with recent fluctuations may be more informative to guide the design of future quality improvement efforts than studying facilities with stable high or low performance. Published by Elsevier Inc.
BACKGROUND: The U.S. is facing an opioid epidemic, but despite mandates for pharmacotherapy for opioid use disorder to be available at Veterans Health Administration (VHA) facilities, the majority of veterans with opioid use disorder do not receive these medications. In implementation research, facilities are often targeted for qualitative inquiry or quality improvement efforts based on quality measure performance during a one-year period. However, sites that experience quality performance changes from one year to the next may be highly informative because mechanisms that impact facility change may be more discoverable. The current study examined changes in receipt of pharmacotherapy for opioid use disorder in a national healthcare system to determine the extent to which sites fluctuated in performance over a two-year period and illustrate how changes in quality measures over time may be useful for implementation research and healthcare surveillance of quality measures. METHODS: Using national VHA data from Fiscal Years (FY) 2016 and 2017, we calculated quality measure performance as the number of patients who received pharmacotherapy for opioid use disorder (i.e., methadone, buprenorphine, and naltrexone) divided by the number of patients with a current non-remitted opioid use disorder diagnosis for each FY at each facility (n = 129) and examined change from FY16 to FY17. RESULTS: The mean rate of receipt of pharmacotherapy for opioid use disorder was 38% (facility range = 3% to 74%) in FY16 and 41% (facility range = 2% to 76%) in FY17. The average facility-level change in performance was 3% and ranged from -19% to 26%. There were 32 facilities that decreased in provision of pharmacotherapy, 12 facilities with no change, and 85 facilities that increased. CONCLUSIONS: For facilities with average or high performance, it was difficult to maintain their performance over time. Identifying and learning from facilities with recent fluctuations may be more informative to guide the design of future quality improvement efforts than studying facilities with stable high or low performance. Published by Elsevier Inc.
Entities:
Keywords:
Buprenorphine; Implementation science; Methadone; Opioid-related disorders; Pharmacotherapy; United States Department of Veterans Affairs
Authors: Adam J Rose; Beth Ann Petrakis; Patricia Callahan; Scott Mambourg; Dimple Patel; Elaine M Hylek; Barbara G Bokhour Journal: Health Serv Res Date: 2012-02-02 Impact factor: 3.402
Authors: Katharine A Bradley; Laura J Chavez; Gwendolyn T Lapham; Emily C Williams; Carol E Achtmeyer; Anna D Rubinsky; Eric J Hawkins; Richard Saitz; Daniel R Kivlahan Journal: Psychiatr Serv Date: 2013-10 Impact factor: 3.084
Authors: Alex H S Harris; Cheng Chen; Anna D Rubinsky; Katherine J Hoggatt; Matthew Neuman; Megan E Vanneman Journal: J Gen Intern Med Date: 2016-04 Impact factor: 5.128
Authors: Alex H S Harris; Constance M Weisner; Mady Chalk; Victor Capoccia; Cheng Chen; Cindy Parks Thomas Journal: J Addict Med Date: 2016 May-Jun Impact factor: 3.702
Authors: Andrea K Finlay; Alex H S Harris; Joel Rosenthal; Jessica Blue-Howells; Sean Clark; Jim McGuire; Christine Timko; Susan M Frayne; David Smelson; Elizabeth Oliva; Ingrid Binswanger Journal: Drug Alcohol Depend Date: 2016-01-24 Impact factor: 4.492
Authors: Andrea K Finlay; Erica Morse; Matthew Stimmel; Emmeline Taylor; Christine Timko; Alex H S Harris; David Smelson; Mengfei Yu; Jessica Blue-Howells; Ingrid A Binswanger Journal: J Gen Intern Med Date: 2020-06-24 Impact factor: 5.128
Authors: Kelsey C Priest; Travis I Lovejoy; Honora Englander; Sarah Shull; Dennis McCarty Journal: J Gen Intern Med Date: 2020-04-14 Impact factor: 5.128
Authors: Erica Morse; Ingrid A Binswanger; Emmeline Taylor; Caroline Gray; Matthew Stimmel; Christine Timko; Alex H S Harris; David Smelson; Andrea K Finlay Journal: J Subst Abuse Treat Date: 2021-03-04
Authors: Emmeline N Taylor; Christine Timko; Ingrid A Binswanger; Alex H S Harris; Matthew Stimmel; David Smelson; Andrea K Finlay Journal: Subst Abus Date: 2021-09-29 Impact factor: 3.984
Authors: Andrea K Finlay; Alex H S Harris; Christine Timko; Mengfei Yu; David Smelson; Matthew Stimmel; Ingrid A Binswanger Journal: J Addict Med Date: 2021-04-01 Impact factor: 4.647