Gwen T Lapham1,2, Cynthia I Campbell3, Bobbi Jo H Yarborough4, Rulin C Hechter5, Brian K Ahmedani6, Irina V Haller7, Andrea H Kline-Simon3, Derek D Satre3,8, Amy M Loree6, Constance Weisner3,8, Ingrid A Binswanger9,10,11. 1. Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA. 2. Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA. 3. Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. 4. Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA. 5. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA. 6. Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA. 7. Essentia Institute of Rural Health, Duluth, Minnesota, USA. 8. Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA. 9. Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA. 10. Colorado Permanente Medical Group, Aurora, Colorado, USA. 11. Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
Abstract
Background: Cannabis use disorders (CUDs) have increased with more individuals using cannabis, yet few receive treatment. Health systems have adopted the Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of initiation and engagement in alcohol and other drug (AOD) dependence treatment, but little is known about the performance of these among patients with CUDs. Methods: This cohort study utilized electronic health records and claims data from 7 health care systems to identify patients with documentation of a new index CUD diagnosis (no AOD diagnosis ≤60 days prior) from International Classification of Diseases, Ninth revision, codes (October 1, 2014, to August 31, 2015). The adjusted prevalence of each outcome (initiation, engagement, and a composite of both) was estimated from generalized linear regression models, across index identification settings (inpatient, emergency department, primary care, addiction treatment, and mental health/psychiatry), AOD comorbidity (patients with CUD only and CUD plus other AOD diagnoses), and patient characteristics. Results: Among 15,202 patients with an index CUD diagnosis, 30.0% (95% confidence interval [CI]: 29.2-30.7%) initiated, 6.9% (95% CI: 6.2-7.7%) engaged among initiated, and 2.1% (95% CI: 1.9-2.3%) overall both initiated and engaged in treatment. The adjusted prevalence of outcomes varied across index identification settings and was highest among patients diagnosed in addiction treatment, with 25.0% (95% CI: 22.5-27.6%) initiated, 40.9% (95% CI: 34.8-47.0%) engaged, and 12.5% (95% CI: 10.0-15.1%) initiated and engaged. The adjusted prevalence of each outcome was generally highest among patients with CUD plus other AOD diagnosis at index diagnosis compared with those with CUD only, overall and across index identification settings, and was lowest among uninsured and older patients. Conclusion: Among patients with a new CUD diagnosis, the proportion meeting HEDIS criteria for initiation and/or engagement in AOD treatment was low and demonstrated variation across index diagnosis settings, AOD comorbidity, and patient characteristics, pointing to opportunities for improvement.
Background: Cannabis use disorders (CUDs) have increased with more individuals using cannabis, yet few receive treatment. Health systems have adopted the Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of initiation and engagement in alcohol and other drug (AOD) dependence treatment, but little is known about the performance of these among patients with CUDs. Methods: This cohort study utilized electronic health records and claims data from 7 health care systems to identify patients with documentation of a new index CUD diagnosis (no AOD diagnosis ≤60 days prior) from International Classification of Diseases, Ninth revision, codes (October 1, 2014, to August 31, 2015). The adjusted prevalence of each outcome (initiation, engagement, and a composite of both) was estimated from generalized linear regression models, across index identification settings (inpatient, emergency department, primary care, addiction treatment, and mental health/psychiatry), AOD comorbidity (patients with CUD only and CUD plus other AOD diagnoses), and patient characteristics. Results: Among 15,202 patients with an index CUD diagnosis, 30.0% (95% confidence interval [CI]: 29.2-30.7%) initiated, 6.9% (95% CI: 6.2-7.7%) engaged among initiated, and 2.1% (95% CI: 1.9-2.3%) overall both initiated and engaged in treatment. The adjusted prevalence of outcomes varied across index identification settings and was highest among patients diagnosed in addiction treatment, with 25.0% (95% CI: 22.5-27.6%) initiated, 40.9% (95% CI: 34.8-47.0%) engaged, and 12.5% (95% CI: 10.0-15.1%) initiated and engaged. The adjusted prevalence of each outcome was generally highest among patients with CUD plus other AOD diagnosis at index diagnosis compared with those with CUD only, overall and across index identification settings, and was lowest among uninsured and older patients. Conclusion: Among patients with a new CUD diagnosis, the proportion meeting HEDIS criteria for initiation and/or engagement in AOD treatment was low and demonstrated variation across index diagnosis settings, AOD comorbidity, and patient characteristics, pointing to opportunities for improvement.
Entities:
Keywords:
Cannabis; comorbidity; health services research; quality indicators; substance use disorder; treatment
Authors: Deborah W Garnick; Margaret T Lee; Constance Horgan; Andrea Acevedo; Michael Botticelli; Spencer Clark; Steven Davis; Robert Gallati; Karin Haberlin; Andrew Hanchett; Dawn Lambert-Wacey; Tracy Leeper; James Siemianowski; Minakshi Tikoo Journal: J Subst Abuse Treat Date: 2011-01-22
Authors: Deborah S Hasin; Charles P O'Brien; Marc Auriacombe; Guilherme Borges; Kathleen Bucholz; Alan Budney; Wilson M Compton; Thomas Crowley; Walter Ling; Nancy M Petry; Marc Schuckit; Bridget F Grant Journal: Am J Psychiatry Date: 2013-08 Impact factor: 18.112
Authors: Deborah W Garnick; Constance M Horgan; Andrea Acevedo; Margaret T Lee; Lee Panas; Grant A Ritter; Robert Dunigan; Alfred Bidorini; Kevin Campbell; Karin Haberlin; Alice Huber; Dawn Lambert-Wacey; Tracy Leeper; Mark Reynolds; David Wright Journal: J Subst Abuse Treat Date: 2013-10-14
Authors: Peggy van der Pol; Nienke Liebregts; Ron de Graaf; Dirk J Korf; Wim van den Brink; Margriet van Laar Journal: Drug Alcohol Depend Date: 2013-08-26 Impact factor: 4.492
Authors: Kenneth Blum; Joseph Morgan; Jean Lud Cadet; David Baron; Paul R Carney; Jag Khalsa; Rajendra D Badgaiyan; Mark S Gold Journal: Neurology (ECronicon) Date: 2021-03-31