Mattke Soeren, Predmore Zachary, Sloss Elizabeth, Wilks Asa, Watkins Katherine E
J Healthc Qual. 2018 Jul/Aug;40(4):228-235. doi: 10.1097/JHQ.0000000000000106.
The National Committee for Quality Assurance's (NCQA) measure "Initiation and Engagement of Alcohol and Other Drug Dependence Treatment" captures the proportion of substance use patients with (1) treatment initiation within 14 days and (2) treatment engagement within 30 days thereafter. The definition of treatment considers only counseling but not medication-assisted treatment (MAT), although MAT is supported by current guidelines. Our research question is whether this omission results in meaningful measurement error.
We analyze claims data for members of commercial health plans to investigate whether including MAT would meaningfully change the measure rate and health plan rankings.
Including MAT increased both the initiation and engagement rates. The initiation and engagement rates increased 2.4% (38.9-39.8%) and 9.9% (12.9-14%), respectively. These differences imply that 19% of health plans would change their ranking by at least one quintile for the initiation measure and 27% for the engagement measure.
The current specifications result in erroneous conclusions about the quality of care provided by different health plans. Our results suggest that aligning the measure specifications with guideline recommendations, as recently proposed by NCQA, would result in more accurate information.
美国国家质量保证委员会（NCQA）的衡量指标“酒精及其他药物依赖治疗的启动与参与”涵盖了物质使用患者中（1）在14天内开始治疗以及（2）此后30天内参与治疗的比例。治疗的定义仅考虑咨询，而不包括药物辅助治疗（MAT），尽管MAT得到了当前指南的支持。我们的研究问题是这种遗漏是否会导致有意义的测量误差。
我们分析商业健康计划成员的索赔数据，以调查纳入MAT是否会显著改变衡量率和健康计划排名。
纳入MAT提高了启动率和参与率。启动率和参与率分别提高了2.4%（从38.9%提高到39.8%）和9.9%（从12.9%提高到14%）。这些差异意味着19%的健康计划在启动衡量指标上排名至少会上升一个五分位数，在参与衡量指标上则为27%。
当前的规范导致了关于不同健康计划提供的护理质量的错误结论。我们的结果表明，按照NCQA最近提议的那样，使衡量规范与指南建议保持一致，将产生更准确的信息。
