Kamran Hasham, Piske Micah, Min Jeong Eun, Pearce Lindsay A, Zhou Haoxuan, Homayra Fahmida, Wang Linwei, Small Will, Nosyk Bohdan
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Drug Alcohol Depend Rep. 2022 Sep 8;5:100095. doi: 10.1016/j.dadr.2022.100095. eCollection 2022 Dec.
Limited data exists on the performance of the healthcare system in opioid use disorder (OUD). We evaluated the face validity and potential risks of a set of health system performance measures for OUD collaboratively with clinicians, policymakers and people with lived experience of opioid use (PWLE) in the interest of establishing an endorsed set of measures for public reporting.
Through a two-stage Delphi-panel approach, a panel of clinical and policy experts validated and considered 102 previously constructed OUD performance measures for endorsement using information on measurement construction, sensitivity analyses, quality of evidence, predictive validity, and feedback from local PWLE. We collected quantitative and qualitative survey responses from 49 clinicians and policymakers, and 11 PWLE. We conducted inductive and deductive thematic analysis to present qualitative responses.
A total of 37 measures of 102 were strongly endorsed (9/13 cascade of care, 2/27 clinical guideline compliance, 17/44 healthcare integration, and 9/18 healthcare utilization measures). Thematic analysis of responses revealed several themes regarding measurement validity, unintended consequences, and key contextual considerations. Overall, measures related to the cascade of care (excluding opioid agonist treatment dose tapering) received strong endorsements. PWLE highlighted barriers to accessing treatment, undignified aspects of treatment, and lack of a full continuum of care as their concerns.
We defined 37 endorsed health system performance measures for OUD and presented a range of perspectives on their validity and use. These measures provide critical considerations for health system improvement in the care of people with OUD.
关于医疗保健系统在阿片类药物使用障碍（OUD）方面表现的数据有限。为了建立一套经认可的用于公共报告的指标，我们与临床医生、政策制定者以及有阿片类药物使用经历的人（PWLE）合作，评估了一套针对OUD的卫生系统绩效指标的表面效度和潜在风险。
通过两阶段德尔菲专家小组方法，一组临床和政策专家利用测量构建、敏感性分析、证据质量、预测效度以及当地PWLE的反馈信息，对先前构建的102项OUD绩效指标进行了验证并考虑是否认可。我们收集了49名临床医生和政策制定者以及11名PWLE的定量和定性调查回复。我们进行了归纳和演绎主题分析以呈现定性回复。
102项指标中共有37项获得了强烈认可（13项照护级联指标中的9项、27项临床指南依从性指标中的2项、44项医疗整合指标中的17项以及18项医疗利用指标中的9项）。对回复的主题分析揭示了几个关于测量效度、意外后果和关键背景因素的主题。总体而言，与照护级联相关的指标（不包括阿片类激动剂治疗剂量递减）获得了强烈认可。PWLE强调了获得治疗的障碍、治疗中不体面的方面以及缺乏完整的连续照护是他们所关注的问题。
我们定义了37项经认可的针对OUD的卫生系统绩效指标，并就其效度和用途提出了一系列观点。这些指标为改善OUD患者护理的卫生系统提供了关键考虑因素。
