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Abstract

Objective

Valid quality indicators are needed to monitor and encourage identification and management of mental health and substance use conditions (behavioral conditions). Because behavioral conditions are frequently underidentified, quality indicators often evaluate the proportion of patients who screen positive for a condition who also have appropriate follow-up care documented. However, these “positive-screen–based” quality indicators of follow-up for behavioral conditions could be biased by differences in the denominator due to differential screening quality (“denominator bias”) and could reward identification of fewer patients with the behavioral conditions of interest. This study evaluated denominator bias in the performance of Veterans Health Administration (VHA) networks on a quality indicator of follow-up for alcohol misuse that used the number of patients with positive alcohol screens as the denominator.

Methods

Two quality indicators of follow-up for alcohol misuse—a positive-screen–based quality indicator and a population-based quality indicator—were compared among 21 VHA networks by review of 219,119 medical records.

Results

Results for the two quality indicators were inconsistent. For example, two networks performed similarly on the quality indicators (64.7% and 65.4% follow-up) even though one network identified and documented follow-up for almost twice as many patients (5,411 and 2,899 per 100,000 eligible, respectively). Networks that performed better on the positive-screen–based quality indicator identified fewer patients with alcohol misuse than networks that performed better on the population-based quality indicator (mean 4.1% versus 7.4%, respectively).

Conclusions

A positive-screen–based quality indicator of follow-up for alcohol misuse preferentially rewarded networks that identified fewer patients with alcohol misuse.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: Walter Martin, by Dickson Reeder, 1956. Oil on canvas. Collection of the San Antonio Art League and Museum, San Antonio, Texas.

Psychiatric Services
Pages: 1018 - 1025
PubMed: 23852137

History

Published online: 1 October 2013
Published in print: October 2013

Authors

Details

Katharine A. Bradley, M.D., M.P.H.
Dr. Bradley and Dr. Lapham are with the Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101 (e-mail: [email protected]). Ms. Chavez, Dr. Williams, Ms. Achtmeyer, Dr. Rubinsky, and Dr. Kivlahan are with the Northwest Center of Excellence, Veterans Affairs (VA) Health Services Research and Development, Seattle. Ms. Chavez and Dr. Williams are also with the Department of Health Services, School of Public Health, University of Washington, Seattle. Dr. Hawkins is with the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle. Dr. Saitz is with the Department of General Internal Medicine, Boston University, Boston.
Laura J. Chavez, M.P.H.
Dr. Bradley and Dr. Lapham are with the Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101 (e-mail: [email protected]). Ms. Chavez, Dr. Williams, Ms. Achtmeyer, Dr. Rubinsky, and Dr. Kivlahan are with the Northwest Center of Excellence, Veterans Affairs (VA) Health Services Research and Development, Seattle. Ms. Chavez and Dr. Williams are also with the Department of Health Services, School of Public Health, University of Washington, Seattle. Dr. Hawkins is with the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle. Dr. Saitz is with the Department of General Internal Medicine, Boston University, Boston.
Gwendolyn T. Lapham, Ph.D., M.P.H.
Dr. Bradley and Dr. Lapham are with the Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101 (e-mail: [email protected]). Ms. Chavez, Dr. Williams, Ms. Achtmeyer, Dr. Rubinsky, and Dr. Kivlahan are with the Northwest Center of Excellence, Veterans Affairs (VA) Health Services Research and Development, Seattle. Ms. Chavez and Dr. Williams are also with the Department of Health Services, School of Public Health, University of Washington, Seattle. Dr. Hawkins is with the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle. Dr. Saitz is with the Department of General Internal Medicine, Boston University, Boston.
Emily C. Williams, Ph.D., M.P.H.
Dr. Bradley and Dr. Lapham are with the Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101 (e-mail: [email protected]). Ms. Chavez, Dr. Williams, Ms. Achtmeyer, Dr. Rubinsky, and Dr. Kivlahan are with the Northwest Center of Excellence, Veterans Affairs (VA) Health Services Research and Development, Seattle. Ms. Chavez and Dr. Williams are also with the Department of Health Services, School of Public Health, University of Washington, Seattle. Dr. Hawkins is with the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle. Dr. Saitz is with the Department of General Internal Medicine, Boston University, Boston.
Carol E. Achtmeyer, M.N.
Dr. Bradley and Dr. Lapham are with the Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101 (e-mail: [email protected]). Ms. Chavez, Dr. Williams, Ms. Achtmeyer, Dr. Rubinsky, and Dr. Kivlahan are with the Northwest Center of Excellence, Veterans Affairs (VA) Health Services Research and Development, Seattle. Ms. Chavez and Dr. Williams are also with the Department of Health Services, School of Public Health, University of Washington, Seattle. Dr. Hawkins is with the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle. Dr. Saitz is with the Department of General Internal Medicine, Boston University, Boston.
Anna D. Rubinsky, Ph.D., M.S.
Dr. Bradley and Dr. Lapham are with the Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101 (e-mail: [email protected]). Ms. Chavez, Dr. Williams, Ms. Achtmeyer, Dr. Rubinsky, and Dr. Kivlahan are with the Northwest Center of Excellence, Veterans Affairs (VA) Health Services Research and Development, Seattle. Ms. Chavez and Dr. Williams are also with the Department of Health Services, School of Public Health, University of Washington, Seattle. Dr. Hawkins is with the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle. Dr. Saitz is with the Department of General Internal Medicine, Boston University, Boston.
Eric J. Hawkins, Ph.D.
Dr. Bradley and Dr. Lapham are with the Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101 (e-mail: [email protected]). Ms. Chavez, Dr. Williams, Ms. Achtmeyer, Dr. Rubinsky, and Dr. Kivlahan are with the Northwest Center of Excellence, Veterans Affairs (VA) Health Services Research and Development, Seattle. Ms. Chavez and Dr. Williams are also with the Department of Health Services, School of Public Health, University of Washington, Seattle. Dr. Hawkins is with the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle. Dr. Saitz is with the Department of General Internal Medicine, Boston University, Boston.
Richard Saitz, M.D., M.P.H.
Dr. Bradley and Dr. Lapham are with the Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101 (e-mail: [email protected]). Ms. Chavez, Dr. Williams, Ms. Achtmeyer, Dr. Rubinsky, and Dr. Kivlahan are with the Northwest Center of Excellence, Veterans Affairs (VA) Health Services Research and Development, Seattle. Ms. Chavez and Dr. Williams are also with the Department of Health Services, School of Public Health, University of Washington, Seattle. Dr. Hawkins is with the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle. Dr. Saitz is with the Department of General Internal Medicine, Boston University, Boston.
Daniel R. Kivlahan, Ph.D.
Dr. Bradley and Dr. Lapham are with the Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101 (e-mail: [email protected]). Ms. Chavez, Dr. Williams, Ms. Achtmeyer, Dr. Rubinsky, and Dr. Kivlahan are with the Northwest Center of Excellence, Veterans Affairs (VA) Health Services Research and Development, Seattle. Ms. Chavez and Dr. Williams are also with the Department of Health Services, School of Public Health, University of Washington, Seattle. Dr. Hawkins is with the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle. Dr. Saitz is with the Department of General Internal Medicine, Boston University, Boston.

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