Article

Adapting Washington Circle performance measures for public sector substance abuse treatment systems

Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, USA.
Journal of substance abuse treatment (Impact Factor: 2.9). 09/2008; 36(3):265-77. DOI: 10.1016/j.jsat.2008.06.008
Source: PubMed

ABSTRACT The Washington Circle, a group focused on developing and disseminating performance measures for substance abuse services, developed three such measures for private health plans. In this article, we explore whether these measures are appropriate for meeting measurement goals in the public sector and feasible to calculate in the public sector using data collected for administrative purposes by state and local substance abuse and/or mental health agencies. Working collaboratively, 12 states specified revised measures and 6 states pilot tested them. Two measures were retained from the original specifications: initiation of treatment and treatment engagement. Additional measures were focused on continuity of care after assessment, detoxification, residential or inpatient care. These data demonstrate that state agencies can calculate performance measures from routinely available information and that there is wide variability in these indicators. Ongoing research is needed to examine the reasons for these results, which might include lack of patient interest or commitment, need for quality improvement efforts, or financial issues.

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    • "It has been well established that members of racial and ethnic minority groups are more likely than Whites to experience difficulty entering and remaining in SAT beyond the general threshold of 90 days necessary to derive benefits from treatment (Amaro et al., 2006; Friedmann et al., 2003; Marsh et al., 2009; Tonigan, 2003; Zhang et al., 2003). As a reflection of their importance to treatment, wait time and retention have been included among program performance measures developed by nationally recognized research groups (Garnick et al., 2009; McCarty et al., 2007), as well as county and state administrative data systems (Hyde, 2011; Rawson and McLellan, 2010). Thus, it is critical to rely on these process measures to analyze program capacity to enhance standards of care. "
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    ABSTRACT: BACKGROUND: Health insurance coverage and quality of care are common factors believed to improve access for and retention of racial and ethnic minority groups in health care. However, there is little evidence that acceptance of public insurance and provision of culturally responsive care decrease wait time and retention of minority populations in community-based substance abuse treatment. METHODS: We analyzed client and program data collected in 2010-2011 from publicly funded treatment programs in Los Angeles County, CA. An analytical sample of 13,328 primarily African American and Latino clients nested within 104 treatment programs located in minority communities was analyzed using multilevel negative binomial regressions on count measures of days to initiate and days spent in treatment. RESULTS: Programs that accepted public insurance (p<.001) and in which staff reported personal involvement (p<.01) and linkages and resources with minority communities (p<.001) were negatively associated with client wait time. Similarly, programs with culturally responsive policies and assessment and treatment practices (p<.05) were positively associated with retention in treatment, after controlling for individual and program characteristics. CONCLUSIONS: These preliminary findings provide an evidentiary base for the role of community-based financial and cultural practices in improving accessibility and treatment adherence in a population at high risk of treatment dropout. Implications related to health care reform legislation, which seeks to expand public insurance and enhance culturally competent care, are discussed.
    Drug and alcohol dependence 05/2013; 132(3). DOI:10.1016/j.drugalcdep.2013.04.005 · 3.28 Impact Factor
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    • "Using multicross-sectional annual data (2006–2009) from adult participants who received treatment for the first time in Los Angeles County, this study tests the extent to which between-and within-group differences in individual and program characteristics exist for African American, Latino, and White clients, and how these differences interact with treatment completion in outpatient settings. Successful completion of SAT is a well-established process outcome measure associated with long-term outcomes, such as less future criminal involvement and fewer readmissions (Evans, Li, and Hser 2009; Garnick et al. 2009). As such, this measure is particularly relevant for clients during their first exposure to treatment because successful completion reflects achievement of treatment goals at the client level and, under health care reform legislation , it may become a prevalent measure of program performance at the system level (Arndt 2010; Borys 2011). "
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    ABSTRACT: OBJECTIVE: To evaluate disparities in substance abuse treatment completion between and within racial and ethnic groups in publicly funded treatment in Los Angeles County, California. DATA SOURCE: The Los Angeles County Participant Reporting System with multicross-sectional annual data (2006-2009) for adult participants (n = 16,637) who received treatment from publicly funded programs (n = 276) for the first time. STUDY DESIGN: Retrospective analyses of county discharge and admission data. Hierarchical linear regressions models were used to test the hypotheses. DATA COLLECTION: Client data were collected during personal interviews at admission and discharge for most participants. PRINCIPAL FINDINGS: African Americans and Latinos reported lower odds of completing treatment compared with Whites. Within-group analysis revealed significant heterogeneity within racial and ethnic groups, highlighting primary drug problem, days of drug use before admission, and homelessness as significant factors affecting treatment completion. Service factors, such as referral by the criminal justice system, enabled completion among Latinos and Whites only. CONCLUSIONS: These findings have implications for reducing health disparities among members of racial and ethnic minorities by identifying individual and service factors associated with treatment adherence, particularly for first-time clients.
    Health Services Research 01/2013; 48(4). DOI:10.1111/1475-6773.12031 · 2.49 Impact Factor
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    • "The WC measures have been tested in both the private sector (health plans) and public sector (state substance abuse systems) and have been endorsed by the National Quality Forum (National Quality Forum, 2007). They are used by various entities including the NCQA, the Veterans Health Administration, and some state substance abuse service agencies (Garnick et al., 2009; Harris, Humphreys, & Finney, 2007; NCQA, 2007). "
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    ABSTRACT: We examined the relationship between treatment quality, using during-treatment process measures, and mutual help group (e.g., Alcoholics Anonymous) attendance after outpatient substance use disorder (SUD) treatment for 739 clients in the Alcohol and Drug Services Study. Logistic regression models estimated any and regular mutual help attendance after treatment. Clients referred to mutual help groups were significantly more likely to attend any mutual help after treatment. Results were mixed for facility offered mutual help groups; treatment engagement and retention were not significant. These findings offer treatment providers further evidence of the importance of referring clients to post-treatment mutual help groups, an effective, low-cost option.
    Alcoholism Treatment Quarterly 03/2012; 30(2):190-210. DOI:10.1080/07347324.2012.663305
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