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Predictive Validity of Outpatient Follow-up After Detoxification as a Quality Measure

Schmidt, Eric M. PhD; Gupta, Shalini MS; Bowe, Thomas PhD; Ellerbe, Laura S. MS; Phelps, Tyler E. MLIS, MS; Finney, John W. PhD; Humphreys, Keith PhD; Trafton, Jodie PhD; Vanneman, Megan E. PhD; Harris, Alex H.S. PhD, MS

doi: 10.1097/ADM.0000000000000298
Original Research

Objectives: Care coordination for substance use disorder (SUD) treatment is a persistent challenge. Timely outpatient follow-up after detoxification from alcohol and opiates is associated with improved outcomes, leading some care systems to attempt to measure and incentivize this practice. This study evaluated the predictive validity of a 7-day outpatient follow-up after detoxification quality measure used by the Veterans Health Administration (VHA).

Methods: A national sample of patients who received detoxification from alcohol or opiates (N = 25,354) was identified in VHA administrative data. Propensity score-weighted mixed-effects regressions modeled associations between receiving an outpatient follow-up visit within 7 days of completing detoxification and patient outcomes, controlling for facility-level performance and clustering of patients within facilities.

Results: Baseline differences between patients who did (39.6%) and did not (60.4%) receive the follow-up visit were reduced or eliminated with propensity score weighting. Meeting the quality measure was associated with significantly more outpatient treatment for SUD (b = 1.07 visits) and other mental health conditions (b = 0.58 visits), and higher inpatient utilization for SUD (b = 0.75 admissions) and other mental health conditions (b = 0.76 admissions). Notably, meeting the quality measure was associated with 53.3% lower odds of 2-year mortality (P < 0.001 for all).

Conclusions: These findings support the predictive validity of 7-day follow-up after detoxification as a care coordination measure. Well-coordinated care may be associated with higher outpatient and inpatient utilization, and such engagement in care may be protective against mortality in people who receive detoxification from alcohol or opiates.

Center for Innovation to Implementation (Ci2i),Veterans Affairs Palo Alto Health Care System (EMS, SG, TB, LSE, TEP, JWF, KH, JT, MEV, AHSH); Center for Health Policy/Primary Care and Outcomes Research (CHP/PCOR), and the Department of Surgery, Stanford University (EMS, MEV, AHSH); and Program Evaluation and Resource Center, Office of Mental Health Operations, Veterans Affairs Central Office (JT).

Send correspondence and reprint requests to Alex H.S. Harris, PhD, Center for Innovation to Implementation (Ci2i), Health Services Research and Development Service, VA Palo Alto Health Care System, 795 Willow Road (152), Menlo Park, CA 94025. E-mail:

Received 24 August, 2016

Accepted 21 December, 2016

Funding: This study was funded by the VA Health Services Research and Development Service (Grant nos. SUS 99-015, IIR 10-370-2, RCS-14-232, RCS-04-141).

Conflicts of interest: Dr Schmidt's and Dr Vanneman's work was supported by the Department of Veterans Affairs (VA) Office of Academic Affiliations Advanced Fellowship in Health Services Research and Development (HSR&D) and the VA HSR&D Service. The views expressed herein are not necessarily those of the Department of Veterans Affairs or of Stanford University. The Veterans Health Administration had no role in the design of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

© 2017 American Society of Addiction Medicine