Developing an opioid use disorder treatment cascade: A review of quality measures

https://doi.org/10.1016/j.jsat.2018.06.001Get rights and content

Highlights

  • We propose an OUD Treatment Cascade framework for quality measure development

  • Key stages for patients identified with OUD include: 1). Treatment engagement, 2). MAT initiation, 3). Retention, and 4). Remission

  • Among thousands of quality measures throughout healthcare, only a few related to SUDs can be applied to the treatment of OUD (n = 7)

  • Identified measures, are all process measures that reflect patterns of service delivery and few incorporate the evidence base for OUD treatment

  • The identified measures show modest but consistent beneficial outcomes for patients with SUDs who engage in care

  • There is a critical opportunity to expand and coordinate quality measures to improve patient outcomes

  • Greater specification of measures could also be tailored for patients post-overdose in the acute setting

Abstract

Background

Despite increasing opioid overdose mortality, problems persist in the availability and quality of treatment for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and naltrexone) have high quality evidence supporting their use, but most individuals with OUD do not receive them and many experience relapse following care episodes. Developing and organizing quality measures under a unified framework such as a Cascade of Care could improve system level practice and treatment outcomes. In this context, a review was performed of existing quality measures relevant to the treatment of OUD and the literature assessing the utility of these measures in community practice.

Methods

Systematic searches of two national quality measure clearinghouses (National Quality Forum and Agency for Healthcare Research and Quality) were performed for measures that can be applied to the treatment of OUD. Measures were categorized as structural, process, or outcome measures. Second stage searches were then performed within Ovid/Medline focused on published studies investigating the feasibility, reliability, and validity of identified measures, predictors of their satisfaction, and related clinical outcomes.

Results

Seven quality measures were identified that are applicable to the treatment of OUD. All seven were process measures that assess patterns of service delivery. One recently approved measure addresses retention in medication-assisted treatment for patients with OUD. Twenty-nine published studies were identified that evaluate the quality measures, primarily focused on initiation and engagement in care for addiction treatment generally. Most measures and related studies do not specifically incorporate the evidence base for the treatment of OUD or assess patient level outcomes such as overdose.

Conclusion

Despite considerable progress, gaps exist in quality measures for OUD treatment. Development of a unified quality measurement framework such as an OUD Treatment Cascade will require further elaboration and refinement of existing measures across populations and settings. Such a framework could form the basis for applying strategies at clinical, organizational, and policy levels to expand access to quality care and reduce opioid-related mortality.

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