Association between process measures and mortality in individuals with opioid use disorders
Katherine E Watkins1, Susan M Paddock1, Teresa J Hudson2
1RAND Corporation,1776 Main Street, Santa Monica, CA, 90407, USA.
Drug and Alcohol Dependence
|July 1, 2017
Summary
Individuals with opioid use disorders have higher mortality rates. Key treatment processes like regular physician visits and avoiding opioid/benzodiazepine prescriptions were linked to lower mortality, suggesting potential quality measures.
Area of Science:
- Addiction Medicine
- Public Health
- Health Services Research
Background:
- Opioid use disorder (OUD) is associated with significantly elevated mortality rates compared to the general population.
- The impact of specific treatment process measures on mortality outcomes in OUD patients remains largely uncharacterized.
Purpose of the Study:
- To investigate the association between seven distinct patient-level process measures and all-cause mortality at 12 and 24 months post-index period.
- To identify potential quality indicators for OUD treatment that may influence patient survival.
Main Methods:
- Retrospective cohort study of OUD patients within the Veterans Administration system (October 2006 - September 2007).
- Logistic regression models were employed to assess the relationship between seven process measures and 12/24-month mortality, controlling for patient characteristics.
- Process measures included physician visits, pharmacotherapy, psychosocial treatment, screenings (Hepatitis B/C, HIV), and avoidance of specific prescriptions (benzodiazepines, opioids).
Main Results:
- Not being prescribed opioids or benzodiazepines, receiving any psychosocial treatment, and quarterly physician visits were significantly associated with reduced mortality at both 12 and 24 months.
- Hepatitis/HIV screening and pharmacotherapy-related measures did not show a significant association with mortality.
- Sensitivity analyses confirmed the robustness of findings, indicating that unobserved confounders would need substantial prevalence or effect to negate the observed associations.
Conclusions:
- This study provides the first evidence linking specific process measures to mortality outcomes in patients with opioid use disorders.
- Findings suggest that certain non-pharmacotherapy-related process measures, such as regular physician engagement and judicious prescribing, may serve as valuable quality indicators for OUD care.
Keywords:
Measure validationMortalityOpioid use disordersProcess measuresQuality improvementQuality of careMore Related Videos
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