Validation of Medicaid claim-based opioid treatment program retention quality measures

Understanding the quality of care that opioid treatment programs (OTPs) deliver is a long-standing goal in the United States. In a prior study, this study team developed casemix adjusted OTP-level quality measures of patient retention that revealed a median 180-day OTP retention rate of 26% (25th percentile = 11%; 75th percentile = 37%) in Measurement Year (MY) 2023 (July 1, 2022 - June 30, 2023). The present study evaluated the measures' validity, particularly the association between each OTP's retention and their rate of substance use disorder (SUD) hospitalizations or emergency department (ED) visits, SUD-related mortality, and all-cause mortality.

This study used previously developed OTP retention measures derived from Medicaid claims data to ascertain patient retention for >30, > 90, and >180 days. Using the same Medicaid claims data, the authors created measures of each OTP's rate of SUD hospitalizations or ED visits, SUD-related mortality, and all-cause mortality within 180 days of initiating treatment at an OTP. The authors assessed the validity of the OTP-level retention measures by estimating their rank-correlations with OTP-level SUD hospitalizations or ED visits, with SUD-related mortality, and with all-cause mortality, adjusted for patient casemix. Beta regression was used to assess the magnitude and direction of the associations between the retention measures and outcomes. Logistic regression tested whether episode-level retention predicted outcomes.

The sample included 1218 OTPs treating 268,003 newly initiating patients for 441,603 episodes in MY2023. Validity was indicated by negative correlations between OTP retention and SUD hospitalizations or ED visits and SUD-related mortality. Higher OTP retention was associated with lower odds of SUD hospitalizations or ED visits (OR 0.718, 95% CI 0.621-0.830 in MY2023 for >180-day retention) and SUD-related mortality (OR 0.675, 95% CI 0.471-0.968 in MY2020 for >180-day retention). Episode-level analyses confirmed these associations.

OTPs with higher retention had fewer negative outcomes after adjusting for patient casemix. These findings validate OTP-level retention as a quality indicator. Measuring OTP-level retention could support quality improvement efforts to increase retention in OTPs and reduce costly healthcare utilization related to opioid use disorder (OUD).