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Association Between Quality Measures and Mortality in Individuals With Co-Occurring Mental Health and Substance Use Disorders.
- Source :
-
Journal of substance abuse treatment [J Subst Abuse Treat] 2016 Oct; Vol. 69, pp. 1-8. Date of Electronic Publication: 2016 Jun 07. - Publication Year :
- 2016
-
Abstract
- Importance: Individuals with co-occurring mental and substance use disorders have increased rates of mortality relative to the general population. The relationship between measures of treatment quality and mortality for these individuals is unknown.<br />Objective: To examine the association between 5 quality measures and 12- and 24-month mortality.<br />Design, Setting and Participants: Retrospective cohort study of patients with co-occurring mental illness (schizophrenia, bipolar disorder, post-traumatic stress disorder and major depression) and substance use disorders who received care for these disorders paid for by the Veterans Administration between October 2006 and September 2007. Logistic regression models were used to examine the association between 12 and 24-month mortality and 5 patient-level quality measures, while risk-adjusting for patient characteristics. Quality measures included receipt of psychosocial treatment, receipt of psychotherapy, treatment initiation and engagement, and a measure of continuity of care. We also examined the relationship between number of diagnosis-related outpatient visits and mortality, and conducted sensitivity analyses to examine the robustness of our findings to an unobserved confounder.<br />Main Outcomes Measure: Mortality 12 and 24 months after the end of the observation period.<br />Results: All measures except for treatment engagement at 24 months were significantly associated with lower mortality at both 12 and 24 months. At 12 months, receiving any psychosocial treatment was associated with a 21% decrease in mortality; psychotherapy, a 22% decrease; treatment initiation, a 15% decrease, treatment engagement, a 31% decrease; and quarterly, diagnosis-related visits a 28% decrease. Increasing numbers of visits were associated with decreasing mortality. Sensitivity analyses indicated that the difference in the prevalence of an unobserved confounder would have to be unrealistically large given the observed data, or there would need to be a large effect of an unobserved confounder, to render these findings non-significant.<br />Conclusions and Relevance: This is the first study to show an association between process-based quality measures and mortality in patients with co-occurring mental and substance use disorders, and provides initial support for the predictive validity of the measures. By devising strategies to improve performance on these measures, health care systems may be able to decrease the mortality of this vulnerable population.<br />Competing Interests: none<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Cohort Studies
Confounding Factors, Epidemiologic
Diagnosis, Dual (Psychiatry)
Female
Humans
Logistic Models
Male
Mental Disorders mortality
Mental Disorders therapy
Middle Aged
Retrospective Studies
Substance-Related Disorders mortality
Substance-Related Disorders rehabilitation
Time Factors
United States
United States Department of Veterans Affairs
Mental Disorders epidemiology
Outcome Assessment, Health Care
Quality Indicators, Health Care
Substance-Related Disorders epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1873-6483
- Volume :
- 69
- Database :
- MEDLINE
- Journal :
- Journal of substance abuse treatment
- Publication Type :
- Academic Journal
- Accession number :
- 27568504
- Full Text :
- https://doi.org/10.1016/j.jsat.2016.06.001