VHA Advances ASAM Follow-Up Measure

ASAM’s Journal of Addiction Medicine recently published the Predictive Validity of Outpatient Follow-up After Detoxification as a Quality Measure study in its May/June issue, which evaluated the predictive validity of a 7-day outpatient follow-up after detoxification quality measure used by the Veterans Health Administration (VHA).

Nationally, the VHA serves more than 600,000 patients with Substance Abuse Disorder (SUD) each year, and it mandates both that detoxification services be available for patients when clinically indicated and that follow-up services are coordinated upon completion of detoxification (US Department of Veterans Affairs 2008, VHA/DoD, 2015). In 2013, the rate of attending a follow-up visit ranged from 11.1% to 76.4% across 141 VHA facilities (Timko et al., 2016). Given this undesirable variability and room for improvement, VHA’s follow-up after detoxification has appeal for monitoring care coordination and process quality in SUD treatment (Trafton et al., 2013). However, whether meeting this quality measure predicts outcomes such as SUD treatment utilization and mortality had not been evaluated.

Using administrative data on a national sample of VHA patients who received detoxification services in diverse clinical contexts, the study tested whether meeting the measure criteria was positively associated with subsequent outpatient SUD or mental health (MH) treatment, and negatively associated with subsequent SUD or MH inpatient admissions, detoxifications, and 2-year mortality.

The study found that meeting the measure was associated with 53.3% lower odds of 2-year mortality, and concluded that well-coordinated care may be associated with higher outpatients and inpatient utilization, and such engagement in care may be protective against mortality in people who receive detoxification from alcohol or opiates. These findings support a similar measure from the American Society of Addiction Medicine (ASAM)’s Performance Measures for the Addiction Specialist Physician.

ASAM’s measure, titled “7-day follow-up after withdrawal management,” assesses the extent to which patients initiate treatment within seven days after receiving withdrawal management services. ASAM discovered significant literature about patients not receiving treatment after withdrawal management resulting in relapse, re-admission, and death; emphasizing the need for care plans to ensure consistency across treatment locations and providers, as well as flexibility in adapting to changes in an individual’s needs. The goal of this performance measure is to present data exposing the negative clinical outcomes for patients not receiving treatment within seven days after withdrawal management. The VHA study   advances the testing of ASAM’s measure within military veterans and emphasizes the need for follow-up services, SUD treatment planning, and quality improvement efforts.