SUBSTANCE ABUSE

Substance Abuse



Substance Abuse

Substance Abuse Best Practices

Integrated data system

The substance abuse treatment field also has begun to consider the benefits of developing comprehensive service records that integrate clinical variables such as disease severity with administrative data such as costs and service provision in a single management information system (MIS). An integrated MIS has many benefits for managing care, and it provides important advantages in understanding the relationship between service-level data and clinical outcomes. For example, such a system would be able to test the effects of administrative length of stay and number of counseling hours variables with clinical outcomes, the results of which could provide important insight into quality-of-care aspects missing in the earlier work described by Luft (Coffey et al., 2001). The Illinois Department of Alcohol and Substance Abuse (DASA), for example, uses an automated record retrieval and tracking system (DARTS) to track the treatment of drug abuse within the public sector. Besides traditional administrative data, DARTS includes clinical measures of drug use, method of drug administration, and other diagnostic codes that make it possible to link administrative data to various clinical variables. Moreover, the DARTS protocol collects event-level data on specific services provided. Unfortunately, the protocol also makes the reporting of this important information optional, left to the discretion of the individual provider. In addition to this limitation, DARTS lacks a statistical paradigm that can combine the numerous indicators of clinical status with quality of care to form a single measure (Coffey et al., 2001).

QOC and administrative records

Recent attempts to evaluate the impact of managed care programs have revived interest in measuring quality of care using administrative records. While limited in many ways, there is special attraction to measures such as length of stay, number of counseling hours, and provision of ancillary services extracted from treatment records and insurance claims. In addition to the relative ease and wide availability of these records, the fact that administrative data are not specifically focused on quality of care lends itself to greater objectivity in that the extracted measures are not affected by the self-serving bias of provider self-reports (Sing, Hill, Smolkin, & Heiser, 1998).

Recent evaluations of behavioral health care carve-outs have attempted to measure quality of care using administrative records. Building on earlier work evaluating the quality of general medical treatment, this approach uses administrative records to define quality of care as indicated by (1) the structure of the facility in which the treatment was provided, (2) the apparent quality of the treatment process itself, and (3) the presumed quality of the treatment as manifested in the outcomes created by the treatment. In a study of all patients in the mental health/substance abuse carve-out for the Massachusetts Medicaid program, Callahan and colleagues found 30-day readmissions rates to be unchanged by carve-out implementation. The Dickey et al analysis of the psychiatric subpopulation in the study found a decrease in both the proportion of patients admitted to different hospitals and in the number of rapid ...