Quality Metrics and Systems Transformation: Are We Advancing Alcohol and Drug Screening in Primary Care?
OBJECTIVE
To examine the influence of Oregon's coordinated care organizations (CCOs) and pay-for-performance incentive model on completion of screening and brief intervention (SBI) and utilization of substance use disorder (SUD) treatment services.


DATA SOURCES/STUDY SETTING
Secondary analysis of Medicaid encounter data from 2012 to 2015 and semiannual qualitative interviews with stakeholders in CCOs.


STUDY DESIGN
Longitudinal mixed-methods design with simultaneous data collection with equal importance.


DATA COLLECTION/EXTRACTION METHODS
Qualitative interviews were recorded, transcribed, and coded in ATLAS.ti. Quantitative data included Medicaid encounters 30 months prior to CCO implementation, a 6-month transition period, and 30 months following CCO implementation. Data were aggregated by half-year with analyses restricted to Medicaid recipients 18-64 years of age enrolled in a CCO, not eligible for Medicare coverage or Medicaid expansion.


PRINCIPAL FINDINGS
Quantitative analysis documented a significant increase in SBI rates coinciding with CCO implementation (0.1 to 4.6 percent). Completed SBI was not associated with increased initiation in treatment for SUD diagnoses. Qualitative analysis highlighted importance of aligning incentives, workflow redesign, and leadership to facilitate statewide SBI.


CONCLUSIONS
Results provide modest support for use of a performance metric to expand SBI in primary care. Future research should examine health reform efforts that increase initiation and engagement in SUD treatment.
['Rieckmann|Traci|T|', 'Renfro|Stephanie|S|', 'McCarty|Dennis|D|', 'Baker|Robin|R|', 'McConnell|K John|KJ|']
D000293:Adolescent D000328:Adult D000437:Alcoholism D005260:Female D006801:Humans D007345:Insurance Claim Review D007407:Interviews as Topic D008137:Longitudinal Studies D008297:Male D008403:Mass Screening D008484:Medicaid D008875:Middle Aged D009922:Oregon D011320:Primary Health Care D019984:Quality Indicators, Health Care D012017:Referral and Consultation D012052:Reimbursement, Incentive D012987:Soil D019966:Substance-Related Disorders D014481:United States D055815:Young Adult
primary care Evidence-based practice state health policies substance abuse