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Substance Abuse 2019;40(3):318-327. [doi: 10.1080/08897077.2018.1545728]
Abstract: 
Only 10% of patients with alcohol and other drug (AOD) disorders receive treatment. The AOD Initiation and Engagement in Treatment (AOD-IET) measure was added to the national Healthcare Effectiveness Data and Information Set (HEDIS) to improve access to care. This study, CTN-0072-Ot, identifies factors related to improving AOD-IET rates.
Data from 7 health systems with differing geographic, patient demographic, and organizational characteristics were included. All used a common Virtual Data Warehouse containing electronic health records and insurance claims data. Multilevel logistic regression models examined AOD-IET among adults (18+).
A total of 86,565 patients had an AOD diagnosis qualifying for the HEDIS denominator. The overall initiation rate was 27.9% with wide variation; the overall engagement rate was 11.5% and varied from 4.5% to 17.9%. Women versus men, Black/African Americans versus whites, and patients aged 65+ versus 18-29 had lower odds of initiation. Patients aged 30-49 versus 18-29 and those with prior psychiatric and medical conditions had higher odds of initiation. Identification in primary care versus other departments (emergency departments, psychiatry/AOD treatment, other outpatient) was related to lower odds of initiation. Patients aged 30-49 versus 18-29 had higher odds of engagement. Patients aged 65+ versus 18-29 and Black/African Americans versus whites had lower odds. Those initiating treatment in psychiatry/AOD treatment versus primary care had higher odds of engagement; those in inpatient or other outpatient settings had lower odds.
Conclusions: Rates of initiation and engagement varied but were low. Findings identified age, race/ethnicity, co-occurring conditions, and department of identification as key factors associated with AOD-IET. Focusing on these could help programs develop interventions that facilitate AOD-IET for those less likely to receive care.
Related protocols: CTN-0072-Ot
Only 10% of patients with alcohol and other drug (AOD) disorders receive treatment. The AOD Initiation and Engagement in Treatment (AOD-IET) measure was added to the national Healthcare Effectiveness Data and Information Set (HEDIS) to improve access to care. This study, CTN-0072-Ot, identifies factors related to improving AOD-IET rates.
Data from 7 health systems with differing geographic, patient demographic, and organizational characteristics were included. All used a common Virtual Data Warehouse containing electronic health records and insurance claims data. Multilevel logistic regression models examined AOD-IET among adults (18+).
A total of 86,565 patients had an AOD diagnosis qualifying for the HEDIS denominator. The overall initiation rate was 27.9% with wide variation; the overall engagement rate was 11.5% and varied from 4.5% to 17.9%. Women versus men, Black/African Americans versus whites, and patients aged 65+ versus 18-29 had lower odds of initiation. Patients aged 30-49 versus 18-29 and those with prior psychiatric and medical conditions had higher odds of initiation. Identification in primary care versus other departments (emergency departments, psychiatry/AOD treatment, other outpatient) was related to lower odds of initiation. Patients aged 30-49 versus 18-29 had higher odds of engagement. Patients aged 65+ versus 18-29 and Black/African Americans versus whites had lower odds. Those initiating treatment in psychiatry/AOD treatment versus primary care had higher odds of engagement; those in inpatient or other outpatient settings had lower odds.
Conclusions: Rates of initiation and engagement varied but were low. Findings identified age, race/ethnicity, co-occurring conditions, and department of identification as key factors associated with AOD-IET. Focusing on these could help programs develop interventions that facilitate AOD-IET for those less likely to receive care.
Related protocols: CTN-0072-Ot