Patient-centered quality measurement for opioid use disorder: Development of a taxonomy to address gaps in research and practice

Abstract

Background: Evidence-based treatment is provided infrequently and inconsistently to patients with opioid use disorder (OUD). Treatment guidelines call for high-quality, patient-centered care that meets individual preferences and needs, but it is unclear whether current quality measures address individualized aspects of care and whether measures of patient-centered OUD care are supported by evidence. Methods: We conducted an environmental scan of OUD care quality to (1) evaluate patient-centeredness in current OUD quality measures endorsed by national agencies and in national OUD treatment guidelines; and (2) review literature evidence for patient-centered care in OUD diagnosis and management, including gaps in current guidelines, performance data, and quality measures. We then synthesized these findings to develop a new quality measurement taxonomy that incorporates patient-centered aspects of care and identifies priority areas for future research and quality measure development. Results: Across 31 endorsed OUD quality measures, only two measures of patient experience incorporated patient preferences and needs, while national guidelines emphasized providing patient-centered care. Among 689 articles reviewed, evidence varied for practices of patient-centered care. Many practices were supported by guidelines and substantial evidence, while others lacked evidence despite guideline support. Our synthesis of findings resulted in EQuIITable Care, a taxonomy comprised of six classifications: (1) patient Experience and engagement, (2) Quality of life; (3) Identification of patient risks; (4) Interventions to mitigate patient risks; (5) Treatment; and (6) Care coordination and navigation. Conclusions: Current quality measurement for OUD lacks patient-centeredness. EQuIITable Care for OUD provides a roadmap to develop measures of patient-centered care for OUD.

Keywords:

• Patient-centered care
• quality measurement
• opioid use disorder
• medication treatment for opioid use disorder
• directly observed care
• contextualized care

Acknowledgements

The authors thank Mary Farley for her support in guiding the early development of the study design and manuscript.

Author contributions

ATK developed the study concept, led the literature review, and drafted the initial manuscript. JDB and SGC assisted in the literature search and review. Each coauthor provided critical feedback relating to the review framing, methods, analysis, and discussion; and contributed to the writing, editing, and/or revising of all sections of the manuscript. All authors approved the final version of the manuscript for submission.

Disclosure statement

SJW participates in consulting work that utilizes methods described in this manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or any of its academic affiliates.

Additional information

Funding

This material is based upon work supported by the Vulnerable Veteran Innovative Patient-aligned Care Team (VIP) at VA Salt Lake City Health Care System and the Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA) at the University of Utah. This work was also supported by institutional support from the National Institutes of Health [1UG1DA049444] and VA Salt Lake City Health Care System’s Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation [CIN 13-414]. Drs. Jones and Vanneman are supported by Career Development Awards from VA Health Services Research and Development [CDA 19-233, Award No IK2HX003090; CDA 15-259, Award No 1IK2HX002625-01A1]. Supporting organizations had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.