Variation in 90-day substance use disorder-related acute care events across United States opioid treatment programs

Abstract

BACKGROUND AND AIMS: Creating and tracking quality measures has improved outcomes in many areas of healthcare; however, quality measures specific to opioid treatment programs (OTPs) have not yet been developed. Based on the success seen in other fields, introducing quality measures in OTPs should help enhance positive outcomes and decrease negative outcomes. Substance use disorder (SUD) hospitalizations and emergency department (ED) visits are adverse and preventable outcomes for the populations that OTPs serve. Using Medicaid claims data, we created OTP-level quality measures that captured the percentage of newly treated patients that had a hospitalization or an ED visit for SUD within 90 days of initiation. We described and compared findings on this measure for OTPs across the United States.

DESIGN: Cross-sectional analysis.

SETTING: The study was conducted using Medicaid claims and enrollment data for patients treated at OTPs located across the United States.

PARTICIPANTS: The study population was Medicaid enrollees, excluding those dually eligible for Medicare, diagnosed with opioid use disorder who received care at an OTP.

MEASUREMENTS: The quality measure was defined as the percentage of an OTP's treatment episodes that had a hospitalization or an ED visit with a SUD diagnosis within 90 days of initiation.

RESULTS: We calculated the measure for 1226 OTPs in measure-year 2024 using 412 411 new treatment episodes and 257 986 patients. At the OTP level, the median 90-day acute care event percentage was 5.0% in measure-year 2024 with 25th and 75th percentiles of 2.8% and 8.0%, indicating significant variability among OTPs. Casemix adjustment resulted in 46 of the 1226 OTPs moving from the 25th percentile to the 50th percentile and 20 OTPs moving from the 50th percentile to the 75th percentile.

SUMMARY: In 2024, at the median opioid treatment program (OTP), one in 20 United States Medicaid patients who newly initiated care at an OTP had evidence of an acute care event for a substance use disorder within 90 days. Substantial and reliable between-clinic variation was observed.