ArticlePsychiatric services (Washington, D.C.)2013
When quality indicators undermine quality: bias in a quality indicator of follow-up for alcohol misuse.
Article in Psychiatric services (Washington, D.C.), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 32 citations in OpenAlex.
- Study protocol: a cluster-randomized trial implementing Sustained Patient-centered Alcohol-related Care (SPARC trial).Implementation science : IS · 2018Trial
- Physician versus non-physician delivery of alcohol screening, brief intervention and referral to treatment in adult primary care: the ADVISe cluster randomized controlled implementation trial.Addiction science & clinical practice · 2015Trial
- Challenges using electronic health records to support unhealthy alcohol use screening and intervention in primary care practices in the Pacific Northwest.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Improving diagnosis-based quality measures: an application of machine learning to the prediction of substance use disorder among outpatients.BMJ open quality · 2025Article
- Unhealthy alcohol use and brief intervention rates among high and low complexity veterans seeking primary care services in the Veterans Health Administration.Journal of substance use and addiction treatment · 2023Article
- Influence of a national transgender health care directive on receipt of alcohol-related care among transgender Veteran Health Administration patients with unhealthy alcohol use.Journal of substance abuse treatment · 2022Article
- Receipt of evidence-based alcohol-related care in a national sample of transgender patients with unhealthy alcohol use: Overall and relative to non-transgender patients.Journal of substance abuse treatment · 2021Article
- Alcohol Use and Antiretroviral Adherence Among Patients Living with HIV: Is Change in Alcohol Use Associated with Change in Adherence?AIDS and behavior · 2021Article
- Assessing the postdeployment quality of treatment for substance use disorders among Army enlisted soldiers in the Military Health System.Journal of substance abuse treatment · 2020Article
- Addressing identification bias in the design and analysis of cluster-randomized pragmatic trials: a case study.Trials · 2020Article
- HIV Disease Severity Is Sensitive to Temporal Changes in Alcohol Use: A National Study of VA Patients With HIV.Journal of acquired immune deficiency syndromes (1999) · 2019Article
- The prevalence of Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement in treatment among patients with cannabis use disorders in 7 US health systems.Substance abuse · 2019Observational
- Facility-level changes in receipt of pharmacotherapy for opioid use disorder: Implications for implementation science.Journal of substance abuse treatment · 2018Article
- Receipt of alcohol-related care among patients with HCV and unhealthy alcohol use.Drug and alcohol dependence · 2018Article
- Evaluation of a Pilot Implementation to Integrate Alcohol-Related Care within Primary Care.International journal of environmental research and public health · 2017Article
- Quality of care measures for the management of unhealthy alcohol use.Journal of substance abuse treatment · 2017Article
- Among patients with unhealthy alcohol use, those with HIV are less likely than those without to receive evidence-based alcohol-related care: A national VA study.Drug and alcohol dependence · 2017Article
- Are Improvements in Measured Performance Driven by Better Treatment or "Denominator Management"?Journal of general internal medicine · 2016Article
- Implementing Effective Substance Abuse Treatments in General Medical Settings: Mapping the Research Terrain.Journal of substance abuse treatment · 2016Review
- Predictive validity of two process-of-care quality measures for residential substance use disorder treatment.Addiction science & clinical practice · 2015Article
Corrections and comments
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
objectiveValid quality indicators are needed to monitor and encourage identification and management of mental health and substance use conditions (behavioral conditions). Because behavioral conditions are frequently underidentified, quality indicators often evaluate the proportion of patients who screen positive for a condition who also have appropriate follow-up care documented. However, these "positive-screen-based" quality indicators of follow-up for behavioral conditions could be biased by differences in the denominator due to differential screening quality ("denominator bias") and could reward identification of fewer patients with the behavioral conditions of interest. This study evaluated denominator bias in the performance of Veterans Health Administration (VHA) networks on a quality indicator of follow-up for alcohol misuse that used the number of patients with positive alcohol screens as the denominator.
methodsTwo quality indicators of follow-up for alcohol misuse--a positive-screen-based quality indicator and a population-based quality indicator-were compared among 21 VHA networks by review of 219,119 medical records.
resultsResults for the two quality indicators were inconsistent. For example, two networks performed similarly on the quality indicators (64.7% and 65.4% follow-up) even though one network identified and documented follow-up for almost twice as many patients (5,411 and 2,899 per 100,000 eligible, respectively). Networks that performed better on the positive-screen-based quality indicator identified fewer patients with alcohol misuse than networks that performed better on the population-based quality indicator (mean 4.1% versus 7.4%, respectively).
conclusionsA positive-screen-based quality indicator of follow-up for alcohol misuse preferentially rewarded networks that identified fewer patients with alcohol misuse.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.