Quality of Preventive and Chronic Illness Care for Insured Adults With Opioid Use Disorder

Abstract

Importance: Nearly all initiatives to improve care for individuals with opioid use disorder (OUD) have focused on improving OUD identification and treatment. Whether individuals with OUD have lower quality of care than individuals without OUD remains unclear.

Objective: To measure quality of non-OUD preventive and chronic illness care and care coordination for individuals with OUD compared with individuals without OUD.

Design, setting, and participants: A cross-sectional study of deidentified data on outpatients throughout the US was conducted. Claims for 79 372 commercially insured and Medicare Advantage enrollees aged 18 years or older with diagnosis codes for OUD between January 1, 2018, and December 31, 2019, and 46 601 individuals without OUD were included in the analysis.

Exposure: Diagnosis of OUD.

Main outcomes and measures: Quality indicator performance was calculated, using claims for individuals with OUD and matched comparators without OUD. Within 3 domains of outpatient care quality (preventive care, chronic illness care, and care coordination), 6 indicators used in accountability programs were selected. Performance for individuals with and without OUD was compared, and logistic regression was used to analyze sociodemographic and comorbidity characteristics associated with higher quality of health care.

Results: The study included 125 973 individuals, including 69 466 (55.1%) women and 78 225 (62.1%) White individuals, with a mean (SD) age of 59.0 (16.1) years. For the preventive care measure examining breast cancer screening, performance for the OUD cohort was 55.4% (95% CI, 54.7%-56.0%) compared with 65.6% (95% CI, 64.4%-66.7%) for individuals without OUD (P < .001). Quality of care for adherence to statin therapy was lower for individuals with OUD (70.4%; 95% CI, 68.7%-72.1%) compared with individuals without OUD (76.7%; 95% CI, 74.4%-78.7%) (P < .001) and for the hemoglobin A1c testing indicator (OUD: 80.9%; 95% CI, 80.4%-81.5%; comparator: 85.8%; 95% CI, 84.9%-86.8%; P < .001). Care coordination quality also was lower for individuals with OUD compared with those without OUD for mental health follow-up (OUD: 45.3%; 95% CI, 44.6%-46.0%; comparator: 52.5%; 95% CI, 50.0%-55.0%; P < .001) and for potentially avoidable hospitalizations for chronic conditions (OUD: 11.4%; 95% CI, 11.2%-11.7%; comparator: 8.8%; 95% CI, 8.3%-9.2%; P < .001) and diabetes, where a lower score indicates higher quality (OUD: 2.4%; 95% CI, 2.3%-2.5%; comparator: 1.9%; 95% CI, 1.7%-2.1%; P = .001).

Conclusions and relevance: These findings suggest that individuals with OUD have moderately lower quality of care across preventive and chronic illness care and care coordination for non-OUD care compared with individuals without OUD. More attention to measurement and improvement of non-OUD care for these individuals is needed.

Figure 1.. Comparison of Quality Indicator Performance for Individuals With and Without Opioid Use Disorder (OUD), 2018 to 2019

For the breast cancer screening indicator, 22 217 women with OUD and 23 083 matched comparators without OUD were eligible. For the adherence to statin therapy indicator, 2832 individuals with OUD and 5774 matched comparators without OUD were eligible. For the hemoglobin A_1c (HbA_1c) testing indicator, 19 475 individuals with OUD and 21 968 matched comparators without OUD were eligible. For the mental health follow-up indicator, 18 145 individuals with OUD and 9833 matched comparators without OUD were eligible. For the chronic composite and diabetes composite indicators, 79 372 individuals with OUD and 79 372 matched comparators without OUD were eligible. The OUD cohort was matched to the control cohort using 1:1 nearest neighbor matching with replacement. Using propensity score weights, the 46 601 matched comparators simulated 79 372 individuals. This figure reports weighted estimates of quality indicator performance for the matched comparators. Error bars indicate 95% CIs.

Figure 2.. Quality Indicator Performance for Individuals With Opioid Use Disorder (OUD) With Medicare Advantage vs Commercial Insurance (2018-2019)

For the breast cancer screening indicator, 17 772 individuals with Medicare Advantage coverage and 4445 individuals with commercial coverage were eligible. For the adherence to statin therapy indicator, 2453 individuals with Medicare Advantage coverage and 379 individuals with commercial insurance were eligible. For the hemoglobin A_1c (HbA_1c) testing indicator, 15 290 individuals with Medicare Advantage coverage and 4185 individuals with commercial insurance were eligible. For the mental health follow-up indicator, 11 776 individuals with Medicare Advantage coverage and 6369 individuals with commercial insurance were eligible. For the chronic composite and diabetes composite potentially avoidable hospitalization indicators, 54 297 individuals with Medicare Advantage coverage and 25 075 individuals with commercial insurance were eligible. Error bars indicate 95% CIs.