Retention in care as a quality measure for opioid use disorder

Abstract

US health care systems are struggling to formulate quality metrics that are patient-centered and describe outcomes rather than processes. Addiction medicine is no exception. Of particular interest is the identification of quality metrics in opioid use disorder (OUD) treatment. The prevalence and lethality of OUD, together with concomitant efforts to increase provision of its care, makes well-designed and validated quality metrics especially important. One insightful approach has been to use the “cascade of care” model derived from human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) care. A core part of the cascade is “retention in care,” a concept initially identified during the development of methadone-based OUD care. Not only is retention in care associated with improved morbidity and mortality, it also offers strategic approaches to improving care for OUD. This paper provides an introduction to retention in care and its implications for quality measurement.

Keywords:

• Health care
• opiate substitution treatment
• opioid-related disorders
• quality indicators
• treatment adherence and compliance

Acknowledgments

We thank A. Robin Williams for his improvements to the manuscript.

Author contributions

All authors have made contributions to the manuscript, including substantial contributions to the conception or design of the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Additional information

Funding

This study was funded by the Addiction Research and Education Foundation. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.