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

Figures & data

Table 1. Patients with an index cannabis use disorder (CUD) diagnosis.

	CUD only (n = 11,338)		CUD plus other AOD (n = 3,864)		All patients with CUD (n = 15,202)
Characteristic	n	%	n	%	n	%
Female	4,372	(38.6)	1,241	(32.1)*	5,613	(36.9)
Age categories*
18–29	5,403	(47.7)	1,859	(48.1)	7,262	(47.8)
30–49	2,898	(25.6)	1,136	(29.4)	4,034	(26.5)
50–64	2,210	(19.5)	664	(17.2)	2,874	(18.9)
≥65	827	(7.3)	205	(5.3)	1,032	(6.8)
Race/ethnicity*
Black/African American	2,023	(17.8)	546	(14.1)	2,569	(16.9)
Hispanic	2,257	(19.9)	797	(20.6)	3,054	(20.1)
White	5,854	(51.6)	2,080	(53.8)	7,934	(52.2)
Other/unknown	1,204	(10.6)	442	(11.4)	1,645	(10.8)
Insurance*
Commercial/private pay	7,861	(69.3)	2,825	(73.1)	10,686	(70.3)
Medicare	1,436	(12.7)	414	(10.7)	1,850	(12.2)
State subsidized	1,672	(14.7)	489	(12.7)	2,161	(14.2)
Unknown	369	(3.3)	136	(3.5)	505	(3.3)
Other AOD disorder diagnoses at index
Alcohol	—	—	2,254	(58.3)*	2,254	(14.8)
Opioid	—	—	530	(13.7)*	530	(3.5)
Stimulant	—	—	1,075	(27.8)*	1,075	(7.1)
Other drug	—	—	1,141	(29.5)*	1,141	(7.5)
Carlson comorbidity score ≥3 in prior year	970	(8.6)	267	(6.9)*	1,237	(8.1)
Any AOD disorder in year prior to index	4,212	(37.1)	1,936	(50.1)*	6,148	(40.4)
Cannabis	3,929	(34.7)	1,630	(42.2)*	5,559	(36.6)
Nicotine	2,492	(22.0)	1,201	(31.1)*	3,693	(24.3)
Alcohol	601	(5.3)	1,139	(29.5)*	1,740	(11.4)
Opioid	155	(1.4)	358	(9.3)*	513	(3.4)
Stimulant	240	(2.1)	618	(16.0)*	858	(5.6)
Other drug	57	(0.5)	116	(3.0)*	173	(1.1)
Any mental health disorder diagnosis**	5,352	(47.2)	2,188	(56.6)*	7,540	(49.6)
Anxiety	3,101	(27.4)	1,247	(32.3)*	4,348	(28.6)
Depression	3,179	(28.0)	1,313	(34.0)*	4,492	(29.5)
Serious mental illness^†	1,799	(15.9)	937	(24.2)*	2,736	(18.0)
Utilization in 60 days prior to index episode
Emergency department ≥1 visit	2,093	(18.5)	914	(23.7)*	3,007	(19.8)
Primary care ≥1 visit	4,466	(39.4)	1,257	(32.5)*	5,723	(37.6)
Mental Health & psychiatry ≥1 visit	734	(6.5)	338	(8.7)*	1,072	(7.1)
Other specialty ≥1 visit	2,332	(20.6)	599	(15.5)*	2,931	(19.3)
Index identification setting*
Inpatient	2,436	(21.5)	1,152	(29.8)	3,588	(23.6)
Emergency department	3,316	(29.3)	1,100	(28.5)	4,416	(29.1)
Primary care	4,349	(38.4)	748	(19.4)	5,097	(33.5)
Addiction treatment (outpatient)	112	(1.0)	444	(11.5)	556	(3.7)
Mental Health & psychiatry	1,125	(9.9)	420	(10.9)	1,545	(10.2)

Note. CUD = cannabis use disorder; AOD = alcohol and other drugs.

*Chi-square test of independence significant at p < .000.

**In year prior to index diagnosis.

Table 2. Among patients with an index diagnosis of CUD, the adjusted* prevalence of initiation and engagement in AOD treatment by index identification setting.

	Inpatient (n = 3,588)		Emergency department (n = 4,416)		Primary care (n = 5,097)		Addiction treatment (n = 556)		Mental health & psychiatry (n = 1,545)		Total (n = 15,202)
Initiation/engagement	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI
Initiation**
All patients with a CUD	na	na	9.2	(6.4–12.0)	6.2	(4.7–7.6)	25.0	(22.5–27.6)	5.5	(2.5–8.5)	na	na
CUD only	na	na	6.8	(4.1–9.4)	4.4	(3.6–5.1)	21.6	(19.7–23.6)	3.8	(1.9–5.9)	na	na
CUD plus other AOD	na	na	17.1	(14.0–20.2)	11.7	(8.0–15.4)	42.9	(37.4–48.4)	10.4	(4.3–16.5)	na	na
	Inpatient(n = 3,547)		Emergency department (n = 449)		Primary care (n = 231)		Addiction treatment (n = 227)		Mental health & psychiatry (n = 100)		Total (n = 4,554)
Engagement (among those who initiated)†
All patients with a CUD	2.9	(2.0–3.9)	7.3	(5.1–9.6)	15.8	(11.9–19.7)	40.9	(34.8–47.0)	31.3	(12.7–49.9)	6.9	(5.6–8.2)
CUD only	2.3	(1.8–2.7)	5.7	(4.6–6.8)	12.7	(9.5–15.9)	35.4	(26.8–44.1)	26.4	(8.1–44.8)	5.6	(4.7–6.4)
CUD plus other AOD	4.2	(2.1–6.2)	10.2	(5.9–14.5)	21.4	(14.9–27.9)	50.6	(45.4–55.8)	40.1	(20.8–59.4)	8.4	(6.1–10.7)
	Inpatient (n = 3,588)		Emergency department (n = 4,416)		Primary care (n = 5,097)		Addiction treatment (n = 556)		Mental health & psychiatry (n = 1,545)		Total (n = 15,202)
Initiation & engagement (among all patients)‡
All patients with a CUD	2.0	(1.2–2.8)	1.0	(0.5–1.4)	0.9	(0.7–1.1)	12.5	(10.0–15.1)	2.2	(−0.2–4.7)	2.1	(1.7–2.4)
CUD only	1.4	(0.8–2.0)	0.7	(0.4–0.9)	0.6	(0.5–0.8)	9.8	(7.3–12.4)	1.5	(−0.2–3.3)	1.4	(1.1–1.6)
CUD plus other AOD	3.8	(2.1–5.5)	1.8	(0.9–2.7)	1.7	(1.4–2.0)	22.5	(19.8–25.2)	4.1	(−0.2–8.4)	3.1	(2.5–3.7)

Note. CUD = cannabis use disorder; AOD = alcohol and other drugs.

*Adjusted for age, gender, race/ethnicity, health insurance, Charlson comorbidity, any mental health and any AOD disorder diagnoses in year prior to index, and utilization in 60 days prior to index.

**Initiation estimates excluded inpatient index identification setting.

^†Engagement was estimated among all patients who initiated, including patients with an index inpatient encounter (n = 4,554).

^‡Initiation & engagement was estimated among all patients.

Table 3. Adjusted* prevalence of initiation & engagement** across CUD index groups.

	All patients with CUD (n = 15,202)		CUD only (n = 11,338)		CUD plus other AOD (n = 3,864)
Characteristic	%	95% CI	%	95% CI	%	95% CI
Gender
Female	1.7	(1.4–2.1)	0.9	(0.6–1.1)	4.5	(3.5–5.6)
Male	2.2	(1.8–2.7)	1.2	(0.9–1.5)	5.3	(4.3–6.4)
Age categories
18–29	2.2	(1.6–2.8)	1.3	(1.0–1.7)	4.9	(3.5–6.2)
30–49	2.4	(2.1–2.6)	1.1	(0.8–1.4)	6.2	(5.8–6.5)
50–64	1.6	(1.3–2.0)	0.7	(0.5–1.0)	4.4	(3.5–5.2)
≥65	1.2	(0.4–1.9)	0.6	(0.2–1.0)	1.8	(0.8–2.9)
Race/ethnicity
Black/African American	1.7	(1.5–1.9)	0.9	(0.7–1.1)	4.0	(2.8–5.2)
Hispanic	2.2	(1.6–2.7)	1.0	(0.8–1.2)	5.4	(3.7–7.1)
White	2.1	(1.8–2.4)	1.1	(0.8–1.4)	5.2	(4.6–5.8)
Other/unknown	2.2	(1.7–2.7)	1.0	(0.4–1.7)	5.3	(4.6–6.0)
Insurance
Commercial/private pay	2.2	(1.8–2.6)	1.0	(0.8–1.3)	5.5	(4.7–6.2)
Medicare	2.1	(1.5–2.8)	1.4	(1.0–1.7)	4.1	(2.2–6.0)
State subsidized	1.6	(1.0–2.2)	0.9	(0.2–1.7)	3.4	(2.2–4.6)
Unknown	0.8	(0.2–1.3)	0.3	(0.4–0.9)	2.2	(1.5–2.9)
Other AOD disorder diagnoses at index
1	2.8	(2.2–3.5)	na	na	4.6	(3.7–5.5)
≥2	3.6	(2.9–4.4)	na	na	6.1	(5.2–7.0)
Charlson comorbidity score ≥3 in prior year	3.0	(2.2–3.8)	2.2	(1.3–3.1)	4.9	(3.3–6.5)
Any AOD use disorder in year prior to index	2.3	(1.9–2.7)	1.3	(0.8–1.7)	5.1	(4.4–5.8)
Any mental health disorder in prior year	2.3	(1.8–2.7)	1.2	(0.9–1.5)	5.3	(4.4–6.2)
Utilization in 60 days prior to index episode
Emergency department ≥1 visit	2.9	(2.4–3.4)	1.6	(1.0–2.1)	6.7	(5.8–7.6)
Primary care ≥1 visit	1.9	(1.4–2.4)	1.0	(0.6–1.3)	4.6	(3.7–5.4)
Psychiatry ≥1 visit	2.7	(0.9–4.6)	1.9	(0.5–3.4)	5.2	(2.2–8.2)
Other specialty ≥1 visit	2.2	(1.9–2.5)	0.9	(0.7–1.1)	6.3	(4.1–8.5)

Note. CUD = cannabis use disorder; AOD = alcohol and other drugs.

*Adjusted for age, gender, race/ethnicity, health insurance, Charlson comorbidity, any mental health and any AOD disorder diagnoses in year prior to index, and utilization in 60 days prior to index.

**Initiation & engagement was estimated among all patients in each index CUD group.

Table

	All patients with CUD					CUD only					CUD plus other AOD
	No I&E (n = 14,887)		I&E (n = 315)			No I&E (n = 11,220)		I&E (n = 118)			No I&E (n = 3,667)		I&E (n = 197)
Characteristic	n	%	n	%	p value	n	%	n	%	p value	n	%	n	%	p value
Gender					.002					.154					.078
Female	5,523	(37.1)	90	(28.6)		4,334	(38.6)	38	(32.2)		1,189	(32.4)	52	(26.4)
Male	9,364	(62.9)	225	(71.4)		6,886	(61.4)	80	(67.8)		2,478	(67.6)	145	(73.6)
Age categories					.002					.960					.003
18–29	7,107	(47.7)	155	(49.2)		5,345	(47.6)	58	(49.2)		1,762	(48.1)	97	(49.2)
30–49	3,930	(26.4)	104	(33.0)		2,867	(25.6)	31	(26.3)		1,063	(29.0)	73	(37.1)
50–64	2,828	(19.0)	46	(14.6)		2,189	(19.5)	21	(17.8)		639	(17.4)	25	(12.7)
≥65	1,022	(6.9)	10	(3.2)		819	(7.3)	8	(6.8)		203	(5.5)	2	(1.0)
Race/ethnicity					.188					.889					.469
Black/African American	2,530	(17.0)	39	(12.4)		2,005	(17.9)	18	(15.3)		525	(14.3)	21	(10.7)
Hispanic	2,985	(20.1)	69	(21.9)		2,234	(19.9)	23	(19.5)		751	(20.5)	46	(23.4)
White	7,763	(52.1)	171	(54.3)		5,790	(51.6)	64	(54.2)		1,973	(53.8)	107	(54.3)
Other/unknown	1,609	(10.8)	36	(11.4)		1,191	(10.6)	13	(11.0)		418	(11.4)	23	(11.7)
Insurance					.000					.369					.000
Commercial/private pay	10,429	(70.1)	257	(81.6)		7,777	(69.3)	84	(71.2)		2,652	(72.3)	173	(87.8)
Medicare	1,822	(12.2)	28	(8.9)		1,418	(12.6)	18	(15.3)		404	(11.0)	10	(5.1)
State subsidized	2,134	(14.3)	27	(8.6)		1,657	(14.8)	15	(12.7)		477	(13.0)	12	(6.1)
Unknown	502	(3.4)	3	(1.0)		368	(3.3)	1	(0.8)		134	(3.7)	2	(1.0)
Other AOD disorder diagnoses at index															.000
1	2782	18.7	114	36.2		na	na	na	na		2,782	(75.9)	114	(57.9)
≥2	885	5.9	83	26.3		na	na	na	na		885	(24.1)	83	(42.1)
Charlson comorbidity score ≥3 in prior year	1,207	(8.1)	30	(9.5)	.363	950	(8.5)	20	(16.9)	.001	257	(7.0)	10	(5.1)	.298
Any AOD use disorder in year prior to index	5,964	(40.1)	184	(58.4)	.000	4,135	(36.9)	77	(65.3)	.000	1,829	(49.9)	107	(54.3)	.225
Any mental health disorder in prior year	7,338	(49.3)	202	(64.1)	.000	5,267	(46.9)	85	(72.0)	.000	2,071	(56.5)	117	(59.4)	.421
Utilization in 60 days prior to index episode
Emergency department ≥1 visit	2,912	(19.6)	95	(30.2)	.000	2,053	(18.3)	40	(33.9)	.000	859	(23.4)	55	(27.9)	.148
Primary care ≥1 visit	5,616	(37.7)	107	(34.0)	.173	4,418	(39.4)	48	(40.7)	.773	1,198	(32.7)	59	(29.9)	.427
Mental health/psychiatry ≥1 visit	1,034	(6.9)	38	(12.1)	.000	715	(6.4)	19	(16.1)	.000	319	(8.7)	19	(9.6)	.647
Other specialty ≥1 visit	2,873	(19.3)	58	(18.4)	.693	2,306	(20.6)	26	(22.0)	.692	567	(15.5)	32	(16.2)	.768
Index identification setting					.000					.000					.000
Inpatient	3,487	(23.4)	101	(32.1)		2,392	(21.3)	44	(37.3)		1,095	(29.9)	57	(28.9)
Emergency department	4,377	(29.4)	39	(12.4)		3,302	(29.4)	14	(11.9)		1,075	(29.3)	25	(12.7)
Primary care	5,065	(34.0)	32	(10.2)		4,327	(38.6)	22	(18.6)		738	(20.1)	10	(5.1)
Addiction treatment (outpatient)	447	(3.0)	109	(34.6)		93	(0.8)	19	(16.1)		354	(9.7)	90	(45.7)
Mental health & psychiatry	1,511	(10.1)	34	(10.8)		1,106	(9.9)	19	(16.1)		405	(11.0)	15	(7.6)

Note. CUD = cannabis use disorder; AOD = alcohol and other drugs.

*Initiation & engagement was estimated among all patients in each CUD group.

Table

	Initiation**						Engagement†
	All patients with CUD (n = 11,607)		CUD only (n = 8,896)		CUD plus other AOD (n = 2,711)		All patients with CUD (n = 4,554)		CUD only (n = 2,921)		CUD plus other AOD (n = 1,633)
Characteristic	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI
Gender
Female	8.0	(7.4–8.5)	4.9	(3.9–5.8)	18.2	(16.1–20.2)	6.2	(5.2–7.1)	3.6	(2.8–4.3)	11.2	(9.4–13.0)
Male	9.1	(8.4–9.8)	5.9	(5.2–6.5)	19.6	(18.2–21.0)	7.3	(5.5–9.1)	4.3	(3.6–5.1)	12.4	(8.7–16.2)
Age categories
18–29	9.1	(8.4–9.9)	6.5	(5.6–7.5)	18.1	(16.6–19.5)	7.5	(5.3–9.7)	4.7	(3.6–5.8)	12.5	(8.3–16.6)
30–49	8.8	(7.9–9.7)	4.9	(3.8–6.0)	21.6	(19.7–23.5)	7.6	(6.9–8.3)	4.3	(3.5–5.0)	13.4	(11.5–15.3)
50–64	7.5	(6.3–8.7)	4.2	(3.2–5.1)	18.2	(15.3–21.2)	5.7	(4.4–6.9)	3.3	(2.5–4.0)	10.1	(6.8–13.4)
≥65	7.4	(4.9–10.0)	4.3	(2.7–5.8)	17.7	(10.6–24.8)	3.8	(2.1–5.4)	2.5	(1.0–3.9)	4.2	(2.4–6.1)
Race/ethnicity
Black/AA	8.5	(7.9–9.0)	5.2	(4.4–6.0)	19.4	(16.4–22.4)	5.6	(4.9–6.3)	3.7	(3.2–4.2)	9.0	(7.5–10.4)
Hispanic	8.2	(7.0–9.3)	5.1	(3.6–6.6)	18.1	(16.5–19.8)	7.7	(5.8–9.6)	4.4	(3.8–5.1)	13.3	(8.6–18.0)
White	9.0	(8.4–9.5)	5.7	(4.7–6.7)	20.0	(18.5–21.6)	6.9	(5.7–8.2)	4.0	(3.6–4.5)	12.2	(9.7–14.7)
Other/unknown	8.5	(6.1–11.0)	5.9	(3.7–8.1)	16.6	(11.7–21.6)	7.4	(5.3–9.4)	4.0	(2.6–5.5)	13.2	(9.2–17.3)
Insurance
Commercial/private pay	9.2	(8.6–9.8)	5.8	(5.3–6.4)	20.2	(18.3–22.1)	7.0	(5.6–8.4)	3.9	(3.3–4.6)	12.6	(10.0–15.2)
Medicare	8.0	(6.9–9.2)	5.3	(4.0–6.6)	17.1	(14.8–19.3)	7.7	(5.4–10.0)	5.3	(3.5–7.2)	11.1	(5.5–16.6)
State subsidized	7.3	(5.5–9.1)	4.5	(2.8–6.2)	16.2	(13.3–19.2)	6.0	(4.5–7.6)	3.8	(2.0–5.6)	9.2	(4.4–14.0)
Unknown	5.7	(4.1–7.4)	4.2	(2.2–6.1)	10.1	(8.6–11.5)	4.1	(1.0–7.3)	1.7	–(2.8–6.1)	8.3	(6.6–10.0)
Other AOD disorder diagnoses at index
1	12.1	(10.4–13.8)	na	na	16.5	(14.7–18.4)	8.5	(5.8–11.2)	na	na	11.9	(8.6–15.2)
≥2	18.7	(17.0–20.4)	na	na	25.6	(23.7–27.5)	8.3	(6.3–10.3)	na	na	12.3	(9.6–14.9)
Charlson comorbidity score ≥3 in prior year	9.7	(5.3–14.1)	7.4	(2.4–12.5)	15.1	(9.5–20.7)	9.5	(7.8–11.1)	6.8	(5.4–8.2)	13.1	(9.9–16.2)
Any AOD use disorder in year prior to index	12.6	(11.1–14.1)	8.9	(7.9–9.9)	24.9	(20.4–29.3)	6.9	(5.8–8.0)	4.7	(3.6–5.7)	11.1	(8.3–13.8)
Any mental health disorder in prior year	9.8	(9.0–10.5)	6.6	(5.7–7.6)	20.3	(19.7–20.8)	7.5	(5.7–9.2)	4.5	(4.0–5.0)	12.6	(9.4–15.7)
Utilization in 60 days prior to index episode
Emergency department ≥1 visit	18.2	(13.1–23.3)	12.8	(8.8–16.7)	35.9	(27.2–44.6)	7.5	(6.2–8.8)	4.4	(3.7–5.2)	12.7	(9.9–15.6)
Primary care ≥1 visit	8.6	(7.2–10.0)	5.7	(4.6–6.8)	17.7	(15.3–20.2)	6.2	(4.8–7.5)	3.6	(2.7–4.5)	10.7	(8.9–12.5)
Mental health/psychiatry ≥1 visit	12.1	(9.8–14.4)	8.3	(6.0–10.6)	24.6	(21.5–27.7)	7.8	(3.2–12.5)	6.1	(3.0–9.2)	10.6	(4.3–16.9)
Other specialty ≥1 visit	7.7	(7.1–8.3)	4.7	(3.4–6.0)	17.6	(13.3–21.8)	7.1	(5.9–8.4)	3.5	(2.5–4.5)	14.7	(8.2–21.2)

Note. CUD = cannabis use disorder; AOD = alcohol and other drugs.

*Adjusted for age, gender, race/ethnicity, health insurance, Charlson comorbidity, any mental health and any AOD disorder diagnoses in year prior to index, and utilization in 60 days prior to index.

**Initiation estimates excluded patients diagnosed inpatient.

†Engagement was estimated among all patients who initiated, including patients with an index inpatient identification encounter (n = 4,554).