Psychiatric comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) measures of alcohol and other drug treatment initiation and engagement across 7 health care systems

Figures & data

Table 1. Initiation: Patient characteristics stratified by prior psychiatric disorders (N = 86,565).

	Initiation
	No (n = 62,377)			Yes (n = 24,188)
Characteristic	Without PD (n = 25,040)	With PD (n = 37,337)	P value	Without PD (n = 4,190)	With PD (n = 19,998)	P value
Age			<.0001			<.0001
Mean (SD)	43.47 (17.81)	48.67 (17.60)		49.23 (18.43)	50.55 (18.68)
Sex			<.0001			<.0001
Female	7,459 (29.79)	17,087 (45.76)		1,151 (27.47)	8,571 (42.86)
Male	17,581 (70.21)	20,250 (54.24)		3,039 (72.53)	11,427 (57.14)
Race/ethnicity			<.0001			<.0001
White	14,337 (57.26)	26,523 (71.04)		2,682 (64.01)	13,989 (69.95)
Black or African American	2,359 (9.42)	3,644 (9.76)		360 (8.59)	2,250 (11.25)
Asian	1,193 (4.76)	1,056 (2.83)		211 (5.04)	595 (2.98)
Native Hawaiian/Pacific Islander	199 (0.79)	185 (0.50)		32 (0.76)	111 (0.56)
American Indian/Alaskan Native	275 (1.10)	591 (1.58)		50 (1.19)	302 (1.51)
Others	149 (0.60)	192 (0.51)		29 (0.69)	100 (0.50)
Unknown	6,528 (26.07)	5,146 (13.78)		826 (19.71)	2,651 (13.26)
Encounter type			<.0001			<.0001
Ambulatory visit	15,760 (62.94)	26,855 (71.93)		1,742 (41.58)	3,552 (17.76)
Emergency department visit	9,232 (36.87)	10,155 (27.20)		612 (14.61)	2,057 (10.29)
Inpatient setting^a	25 (0.10)	268 (0.72)		1,826 (43.58)	14,367 (71.84)
Others	23 (0.09)	59 (0.16)		10 (0.24)	22 (0.11)
Anxiety disorder^b			—			—
No	25,040 (100.00)	21,336 (57.14)		4,190 (100.00)	12,294 (61.48)
Yes	—	16,001 (42.86)		—	7,704 (38.52)
Depressive disorder^b			—			—
No	25,040 (100.00)	20,046 (53.69)		4,190 (100.00)	10,996 (54.99)
Yes	—	17,291 (46.31)		—	9,002 (45.01)
Psychotic disorder^b			—			—
No	25,040 (100.00)	31,442 (84.21)		4,190 (100.00)	16,014 (80.08)
Yes	—	5,895 (15.79)		—	3,984 (19.92)
Prior AOD use disorder^b			—			—
No	25,040 (100.00)	16,932 (45.35)		4,190 (100.00)	4,324 (21.62)
Yes	—	20,405 (54.65)		—	15,674 (78.38)

PD = psychiatric disorder; AOD = alcohol and other drug.

^a A total of 293 patients who were at inpatient setting but not initiate AOD treatment due to detoxification.

^b Diagnosis a year prior to index AOD diagnosis.

Table 2. Engagement: Patient characteristics stratified by prior psychiatric disorders for those who initiated AOD treatment (n = 24,188).

	Engagement (among those who initiated AOD treatment)
	No (n = 21,406)			Yes (n = 2,782)
Characteristic	Without PD (n = 3,468)	With PD (n = 17,938)	P value	Without PD (n = 722)	With PD (n = 2,060)	P value
Age			.2250			<.0001
Mean (SD)	50.86 (18.7)	51.28 (18.87)		41.4 (14.81)	44.17 (15.46)
Sex			<.0001			<.0001
Female	961 (27.71)	7,698 (42.91)		190 (26.32)	873 (42.38)
Male	2,507 (72.29)	10,240 (57.09)		532 (73.68)	1,187 (57.62)
Race/ethnicity			<.0001			<.0001
White	2,223 (64.1)	12,481 (69.58)		459 (63.57)	1,508 (73.20)
Black or African American	318 (9.17)	2,111 (11.77)		42 (5.82)	139 (6.75)
Asian	180 (5.19)	539 (3.00)		31 (4.29)	56 (2.72)
Native Hawaiian/Pacific Islander	30 (0.87)	97 (0.54)		2 (0.28)	14 (0.68)
American Indian/Alaskan Native	39 (1.12)	278 (1.55)		11 (1.52)	24 (1.17)
Others	23 (0.66)	85 (0.47)		6 (0.83)	15 (0.73)
Unknown	655 (18.89)	2,347 (13.08)		171 (23.68)	304 (14.76)
Encounter type			<.0001			<.0001
Ambulatory visit	1,172 (33.79)	2,408 (13.42)		570 (78.95)	1,144 (55.53)
Emergency department visit	512 (14.76)	1,756 (9.79)		100 (13.85)	301 (14.61)
Inpatient setting	1,775 (51.18)	13,756 (76.69)		51 (7.06)	611 (29.66)
Others	9 (0.26)	18 (0.1)		1 (0.14)	4 (0.19)
Anxiety disorder^a			—			—
No	3,468 (100.00)	11210 (62.49)		722 (100.00)	1,084 (52.62)
Yes	—	6728 (37.51)		—	976 (47.38)
Depressive disorder^a			—			—
No	3,468 (100.00)	10,010 (55.80)		722 (100.00)	986 (47.86)
Yes	—	7,928 (44.20)		—	1,074 (52.14)
Psychotic disorder^a			—			—
No	3,468 (100.00)	1,4340 (79.94)		722 (100.00)	1,674 (81.26)
Yes	—	3,598 (20.06)		—	386 (18.74)
Prior AOD use disorder^a			—			—
No	3,468 (100.00)	3,659 (20.40)		722 (100.00)	665 (32.28)
Yes	—	14,279 (79.60)		—	1,395 (67.72)

PD = psychiatric disorder; AOD = alcohol and other drug.

^a Diagnosis a year prior to index AOD diagnosis.

Table 3. Univariate and multivariate logistic regression analyses for risk of diagnosis of psychiatric disorder a year prior to AOD index associated with AOD treatment initiation and engagement.

	Initiation						Engagement
	Univariate		Multivariate Model 1^a		Multivariate Model 2^b		Univariate		Multivariate Model 1^a		Multivariate Model 2^b
Diagnosis	OR	95% CI	AOR	95% CI	AOR	95% CI	OR	95% CI	AOR	95% CI	AOR	95% CI
Any psychiatric disorder	3.26	(3.14, 3.39)	3.20	(3.08, 3.32)	—	—	0.53	(0.49, 0.59)	0.56	(0.51, 0.61)	—	—
Anxiety disorder	1.38	(1.33, 1.42)	1.42	(1.37, 1.47)	0.97	(0.94, 1.01)	1.17	(1.08, 1.27)	1.09	(1.00, 1.18)	1.21	(1.10, 1.33)
Depressive disorder	1.57	(1.52, 1.62)	1.54	(1.49, 1.60)	1.12	(1.07, 1.16)	1.06	(0.98, 1.16)	1.06	(0.98, 1.16)	1.20	(1.09, 1.32)
Psychotic disorder	1.90	(1.82, 1.98)	2.02	(1.93, 2.11)	1.40	(1.34, 1.47)	0.82	(0.73, 0.92)	0.67	(0.59, 0.75)	0.77	(0.68, 0.86)
Prior AOD use disorder	4.01	(3.89, 4.14)	3.89	(3.77, 4.02)	3.66	(3.54, 3.79)	0.47	(0.43, 0.51)	0.45	(0.42, 0.49)	0.44	(0.40, 0.48)

AOD = alcohol and other drug.

^a Adjusted for age, sex, and race/ethnicity.

^b Adjusted for age, sex, race/ethnicity, anxiety disorder, depressive disorder, psychotic disorder, and prior AOD use disorder diagnoses.