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September 14, 2026Medical Care

Variability, Reliability, and Multilevel Determinants of Care Quality for Substance Use Disorders

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Authors

EWEdwin S. WongARArvind RamaprasanJLJubi Y L Lin

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Overview

Retrospective cohort study reveals low provider- and clinic-level reliability for substance use disorder quality measures, indicating larger sample sizes are required for valid performance assessment.

Key Points

  • To examine the variability, statistical reliability, and multilevel determinants of initiation and engagement in treatment quality measures for substance use disorders.
  • Retrospective cohort study evaluating 32,960 care episodes subject to initiation and engagement in treatment (IET) quality criteria between 2017 and 2022 within a large integrated health system in the Pacific Northwest.
  • Applied mixed-effects models with random intercepts to assess variability and reliability across patient, provider, clinic, and area levels.
  • Overall, 30.0% of episodes met criteria for treatment initiation and 7.8% met criteria for treatment engagement.
  • Provider and clinic levels collectively explained only 2.8% of the variation in initiation and 3.9% in engagement, with no providers meeting the 70% reliability threshold annually.
  • Payer type and a documented history of behavioral health conditions were consistently associated with meeting quality criteria.

Cite This Study

Wong et al. (2026) studied this question.

synapsesocial.com/papers/6aa7b2e10926e14a848b1649https://doi.org/10.1097/mlr.0000000000002378
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Evaluating the effectiveness of substance use disorder treatment centers: a systematic review of international standards and outcomes2026
  2. 2Predictors of outpatient treatment engagement following a visit to a specialized emergency department for substance use: A cohort study using high‐resolution electronic health records2026 · 2 citations
  3. 3Reducing barriers to promote engagement and retention in adolescent substance use treatment: results from a quality improvement evaluation2024 · 3 citations
  4. 4Patient-reported measures in substance use disorder treatment services: a scoping review and preliminary results from a multicenter study2025
  5. 5Advancing person-centered care: Protocol for quality measurement and management (QM2) in the New York State system for opioid use disorder treatment2025