Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)

This Hedis Measure

The percentage of acute inpatient hospitalizations, residential treatment or withdrawal management visits for a diagnosis of substance use disorder among persons 13 years of age and older that result in a follow-up visit or service for substance use disorder. Two rates are reported: 

  1. The percentage of visits or discharges for which the person received follow-up for substance use disorder within the 30 days after the visit or discharge.  
  2. The percentage of visits or discharges for which the person received follow-up for substance use disorder within the 7 days after the visit or discharge. 

Why It Matters

Substance use disorders (SUD) pose significant health risks that necessitate a comprehensive understanding and approach to treatment. Individuals with SUD are at increased risk of overdose, injury, soft tissue infections and mortality (Bahorik, A.L, 2017). Consequently, addressing these risks is critical and the primary goals of alcohol and drug abuse or dependence treatment are abstinence, relapse prevention, rehabilitation and recovery (NIDA, 2018a). Research supports the need for individuals with SUD to not only receive timely follow-up care following treatment in a high-intensity care setting (e.g. hospitalization, medically managed withdrawal/detoxification, residential treatment visit), but also to stabilize or cease using the substance(s) and engage in ongoing treatment to prevent relapse (NIDA, 2018a; Proctor & Herschman, 2014, McKay, 2021). Individuals who receive timely follow-up care may be more likely to complete treatment or receive more days of treatment than those who do not receive follow-up care. (Proctor & Herschman, 2014). 

Total overall costs of substance misuse and substance use disorders in the U.S., including loss of work productivity, direct health care expenditures and crime-related costs, exceed $700 billion annually (NIDA, 2020). One study estimated that the hospital costs for treating SUD are $13.2 billion annually (Peterson et al., 2021). Another study modeled commercial health insurance costs for SUD and found that the attributable medical expenditure each year was over $15,000 per enrollee with a SUD diagnosis (Li et al., 2023). Conservative estimates suggest that for every dollar invested in addiction treatment programs, between $4 and $7 are directly returned in decreased drug-related crime, criminal justice costs and theft (NIDA, 2018b). 

Key stakeholder groups such as the American Society of Addiction Medicine (ASAM, 2015), the Substance Abuse and Mental Health Services Administration (SAMHSA, 2015), the National Institute on Drug Addiction (NIDA, 2018), the Veteran Affairs/Department of Defense (Management of Substance use Disorders Work Group, 2015) and the American Psychiatric Association (Work Group on Substance Use Disorders, 2006) havel issued guidelines and recommendations on the treatment of substance use disorders. Existing guidelines for SUD treatment target drug of choice, age range and other factors such as pregnancy or justice involvement. Overall, the guidelines suggest that clinicians should ensure that treatment plans are personalized and frequently reassessed to maintain effectiveness and safety, as well as to reduce the risk of relapse. The guidelines support services that continue care after discharge from inpatient and other high intensity settings and ensure timely access to care. 

Historical Results – National Averages

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References

  1. American Society of Addiction Medicine (ASAM). 2014. The ASAM Criteria, Third Edition. http://www.asamcriteria.org/
  2. Bahorik, A.L., D.D. Satre, A.H. Kline-Simon, C.M. Weisner, C.L. Campbell. 2017. “Alcohol, Cannabis, and Opioid Use Disorders, and Disease Burden in an Integrated Health Care System.” J Addiction Medicine 11(1):3–9.
  3. Li, M., Peterson, C., Xu, L., Mikosz, C. A., & Luo, F. 2023. “Medical Costs of Substance Use Disorders in the US Employer-Sponsored Insurance Population.” JAMA network open, 6(1), e2252378. https://doi.org/10.1001/jamanetworkopen.2022.52378
  4. Management of Substance Use Disorders Work Group. 2015. VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders. Version 3.0. December 2015. Washington (DC): Department of Veterans Affairs, Department of Defense. 169 p. [327 references]. https://www.healthquality.va.gov/guidelines/MH/sud/VADoDSUDCPGRevised22216.pdf
  5. McKay J. R. 2021. “Impact of Continuing Care on Recovery From Substance Use Disorder.” Alcohol research : current reviews, 41(1), 01. https://doi.org/10.35946/arcr.v41.1.01
  6. NIDA. 2018b. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). January 17, 2018. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition
  7. NIDA. 2020. Trends & Statistics. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/trends-statistics
  8. Peterson, C., Li, M., Xu, L., Mikosz, C. A., & Luo, F. 2021. “Assessment of Annual Cost of Substance Use Disorder in US Hospitals.” JAMA network open, 4(3), e210242. https://doi.org/10.1001/jamanetworkopen.2021.0242
  9. Proctor, S., P. Herschman. 2014. “The Continuing Care Model of Substance Use Treatment: What Works, and When Is ‘Enough,’ Enough?”. Psychiatry Journal. Volume 2014, Article ID 692423, 16 pages.
  10. SAMHSA. 2015. Federal Guidelines for Opioid Treatment Programs. HHS Publication No. HSS28320070053I/HHSS28342003T. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015. http://mpcmh.org/wp-content/uploads/2017/12/SAMHSA_Guidelines_Opiod-Treatment-Programs.pdf

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