Assesses emergency department (ED) visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence, who had a follow up visit for AOD.
Two rates are reported:
- ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
- ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).
Why It Matters
In 2016, 20.1 million Americans over 12 years of age (about 7.5% of the population) were classified as having a substance use disorder involving AOD.1 High ED use for individuals with AOD may signal a lack of access to care or issues with continuity of care.2 Timely follow-up care for individuals with AOD who were seen in the ED is associated with a reduction in substance use, future ED use, hospital admissions and bed days.3,4,5
Results – National Averages
Follow-Up Within 7 Days of ED Visit (Total)
| Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2021 | 11.8 | 11 | 13.4 | 11.4 | 11 |
| 2020 | 12.7 | 11.6 | 13.8 | 11.0 | 9.7 |
| 2019 | 11.3 | 10.5 | 13.3 | § | § |
| 2018 | 11.3 | 9.9 | 13.0 | 8.9 | 7.7 |
| 2017 | 10.9 | 10.1 | 12.2 | 8.4 | 8.3 |
Follow-Up Within 30 Days of ED Visit (Total)
| Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2021 | 16.2 | 15.2 | 19.8 | 16.8 | 15.9 |
| 2020 | 17.2 | 15.7 | 20.2 | 16.1 | 13.7 |
| 2019 | 15.2 | 14.2 | 19.6 | § | § |
| 2018 | 15.5 | 13.9 | 19.2 | 13.0 | 10.9 |
| 2017 | 15.0 | 13.8 | - | 12.2 | 11.8 |
§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.
This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.
References
- Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
- New England Health Care Institute (NEHI). 2010. “A Matter of Urgency: Reducing Emergency Department Overuse, A NEHI Research Brief.” Available from URL: http://www.nehi.net/writable/publication_files/file/nehi_ed_overuse_issue_brief_032610finaledits.pdf.
- Kunz, F.M., French, M.T., Bazargan-Hejazi, S. (2004). Cost-effectiveness analysis of a brief intervention delivered to problem drinkers presenting at an inner-city hospital emergency department. Journal of Studies on Alcohol and Drugs, 65, 363-370.
- Mancuso, D., Nordlund, D.J., Felver, B. (2004). Reducing emergency room visits through chemical dependency treatment: focus on frequent emergency room visitors. Olympia, Wash: Washington State Department of Social and Health Services, Research and Data Analysis Division.
- Parthasarathy, S., Weisner, C., Hu, T.W., Moore, C. (2001). Association of outpatient alcohol and drug treatment with health care utilization and cost: revisiting the offset hypothesis. Journal of Studies on Alcohol and Drugs, 62, 89-97.