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The Washington Circle Group

Efforts to improve the quality of the substance use disorder treatment system are aided by the development, use and tracking of standardized measures that track the quality of alcohol and other drug (AOD) treatment services.  The Washington Circle Group is an organization focused on the development and dissemination of such measures.  The three initial measures developed by the Washington Circle for the treatment of Alcohol and Other Drug Use were: Identification of adults with an AOD disorder, Initiation of AOD services, and Continuation of AOD services.  A brief description of each measure is provided below:

Identification:  The percentage of adult enrollees with a substance abuse claim, defined as containing a diagnosis of substance abuse or dependence or a specific substance abuse-related service, on an annual basis.

Initiation: The percentage of adults aged 18 and over diagnosed with AOD abuse or dependence and receiving a related service who initiate treatment through one of the following:

  • An inpatient AOD admission, or
  • An outpatient service for AOD abuse or dependence and any additional AOD services within 14 days

Engagement: The percentage of adults with two additional AOD treatments within 30 days after initiating treatment.
While these three measures were initially developed for commercial populations, the Washington Circle assembled a workgroup to assess the feasibility and utility of using these measures within the public sector.  The workgroup included representatives from a number of public sector users including substance abuse and mental health agencies in twelve states. Workgroup findings suggested that the calculation of the identification measure may be problematic for many public sector agencies given that many states do not serve fixed enrolled populations, and thus calculating the total number of individuals eligible for care in a given year may be difficult, or even impossible.   However, the workgroup found that the other two measures- initiation and engagement were both useful with some modifications. The workgroup suggested the initiation and engagement measures be expanded to include the following:

  • Initiation after outpatient
  • Initiation after intensive outpatient
  • Engagement after outpatient
  • Engagement after outpatient or intensive outpatient

It is worth noting that many Medicaid HMOs are able to collect and report on the results of the three HEDIS measures collected by NCQA. More information on the results of these measures, and developing expectations for Medicaid plans that collect this information can be found here.

For More Information:

More information on the Washington Circle Public Sector Workgroup can be found here.

Detailed specifications for the three measures described above can be found here.

Preliminary research suggesting an association between increased adherence to Washington Circle measures and decreased criminal justice involvement can be found here.

VA/DoD Clinical Practice Guidelines for the Management of Substance Use Disorders

Adopting a standard set of clinical guidelines can help organizations and agencies to improve the care provided to individuals with substance use disorders by increasing both the quality and consistency of services. One of the most comprehensive and well-researched set of clinical practice guidelines for the management of substance use disorders was developed by the Department of Veterans Affairs and the Department of Defense (VA/DoD).

In August 2009, the VA/DoD released an updated version of Clinical Practice Guidelines for the Management of Substance Use Disorders. These guidelines include specific, step-by-step algorithms for treating substance use disorders that are applicable to providers in both primary and specialty care settings. The guidelines address treatment practices for a range of substance use disorders: from risky and hazardous use to substance dependence. While specifically developed for use with VA/DoD populations, the guidelines are based on research that has been conducted in a variety of different health care settings and are general enough to be applicable and appropriate for us in varied populations.

The VA/DoD guidelines include five separate modules that address care for patients with substance use disorders. The five modules included in the guidelines are:

Module A: Screening and Initial Assessment for Substance Use includes information on screening, brief intervention, and specialty referral considerations.

Module B: Management of SUD in Specialty SUD Care focuses on patients in need of further assessment or motivational enhancement or who are seeking remission.

Module C: Management of SUD in General Healthcare (including primary care) emphasizes earlier intervention for less severe SUD, or chronic disease management for patients unwilling or unable to engage in treatment in specialty SUD care or not yet ready to abstain.

Module P: Addiction-Focused Pharmacotherapy addresses use of medication approved by the Food and Drug Administration for the treatment of alcohol and opioid dependence.

Module S: Stabilization and Withdrawal Management addresses withdrawal

Each module includes straightforward, step-by-step instructions that outline a clear decision-making process for the treatment of patients with substance use disorders. Each module also includes a brief description of the research literature supporting each recommendation and a rating of the strength of the evidence supporting each recommendation.

The full report, VA/DoD Clinical Practice Guidelines for the Management of Substance Use Disorders can be found here:

A summary of the VA/DoD Guidelines can be found here: