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Administrative Data Based Measures

Patients receiving AOD-related services can be identified and their care tracked over time and across settings via administrative data. Large amounts of data are available, information already is collected by organizations that are familiar with its use, and data usually are collected with common data elements and formats.

Insurance claims data, one type of administrative data, have been used for measuring the quality of AOD services in a variety of settings, including commercial health plans and the Federal Government’s Medicare and Medicaid programs. In addition, systems such as staff-model managed care plans, which directly manage and pay physicians, as well as State-run specialty hospitals and Department of Veterans’ Affairs (VA) facilities, deliver care through facilities they own and providers they employ. Most of these systems generate encounter-level records that have dates and descriptions of services, such as are included in claims.
Data generated by publicly funded mental health and AOD treatment systems administered through State departments of public health, mental health, or substance abuse could be useful for performance measurement.

Across the 50 States, the availability of data to support performance measurement varies widely, however. Some States are leaders in data systems and have detailed data on date of service, types of services, and diagnoses for specific clients, but many still report only aggregate service-use statistics or the start and end dates of episodes of care without specific detail on dates for all services. More States are moving toward designing systems to accumulate the level of detail required for many performance measures.

The WC has specified and tested three administrative data-based measures: Identification, Initiation, and Engagement in Care.