Comparing alternative specifications of quality measures: access to pharmacotherapy for alcohol use disorders.

Availability and consideration of pharmacotherapy for the treatment of alcohol use disorders (AUD) are now consensus standards for evidence-based treatment. This study compares three competing specifications of the proportion of patients with AUD receiving approved medications. We examined how altering the numerator and denominator definitions affects observed rates of pharmacotherapy use and facilities' percentile ranks. Using pharmacy and administrative data from the Veterans Health Administration (VHA), three measures of pharmacotherapy receipt were calculated for 129 VHA facilities. Difference in measure specifications alters the overall estimates of pharmacotherapy receipt but unevenly across facilities, with some experiencing no change in percentile rank and others decreasing or increasing by over a quartile. The results demonstrate that the quality measures are not interchangeable, and the choice of which version to implement is of high consequence for some facilities.