National Quality Measure Fails to Capture Most Emergency Department Patients With Opioid Use Disorder

OBJECTIVES: Healthcare Effectiveness Data and Information Set (HEDIS) measure Follow-up After Emergency Department Visit for Substance Use (FUA) assesses care coordination after discharge from an emergency department visit for a high-risk substance-use event. We hypothesized that the FUA denominator undercounts OUD-related ED visits. METHODS: We audited a multihospital public health system's electronic health record (EHR) to identify ED visits by patients with OUD to compare these with the OUD visits captured in the system's automated FUA reporting. RESULTS: From April 1, 2024, through February 28, 2025, there were 1211 emergency department (ED) unique visits related to opioid use disorder (OUD) or overdose. Only 239 (19.7%) of OUD/overdose encounters were using HEDIS methods for FUA. In multivariable logistic regression, ED visits at one of the hospitals were less likely to be included in the FUA measure (adjusted odds ratio, 0.6, 95% CI: 0.4-0.9). CONCLUSIONS: We found the FUA measure failed to identify 4 out of 5 ED visits involving high-risk opioid use disorder-related events. This suggests FUA may obscure quality performance and introduces variability into the national quality measure.