Treatment for opioid use disorder in the Florida medicaid population: Using a cascade of care model to evaluate quality.
Treatment for opioid use disorder in the Florida medicaid population: Using a cascade of care model to evaluate quality.
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佛罗里达州医疗补助人群中阿片类药物使用障碍的治疗：使用一系列护理模型来评估质量。
DOI：
10.1080/00952990.2020.1824236
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发表时间：
2021-03-04
期刊：
影响因子：
--
通讯作者：
McGovern M
中科院分区：
文献类型：
--
作者：
Johnson K;Hills H;Ma J;Brown CH;McGovern M
连续护理（CoC）模式相较于当前的单一测量方法，可能会增进对成瘾治疗可及性和质量方面差距的理解。尽管资金有所增加，但阿片类药物过量使用率仍然很高。因此，了解医疗保健系统在为被诊断患有阿片类药物使用障碍的人提供护理方面存在哪些不足，并评估治疗接受情况的差异至关重要。
利用连续护理框架，按人口统计学特征以及主要诊断与次要诊断，评估2017/2018年佛罗里达州医疗补助人群中阿片类药物使用障碍的治疗质量和结果。
使用2017年和2018年佛罗里达州医疗补助报销数据来计算被诊断、开始用药、至少持续用药180天以及死亡的参保人数。
在被诊断患有阿片类药物使用障碍（OUD）的人中，只有28%开始使用经美国食品药品监督管理局（FDA）批准的药物进行治疗。一旦开始用药，38%的新诊断参保人能持续治疗180天。与未开始治疗的人相比，持续治疗180天的人死亡风险比为0.226（95%置信区间为0.174 - 0.294），死亡率从未接受治疗的10%降低到接受治疗的2%。
诊断后开始用药为减少过量死亡提供了最大的干预机会，不过提高患者持续治疗率的努力也是必要的。利用连续护理模式分析报销数据可确定特定人群的系统运行情况，并为改进提出政策和临床路径建议。
A cascade of care (CoC) model may improve understanding of gaps in addiction treatment availability and quality over current single measure methods. Despite increased funding, opioid overdose rates remain high. Therefore, it is critical to understand where the health-care system is failing in providing care for people with opioid use disorder diagnoses, and to assess disparities in treatment receipt. Using a CoC framework, assess treatment quality and outcomes for opioid use disorder in the Florida Medicaid population in 2017/2018 by demographics and primary vs. secondary diagnosis. Data from Florida Medicaid claims for 2017 and 2018 were used to calculate the number of enrollees who were diagnosed, began medication, were retained on medication for a minimum of 180 days, and who died. Only 28% of those diagnosed with OUD began treatment with an FDA approved medication. Once on medication, 38% of newly diagnosed enrollees were retained in treatment for 180 days. Those who remained in treatment for 180 days had a hazard ratio of death of 0.226 (95% CI = 0.174 to 0.294) compared to those that did not initiate treatment, a reduction in mortality from 10% without care to 2% with care. Initiating medication after diagnosis offers the greatest opportunity for intervention to reduce overdose deaths, though efforts to increase retention are also warranted. Analyzing claims data with CoC identifies system functioning for specific populations, and suggests policies and clinical pathways to target for improvement.
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影响因子：
120.7
作者：
Eisenberg, JM;Power, EJ
通讯作者：
Power, EJ
影响因子：
3.5
作者：
Schmidt, Eric M.;Gupta, Shalini;Harris, Alex H. S.
通讯作者：
Harris, Alex H. S.
影响因子：
33.9
作者：
Rudd, Rose A.;Seth, Puja;Scholl, Lawrence
通讯作者：
Scholl, Lawrence
DOI：
10.15585/mmwr.mm6751521e1
发表时间：
2018-01-04
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Scholl, Lawrence;Seth, Puja;Baldwin, Grant
通讯作者：
Baldwin, Grant
影响因子：
1.5
作者：
Fornili, Katherine S.;Fogger, Susanne A.
通讯作者：
Fogger, Susanne A.