Developing an opioid use disorder treatment cascade: A review of quality measures.
Developing an opioid use disorder treatment cascade: A review of quality measures.
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DOI：
10.1016/j.jsat.2018.06.001
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发表时间：
2018-08
影响因子：
3.9
通讯作者：
Olfson M
中科院分区：
文献类型：
--
作者：
Williams AR;Nunes EV;Bisaga A;Pincus HA;Johnson KA;Campbell AN;Remien RH;Crystal S;Friedmann PD;Levin FR;Olfson M
尽管阿片类药物过量致死率不断上升，但阿片类物质使用障碍（OUD）治疗的可及性和质量问题仍然存在。三种经美国食品药品监督管理局批准的药物（美沙酮、丁丙诺啡和纳曲酮）有高质量的证据支持其使用，但大多数OUD患者并未接受这些药物治疗，且许多人在治疗后复发。在诸如“治疗阶梯”这样的统一框架下制定和组织质量衡量标准，可能会改善系统层面的实践和治疗效果。在此背景下，对与OUD治疗相关的现有质量衡量标准以及评估这些标准在社区实践中效用的文献进行了综述。
对两个国家质量衡量标准信息库（美国国家质量论坛和美国医疗保健研究与质量局）进行了系统性搜索，以查找可应用于OUD治疗的衡量标准。这些标准被归类为结构、过程或结果衡量标准。然后在Ovid/Medline中进行了第二阶段搜索，重点是已发表的研究，这些研究调查所确定衡量标准的可行性、可靠性和有效性、对其满意度的预测因素以及相关临床结果。
确定了七项适用于OUD治疗的质量衡量标准。这七项全部是评估服务提供模式的过程衡量标准。一项最近批准的衡量标准涉及OUD患者在药物辅助治疗中的留存情况。确定了29项已发表的研究对这些质量衡量标准进行评估，主要集中在成瘾治疗的起始和参与护理方面。大多数衡量标准和相关研究没有具体纳入OUD治疗的证据基础，也没有评估患者层面的结果，如过量用药情况。
尽管取得了相当大的进展，但OUD治疗的质量衡量标准仍存在差距。制定一个统一的质量衡量框架，如OUD治疗阶梯，将需要进一步详细阐述和完善不同人群和环境中的现有衡量标准。这样一个框架可以为在临床、组织和政策层面应用策略提供基础，以扩大获得优质护理的机会并降低与阿片类药物相关的死亡率。
Despite increasing opioid overdose mortality, problems persist in the availability and quality of treatment for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and naltrexone) have high quality evidence supporting their use, but most individuals with OUD do not receive them and many experience relapse following care episodes. Developing and organizing quality measures under a unified framework such as a Cascade of Care could improve system level practice and treatment outcomes. In this context, a review was performed of existing quality measures relevant to the treatment of OUD and the literature assessing the utility of these measures in community practice. Systematic searches of two national quality measure clearinghouses (National Quality Forum and Agency for Healthcare Research and Quality) were performed for measures that can be applied to the treatment of OUD. Measures were categorized as structural, process, or outcome measures. Second stage searches were then performed within Ovid/Medline focused on published studies investigating the feasibility, reliability, and validity of identified measures, predictors of their satisfaction, and related clinical outcomes. Seven quality measures were identified that are applicable to the treatment of OUD. All seven were process measures that assess patterns of service delivery. One recently approved measure addresses retention in medication-assisted treatment for patients with OUD. Twenty-nine published studies were identified that evaluate the quality measures, primarily focused on initiation and engagement in care for addiction treatment generally. Most measures and related studies do not specifically incorporate the evidence base for the treatment of OUD or assess patient level outcomes such as overdose. Despite considerable progress, gaps exist in quality measures for OUD treatment. Development of a unified quality measurement framework such as an OUD Treatment Cascade will require further elaboration and refinement of existing measures across populations and settings. Such a framework could form the basis for applying strategies at clinical, organizational, and policy levels to expand access to quality care and reduce opioid-related mortality.
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影响因子：
4.2
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