Opioid Overdoses among Medicaid Beneficiaries: Predictors, Outcomes, and State Policy Effects
医疗补助受益人中阿片类药物过量:预测因素、结果和国家政策影响
基本信息
- 批准号:10348125
- 负责人:
- 金额:$ 79.29万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2019
- 资助国家:美国
- 起止时间:2019-03-01 至 2025-01-31
- 项目状态:未结题
- 来源:
- 关键词:AddressAdultAffectAlcoholsBenzodiazepinesCaringCause of DeathCessation of lifeCharacteristicsClinicalClinical ManagementClinical TreatmentCommunitiesComplexContractsDataDiagnosisDiseaseEventGoalsHealth PolicyHealth systemHealthcare SystemsIncidenceIndividualInterventionKnowledgeLinkMedicaidMedicalMental HealthMissouriModelingNatural experimentNew JerseyOpiate AddictionOpioidOutcomeOverdosePain managementPatientsPatternPlayPoliciesPolypharmacyPopulationPredictive FactorPublic HealthRiskRisk ReductionRoleSpottingsStatutes and LawsSubstance abuse problemSuicideSurvivorsSystemTreatment outcomeUpdateVariantbeneficiaryclinical riskcohortcomorbiditydisabilitydosageexperienceexperimental studyheroin usehigh riskhigh risk populationimprovedimproved outcomeindexingmedication-assisted treatmentmultiple chronic conditionsopioid abuseopioid epidemicopioid overdoseopioid useopioid use disorderoutcome predictionoverdose preventionoverdose riskprescription opioidprogramsrespiratoryresponsesuccesssystemic interventiontreatment disparitytreatment services
项目摘要
Reducing opioid overdose is an urgent national goal that needs to be supported with the best available
understanding of the clinical, treatment, and health system factors that predict overdoses, and points of
intervention for their reduction. For individuals surviving medically treated overdoses, there is a need to better
understand the factors affecting risk of fatal overdose, including effects of post-overdose treatment, in order to
reduce the death toll in this high-risk population. To inform systemic intervention, there is an urgent need for
evidence on the role of state policies in reducing risk and improving outcomes. These issues are particularly
vital in the Medicaid population, which contributes disproportionately to the national overdose toll.
To build evidence on these vital issues, we will use 45-state Medicaid data from 2001-2019, linked to
the National Death Index (NDI), supplemented with regularly updated state data from New Jersey and
Missouri, to identify the interacting factors contributing to overdose risk and to outcomes for overdose
survivors. Under Aim 1, overdose risk will be examined in national incidence cohorts of Medicaid beneficiaries
with new episodes of persistent opioid use, and those with new diagnoses of opioid use disorder (OUD). To
analyze both non-fatal and fatal overdoses, we will link Medicaid data with the NDI for 50,000 individuals with
new persistent use, and 50,000 individuals with new OUD diagnoses, for each year of the Medicaid data,
totaling 950,000 in each cohort over the study period. Under Aim 2, we will examine treatment engagement
and survival following non-fatal medically treated overdoses, linking Medicaid and NDI data on these
overdoses to identify factors affecting post-overdose treatment and outcomes. Under Aim 3, we will examine
the impact of an important natural experiment in state policy: the 2017 enactment of major New Jersey
legislation. Changes included new limitations on opioid prescribing; use of pain management contracts; and
expanded access to medication assisted treatment (MAT) for opioid use disorder. Substantial increases in
Medicaid rates for MAT and other OUD treatment were implemented concurrently. Using analytic models
similar to those in Aims 1 and 2, we will examine changes in overdose risk among individuals with new long-
term opioid use, and among those with new OUD diagnoses, before and after the implementation of the new
legislation, relative to comparison populations in states that did not implement similar policies.
These analyses will advance our fundamental understanding of opioid risks and outcomes in the
Medicaid population with its distinctive demographic characteristics and clinical challenges. By grounding
intervention policy in a more comprehensive understanding of overdose risk, and the complex intersection of
disability, multi-morbidity, and treatment services within which overdose events are embedded, results can
change the paradigm of overdose prevention to one that is informed by a better understanding of these events
and the individuals experiencing them.
减少阿片类药物过量是一项紧迫的国家目标,需要得到最好的支持
了解预测过量用药的临床、治疗和卫生系统因素,以及
进行干预以减少他们的数量。对于在药物过量治疗中存活下来的个人来说,有必要更好地
了解影响服药过量致死风险的因素,包括服药过量后治疗的影响,以便
减少这一高危人群的死亡人数。为了向系统性干预提供信息,迫切需要
国家政策在降低风险和改善结果方面的作用的证据。这些问题尤其是
在医疗补助人口中至关重要,这对全国过量服药人数的贡献不成比例。
为了在这些重要问题上建立证据,我们将使用2001-2019年45个州的医疗补助数据,这些数据与
国家死亡指数(NDI),补充了新泽西州和
密苏里州,以确定导致过量服药风险和过度服药后果的相互作用因素
幸存者。根据目标1,将在医疗补助受益人的全国发病队列中检查过量用药的风险
持续使用阿片类药物的新发作,以及那些被新诊断为阿片使用障碍的人(OUD)。至
分析非致命和致命的过量用药,我们将把医疗补助数据与NDI联系起来,
新的持续使用,以及每年医疗补助数据的50,000名新的OUD诊断患者,
在研究期间,每个队列总共有950,000人。在目标2下,我们将审查治疗参与度
以及非致命性药物过量治疗后的存活率,将医疗补助和NDI数据联系起来
过量用药以确定影响过量用药后治疗和结果的因素。在目标3下,我们将审查
州政策中一项重要的自然实验的影响:2017年新泽西州主要法案的颁布
立法。变化包括对阿片类药物处方的新限制;使用疼痛管理合同;以及
扩大获得阿片类药物使用障碍的药物辅助治疗(MAT)的机会。大幅增加
MAT和其他OUD治疗的医疗补助费率同时实施。使用分析模型
与目标1和目标2中的类似,我们将检查患有新的长期服用药物的个人过量服药风险的变化。
长期阿片类药物的使用,以及在新的OUD诊断中,在新的实施前后
立法,相对于没有实施类似政策的州的比较人口。
这些分析将促进我们对阿片类药物风险和结果的基本理解
医疗补助人群以其鲜明的人口学特征和临床挑战。通过停飞
干预政策在更全面地了解服药过量的风险,以及复杂的交叉点
残疾、多种疾病和治疗服务,其中包含过量用药事件,结果可能
将预防过量用药的范例改为通过更好地了解这些事件而获得信息的范例
以及经历它们的个体。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Stephen Crystal其他文献
Stephen Crystal的其他文献
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{{ truncateString('Stephen Crystal', 18)}}的其他基金
Improving MOUD Access, Opioid-Related Outcomes and Equity Among Medicare Beneficiaries with Disability
改善残疾医疗保险受益人的 MOUD 获取、阿片类药物相关成果和公平
- 批准号:
10693295 - 财政年份:2022
- 资助金额:
$ 79.29万 - 项目类别:
Improving MOUD Access, Opioid-Related Outcomes and Equity Among Medicare Beneficiaries with Disability
改善残疾医疗保险受益人的 MOUD 获取、阿片类药物相关成果和公平
- 批准号:
10583892 - 财政年份:2022
- 资助金额:
$ 79.29万 - 项目类别:
Fatal and Non-Fatal Opioid Overdose Risk Following Prison Release: Associations with Individual Risk Factors, In-Prison Medications for Opioid Use Disorder, and Peer Navigation
出狱后致命和非致命阿片类药物过量风险:与个人风险因素、监狱内治疗阿片类药物使用障碍的药物以及同伴导航的关联
- 批准号:
10370150 - 财政年份:2019
- 资助金额:
$ 79.29万 - 项目类别:
Asian Resource Centers for Minority Aging Research (RCMAR)
亚洲少数民族老龄化研究资源中心 (RCMAR)
- 批准号:
10224080 - 财政年份:2018
- 资助金额:
$ 79.29万 - 项目类别:
Advancing Patient Safety for Antipsychotic-Treated Children: Examining State Implementation of Safe Use Practices
提高接受抗精神病药物治疗的儿童的患者安全:检查国家安全使用实践的实施情况
- 批准号:
10213135 - 财政年份:2018
- 资助金额:
$ 79.29万 - 项目类别:
Advancing Patient Safety for Antipsychotic-Treated Children: Examining State Implementation of Safe Use Practices
提高接受抗精神病药物治疗的儿童的患者安全:检查国家安全使用实践的实施情况
- 批准号:
9980917 - 财政年份:2018
- 资助金额:
$ 79.29万 - 项目类别:
Advancing Patient Safety for Antipsychotic-Treated Children: Examining State Implementation of Safe Use Practices
提高接受抗精神病药物治疗的儿童的患者安全:检查国家安全使用实践的实施情况
- 批准号:
9791352 - 财政年份:2018
- 资助金额:
$ 79.29万 - 项目类别:
Advancing Patient Safety for Antipsychotic-Treated Children: Examining State Implementation of Safe Use Practices
提高接受抗精神病药物治疗的儿童的患者安全:检查国家安全使用实践的实施情况
- 批准号:
10456732 - 财政年份:2018
- 资助金额:
$ 79.29万 - 项目类别:
Asian Resource Centers for Minority Aging Research (RCMAR)
亚洲少数民族老龄化研究资源中心 (RCMAR)
- 批准号:
10461013 - 财政年份:2018
- 资助金额:
$ 79.29万 - 项目类别:
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