Implementation, Outcomes, and Cost of a Novel Medicaid Policy to Reduce Opioids for Back Pain

项目摘要 为了解决阿片类药物滥用和相关的发病率和死亡率，俄勒冈州发起了一项新的全州范围的努力， 使用医疗补助福利设计来促进更安全的阿片类药物处方实践。根据新 政策，俄勒冈州医疗补助将大幅限制阿片类药物治疗急性背痛的覆盖面，并要求 医生制定一项计划，与慢性阿片类药物治疗背痛的患者逐渐减少这种治疗， 2018年初。同时，俄勒冈州医疗补助计划扩大了非药物卫生服务的覆盖范围， 背部疼痛，包括针灸，脊椎按摩，认知行为疗法，物理和 职业疗法、瑜伽、按摩和监督运动疗法。 这项政策是该国第一项此类政策，如果成功，可以作为其他国家的典范。 最大限度地减少长期阿片类药物治疗的潜在危害，同时提供其他循证选择， 减轻疼痛。我们将使用犹他州的医疗补助计划注册者来检验该政策的临床和经济效果 与背痛和俄勒冈州和犹他州医疗补助登记者没有背痛作为对照组，使我们 来隔离政策的影响。 本研究有三个具体目的：首先，我们将评估OBPP对阿片类和非阿片类药物的影响 处方和使用非药物治疗。其次，我们将评估政策对a） 阿片样物质相关的临床结果（例如，过量）或发生阿片类药物使用障碍B）背痛相关 临床结局，如高级成像和/或手术需求所示，以及c）整体医疗保健服务 背痛或阿片类药物相关医疗保健就诊、处方药的利用率和医疗保健总支出， 非药物服务。最后，我们将进行利益相关者访谈和焦点小组， 管理人员和临床医生描述实施方法、障碍和感知效果 的政策。 研究结果将告知政策制定者，卫生管理人员和全国范围内的从业人员， 大规模实施福利设计政策以增加使用循证 减少阿片类药物相关的危害。

Project Summary To address opioid misuse and related morbidity and mortality, Oregon has initiated a novel statewide effort to use Medicaid benefit design to promote safer opioid prescribing practices around back pain. Under the new policy, Oregon Medicaid will sharply curb coverage of opioid medications for acute back pain and require physicians to develop a plan with patients on chronic opioid therapy for back pain to taper off this therapy by early 2018. Concurrently, Oregon Medicaid has expanded coverage of nonpharmacologic health services for back pain, including acupuncture, chiropractic manipulation, cognitive behavioral therapy, physical and occupational therapy, yoga, massage and supervised exercise therapy. This policy is the first of its kind in the country, and if successful, could serve as a model for other states in minimizing the potential harms of long-term opioid therapies while providing other evidence-based options to relieve pain. We will examine the clinical and economic effects of the policy, using Utah Medicaid enrollees with back pain and Oregon and Utah Medicaid enrollees without back pain as comparison groups, allowing us to isolate the effect of the policy. The study has three specific aims: First, we will evaluate the impact of the OBPP on opioid and non-opioid prescribing and use of non-pharmacologic therapies. Second, we will evaluate the impact of the policy on a) opioid-related clinical outcomes (e.g., overdose) or development of opioid use disorders b) back pain related clinical outcomes, as indicated by advanced imaging and/or need for surgery and c) overall healthcare service utilization and total health care spending for back-pain or opioid-related health care visits, prescription drugs, and non-pharmacologic services. Finally, we will conduct stakeholder interviews and focus groups with administrators and clinicians to characterize implementation approaches, barriers, and perceived effectiveness of the policy. Study findings will inform policymakers, health administrators, and practitioners nationwide on the effectiveness of large-scale implementation of benefit design policy to increase use of evidence-based practices and reduce opioid-related harms.