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以及相关的发病率和死亡率问题，俄勒冈州发起了一项新的全州范围内的努力，以 使用医疗补助福利设计，促进背部疼痛周围更安全的阿片类药物处方实践。在新的 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范围，并要求 医生与接受背部疼痛慢性阿片类药物治疗的患者制定一项计划，通过 2018年初。与此同时，俄勒冈州医疗补助计划扩大了非药理学健康服务的覆盖范围 背部疼痛，包括针灸、脊椎按摩、认知行为疗法、生理和 职业治疗、瑜伽、按摩和有指导的运动疗法。 这项政策在美国是第一次，如果成功，可以作为美国其他州的榜样。 将长期阿片类药物治疗的潜在危害降至最低，同时提供其他循证选择 止痛。我们将使用犹他州的医疗补助参与者来检查这项政策的临床和经济影响 背痛和俄勒冈州和犹他州没有背痛的医疗补助参与者作为对照组，允许我们 以隔离该政策的效果。 这项研究有三个具体目标：第一，我们将评估OBPP对阿片类和非阿片类药物的影响 非药物疗法的处方和使用。第二，我们将评估该政策对a)的影响。 与阿片类药物相关的临床结果(例如，过量)或出现阿片类药物使用障碍b)与背部疼痛有关 临床结果，如先进的成像和/或手术需求和c)整体医疗服务 背痛或与阿片类药物相关的医疗就诊、处方药、 和非药理学服务。最后，我们将与利益相关者进行访谈，并与 管理人员和临床医生确定实施方法、障碍和感知的有效性 政策的一部分。 研究结果将向全国的政策制定者、卫生行政人员和从业者通报 大规模实施效益设计政策以增加循证应用的有效性 并减少与阿片类药物有关的危害。

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.