Coaching Performance Driven Practice Change in the Context of Value Based Purchasing Under New York Medicaid

项目摘要 迫切需要提高阿片类药物使用障碍（OUD）治疗质量的战略：增加使用 OUD药物，增加六个月的保留率，并改善恢复结果。作为回应，付款人 过渡到奖励更好的质量指标的支付模式。但大多数 戒毒治疗诊所设备不足，无法成为“学习系统”， 推动临床护理的改善。诊所面临的挑战是有限的资源和劳动力， 在质量改进方法方面具有必要的经验或教育。纽约州医疗补助计划 该计划是付款人向将付款与质量挂钩的新报销模式过渡的一个例子 措施在过去的三年里，纽约州酗酒和药物滥用服务办公室 （OASAS）与成瘾中心合作，为治疗诊所提供技术援助， 向基于价值的新支付模式过渡。在一系列涉及健康的利益相关者会议之后， 保险公司和成瘾计划，我们得出结论，诊所需要：a）诊所级的绩效指标， 能够指导质量管理; B）外部促进者的辅导，帮助领导和直接服务 工作人员--他们在管理科学方面的背景有限--创建质量驱动的组织;以及c）工具 指导直接服务人员以患者为中心的临床护理，特别是共同决策， 监测患者在护理中的进展。根据这些经验和现有的研究，我们一直在 制定新的质量措施和战略，通过临床实践的变化， 将为这项研究提供信息。我们建议进行一项分两阶段的研究，以改善长者日间门诊的治疗质素。第一 阶段将包括一系列利益相关者会议，以获得关于建议的质量措施、质量 随机试验的改进策略、提供者支持工具和研究策略。在此 阶段，干预和研究方案的试验将最终确定和电子工具的供应商将 开发第二阶段将包括一个有30名门诊病人的阶梯楔形随机对照试验 每年为大约2,000名OUD客户提供治疗诊所，以测试诊所级别的 测量驱动的质量改进干预（MDQI）将提高a）治疗过程质量 措施（OUD药物的使用、治疗中症状和治疗进展、治疗保留）和 B）恢复结果（物质使用、健康和医疗保健利用）。 为成瘾诊所提供指导的促进者，包括三个关键组成部分：1）数据培训 驱动管理; 2）以患者为中心的护理和OUD药物的培训和指导;以及3）电子 用于共享决策和患者进展监测的工具。在项目结束时，我们将 制定了具体的培训和指导协议以及电子临床支持工具，以指导质量 这些改进可以在纽约和全国其他地方传播。

Project Summary There is an urgent need for strategies to improve opioid use disorder (OUD) treatment quality: increase use of OUD medication, increase six-month retention rates, and improve recovery outcomes. In response, payers are transitioning to payment models that incentivize better performance on quality measures. However, most addictions treatment clinics are ill-equipped to become `learning systems' that can use quality measures to drive improvements in clinical care. Clinics are challenged by limited resources and a workforce that doesn't have the requisite experience or education in quality improvement methods. The New York State Medicaid program is an example of a payer transitioning to new reimbursement models that link payment to quality measures. Over the past three years, the New York State Office on Alcoholism and Substance Abuse Services (OASAS) has worked with the Center on Addiction to provide technical assistance for treatment clinics to ease the transition to new value-based payment models. After a series of stakeholder meetings involving health insurers and addictions programs, we concluded that clinics need: a) clinic-level performance measures that can guide quality management; b) coaching from external facilitators that help the leadership and direct service staff—with their limited background in management science—create quality driven organizations; and c) tools to guide direct service staff on patient-centered clinical care, specifically for shared decision making and monitoring of patient progress in care. Drawing from these experiences and available research, we have been developing new quality measures and strategies for assisting programs through clinical practice change that will inform this study. We propose to conduct a two phase study to address OUD treatment quality. The first phase will include a series of stakeholder meetings to get input on recommended quality measures, quality improvement strategies, provider support tools, and research strategies for a randomized trial. During this phase, intervention and research protocols for the trial will be finalized and electronic tools for providers will be developed. The second phase will include a stepped-wedge randomized controlled trial with 30 outpatient treatment clinics serving approximately 2,000 OUD clients each year to test whether a clinic-level measurement-driven, quality improvement intervention (MDQI) will improve a) treatment process quality measures (use of OUD medications, in-treatment symptom and therapeutic progress, treatment retention) and b) recovery outcomes (substance use, health, and healthcare utilization).The intervention will use external facilitators to provide guidance to addictions clinics and contain three key components: 1) training on data driven management; 2) training and guidance on patient-centered care and OUD medication; and 3) electronic tools for shared decision making and patient progress monitoring. At the end of the project, we will have developed specific training and coaching protocols as well as electronic clinical support tools to guide quality improvement that can be disseminated within New York and the rest of the country.