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

项目概要 迫切需要改善阿片类药物使用障碍 (OUD) 治疗质量的策略：增加阿片类药物的使用 OUD 药物治疗，提高六个月的保留率，并改善康复结果。对此，付款人表示 过渡到激励质量措施更好绩效的支付模式。然而，大多数 成瘾治疗诊所没有能力成为“学习系统”，无法利用质量措施来 推动临床护理的改进。诊所面临着资源有限和劳动力不足的挑战 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 该计划是付款人过渡到将付款与质量联系起来的新报销模式的一个例子 措施。在过去三年中，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，以缓解 向新的基于价值的支付模式的过渡。在一系列涉及健康问题的利益相关者会议之后 保险公司和成瘾项目，我们得出的结论是，诊所需要：a) 诊所级别的绩效衡量标准 能够指导质量管理； b) 来自外部辅导员的指导，帮助领导层和指导服务 管理科学背景有限的员工创建了质量驱动的组织； c) 工具 指导直接服务人员以患者为中心的临床护理，特别是共同决策和 监测患者的护理进展。根据这些经验和现有研究，我们 制定新的质量措施和战略，通过临床实践变革来协助项目， 将为本研究提供信息。我们建议进行一项两阶段研究来解决 OUD 治疗质量问题。第一个 阶段将包括一系列利益相关者会议，以就建议的质量措施、质量 随机试验的改进策略、提供者支持工具和研究策略。在此期间 试验的阶段、干预和研究方案将最终确定，并且将为提供者提供电子工具 开发的。第二阶段将包括一项针对 30 名门诊患者的阶梯式楔形随机对照试验 治疗诊所每年为大约 2,000 名 OUD 客户提供服务，以测试诊所级别是否 测量驱动的质量改进干预 (MDQI) 将改善 a) 处理过程质量 措施（OUD 药物的使用、治疗中的症状和治疗进展、治疗保留）以及 b) 恢复结果（药物使用、健康和医疗保健利用）。干预措施将使用外部 协调员为成瘾诊所提供指导，包含三个关键组成部分：1）数据培训 驱动管理； 2）以患者为中心的护理和OUD用药的培训和指导； 3) 电子 用于共享决策和患者进展监控的工具。在项目结束时，我们将拥有 制定具体的培训和指导协议以及电子临床支持工具来指导质量 可以在纽约和全国其他地区传播的改进措施。

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.