Improving value-based healthcare delivery for opioid use disorder

改善阿片类药物使用障碍的基于价值的医疗保健服务

• 批准号: 10435566
• 负责人: Heather Hsu
• 金额: $ 17.59万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10435566
• 关键词: Address; Adopted; Advisory Committees; American; Applied Research; Benchmarking; Boston; Caring; Cause of Death; Clinical; Community Surveys; Complex; Data; Diabetes Mellitus; Educational workshop; Effectiveness; Electronic Health Record; Enrollment; Ensure; Evidence based intervention; Evidence based treatment; Foundations; Funding; Goals; Group Practice; Health; Health Care Reform; Health Services Research; Health system; Healthcare; Healthcare Systems; Home; Homelessness; Hospitals; Hypertension; Incentives; Infectious Disease Epidemiology; Interruption; Intervention; K-Series Research Career Programs; Knowledge; Lead; Link; Managed Care Programs; Massachusetts; Measures; Medicaid; Medical; Medical center; Medicine; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; National Institute of Drug Abuse; Natural experiment; Neighborhood Health Center; Neighborhoods; Organizational Models; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Performance; Persons; Pharmacotherapy; Physicians; Positioning Attribute; Prevention strategy; Principal Investigator; Process; Provider; Public Health; Quality of Care; Quasi-experiment; Research; Research Design; Research Personnel; Retrospective cohort study; Risk; Risk Adjustment; Risk Factors; Service delivery model; Strategic Planning; Substance Use Disorder; System; Time Series Analysis; Training; Treatment Efficacy; United States; Universities; addiction; base; behavioral health; beneficiary; care costs; care delivery; care outcomes; care providers; career; comparison group; cost; disability; econometrics; effectiveness evaluation; efficacious treatment; evidence base; experience; health care delivery; health care model; health care quality; health economics; health management; housing instability; improved; innovation; medical schools; member; novel; opioid use disorder; payment; population health; predictive modeling; primary outcome; programs; safety net; skills; social; social health determinants; substance use; treatment strategy; uptake

Project Summary Opioid use disorder (OUD) is an increasingly common cause of death, disability, and cost to the healthcare system. Though evidence-based OUD treatment exists, uptake is often poor; and those with OUD frequently have profound health-related social needs that complicate their care. Improving OUD outcomes depends not only on treatment efficacy, but also on optimizing the healthcare delivery and payment systems in which efficacious treatments are deployed. Value-based care – a healthcare delivery and payment model that aims to incentivize value rather than volume of care – represents a widespread approach to healthcare reform touted for its potential to improve OUD care processes and outcomes. Despite this promise, however, large knowledge gaps remain in our understanding of whether – and how – value-based care may promote quality care for people with OUD. This K01 proposal therefore leverages an opportunity to assess the effectiveness of value-based care delivery for OUD in the context of Massachusetts’ implementation of an innovative new Medicaid accountable care organization (ACO) model of care. The Massachusetts Medicaid ACO program is the first of its kind to base ACO payments not only on beneficiaries’ medical complexity, but also on behavioral health and social complexity. The research aims are to use implementation of this novel ACO program as a natural experiment to 1) assess the impact of value-based care reform on OUD care quality, 2) understand whether current risk adjustment methods for setting ACO payments adequately cover costs of care for socially complex patients with OUD and housing instability, and 3) develop a pilot risk adjustment model for OUD care quality measures. The Principal Investigator, Dr. Heather Hsu, is an early career clinician-investigator with prior research experience at the intersection of infectious disease epidemiology, health services research, and value-based care. With this K01, she seeks to transition the clinical focus of her research to substance use, focusing on developing content expertise in addiction healthcare delivery and advanced methodologic skills in quasi-experimental study design and risk adjustment for quality and payment. Dr. Hsu will acquire these skills and conduct the proposed research at Boston Medical Center and Boston University School of Medicine, national leaders in addiction medicine and research and home to the largest group of Medicaid ACOs in Massachusetts. The proposal is supported by an interdisciplinary mentorship and advisory team with expertise in addiction medicine, substance use research, social determinants of health, advanced methods for causal inference, health economics, econometrics, and risk adjustment. Training will be accomplished through an intensive combination of formal coursework, workshops, field experience, applied research experience, guided tutorials, and focused mentorship. At the end of the K01 award period, Dr. Hsu will be well-positioned to accomplish her long-term goal to become an independent investigator and expert on improving value-based healthcare delivery to persons with substance use disorders.

项目概要 阿片类药物使用障碍 (OUD) 是导致死亡、残疾和医疗费用的日益常见的原因 系统。尽管存在基于证据的 OUD 治疗，但采用率往往很低；以及经常患有 OUD 的人 具有与健康相关的深刻社会需求，这使他们的护理变得复杂。改善 OUD 结果并不取决于 不仅注重治疗效果，还注重优化医疗保健服务和支付系统，其中 采取有效的治疗措施。基于价值的护理——一种医疗保健提供和支付模式，旨在 激励价值而不是护理量——代表了一种广泛宣传的医疗改革方法 因其具有改善 OUD 护理流程和结果的潜力。尽管有这样的承诺，但是，大 我们对基于价值的护理是否以及如何提高质量的理解仍然存在知识差距 照顾 OUD 患者。因此，本 K01 提案利用了一个评估以下方案有效性的机会： 在马萨诸塞州实施创新的新政策的背景下，为 OUD 提供基于价值的护理服务 医疗补助责任护理组织 (ACO) 护理模式。马萨诸塞州医疗补助 ACO 计划是 同类中第一个不仅基于受益人的医疗复杂性，而且还基于行为的 ACO 付款 健康和社会复杂性。研究目的是利用这一新颖的 ACO 计划的实施作为 自然实验 1) 评估基于价值的护理改革对 OUD 护理质量的影响，2) 了解 目前设定 ACO 付款的风险调整方法是否足以涵盖社会护理费用 患有 OUD 和住房不稳定的复杂患者，以及 3) 开发 OUD 护理试点风险调整模型 质量措施。首席研究员 Heather Hsu 博士是一位早期职业临床医生研究员，拥有丰富的临床经验 在传染病流行病学、卫生服务研究和 基于价值的护理。通过这款 K01，她试图将研究的临床重点转向药物使用， 专注于发展成瘾医疗保健提供的内容专业知识和先进的方法技能 准实验研究设计以及质量和付款的风险调整。徐博士将获得这些技能 并在波士顿医学中心和波士顿大学医学院进行拟议的研究， 成瘾医学和研究领域的国家领导者，也是美国最大的医疗补助 ACO 群体的所在地 马萨诸塞州。该提案得到了具有专业知识的跨学科指导和咨询团队的支持 成瘾医学、物质使用研究、健康的社会决定因素、因果关系的先进方法 推理、卫生经济学、计量经济学和风险调整。培训将通过 正式课程、研讨会、现场经验、应用研究经验、指导的密集结合 教程和重点指导。在 K01 奖励期结束时，许博士将处于有利地位 实现她的长期目标，成为一名独立调查员和提高基于价值的专家 向患有物质使用障碍的人提供医疗保健服务。