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

项目摘要 在美国，人们越来越关注种族间的差异和不平等。阿片类药物流行病 和COVID-19大流行暴露了预先存在的种族-民族差异，耻辱和隐性偏见， 治疗设置。有色人种药物使用障碍人群种族-民族差异的原因 (SUD)在临床遭遇的背景下，长期以来一直未得到充分研究。在这一行政建议中， 补充补助金，我们的目标是利用现有的数据，从母基金，“教练性能驱动 纽约医疗补助下基于价值的采购背景下的实践变化（CARE研究） （R33 DA 049252 -01）”，并通过使用解释性序列解决种族-民族差异来对其进行补充 混合方法的方法，指导下的基尔本框架，研究在医疗保健的差距。目标 这项研究的目的是（1）检测临床水平的种族差异，（2和3）了解临床 在具有高质量或低质量指标的诊所中遇到患者和提供者的经验。具体 目标1将通过使用医疗补助和其他州行政数据，通过检查诊所的变化来实现 水平差异和客户对以下患者就诊质量指标的使用：MOUD的使用，频率 个人和团体咨询，技术（即，远程保健）、尿液筛查、患者报告的治疗 进步和保留。具体目标2和3将参考目标1的调查结果。我们计划进行 对来自样本诊所的患者（目标2）和提供者（目标3）进行访谈，以了解不同的 患者与提供者接触的经验。总的来说，这些目标可以帮助解释为什么和如何种族- 种族差异归因于有色人种的结果加剧，因为他们专注于多个层面的 潜在因素包括他们的临床遭遇。我们提出的目标将为发展提供信息， 减少或消除SUD患者治疗差异的干预措施。

Project Summary There is increasing attention to racial-ethnic disparities and inequities in the United States. The opioid epidemic and the COVID-19 pandemic exposed pre-existing racial-ethnic disparities, stigma, and implicit biases in treatment settings. The causes of racial-ethnic disparities on populations of color with substance use disorder (SUD), in the context of clinical encounters, have been long understudied. In this proposed administrative supplement grant, we aim to leverage the existing data from the parent grant, “Coaching Performance Driven Practice Change in the Context of Value Based Purchasing Under New York Medicaid (CARE study) (R33DA049252-01)” and supplement it by addressing racial-ethnic disparities using an explanatory sequential mixed-methods approach, guided by the Kilbourne framework for studying disparities in healthcare. The aims of this research is to (1) detect clinic-level racial disparities in retention and (2 & 3) understand clinical encounter experiences of patients and providers across clinics that have high- or low-quality metrics. Specific Aim 1 will be achieved using Medicaid and other state administrative data, by examining variation at the clinic level disparities and clients’ use of the following quality metrics of patient encounters: use of MOUD, frequency of individual and group counseling, technology (i.e., telehealth), urine screening, patient reported treatment progress, and retention. Specific Aim 2 & 3 will be informed by findings from Aim 1. We plan to conduct interviews with patients (Aim 2) and providers (Aim 3) from a sample of clinics to understand diverse experiences in patient-provider encounters. Taken together, these aims can help explain why and how racial- ethnic disparities attribute to exacerbated outcomes for people of color by focusing on multiple levels of potential factors including their clinical encounters. Our proposed aims will inform the development of interventions that reduce or eliminate treatment disparities for patients with SUD.