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

项目摘要 美国的种族-民族差异和不平等现象日益受到关注。阿片类药物的流行 新冠肺炎大流行暴露了先前存在的种族差异、耻辱和隐性偏见 治疗设置。物质使用障碍有色人种人群种族差异的原因 (SUD)，在临床接触的背景下，长期以来一直没有得到充分的研究。在这项拟议的行政管理中 补充奖助金，我们的目标是利用来自父母奖助金的现有数据，“教练业绩驱动 纽约医疗补助计划下基于价值的采购背景下的实践变化(CARE研究) (R33DA049252-01)“，并通过使用解释性顺序解决种族-民族差异来补充它 混合方法，在基尔本框架的指导下，用于研究医疗保健方面的差异。目标 这项研究的目的是(1)检测临床水平的种族差异，(2)了解临床 遇到具有高质量或低质量指标的诊所的患者和提供者的体验。特定的 目标1将使用医疗补助和其他州管理数据，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：使用Moud、频率 个人和团体咨询、技术(即远程医疗)、尿检、患者报告治疗 进步和保留。具体目标2和3将以目标1的调查结果为依据。我们计划进行 对来自诊所样本的患者(目标2)和提供者(目标3)进行访谈，以了解不同 患者与提供者接触的经验。综上所述，这些目标可以帮助解释为什么以及如何种族- 种族差异归因于通过关注多个层面的 潜在的因素，包括他们的临床遭遇。我们提出的目标将为发展 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.