Addictions treatment organizational response to COVID-19: impact on disparities in quality of care

项目摘要 新冠肺炎突发公共卫生事件给救治SUD带来了非同寻常的外源性冲击 组织，迫使他们提供护理的方式迅速改变。在新冠肺炎之前，治疗模式依赖于 主要依靠实体诊所提供亲身医疗和心理社会治疗，包括 通过医务室提供的专科门诊成瘾治疗(SOAT)和药物治疗 成瘾治疗(OBAT)。由于政府要求物理距离和放松 对使用远程医疗的限制，Soat和OBAT提供商迅速从根本上改变了他们的 工作流程，包括：新形式的医疗筛查和用药管理；在 允许患者在家里自行给药；通过以下方式通过个性化和小组会议进行治疗 远程保健；减少对药物使用筛查的依赖；以及治疗参与的新战略。这些 变化将对治疗保留、成瘾药物治疗的使用以及更长时间产生未知的影响- 期限结果。门诊治疗系统对这些外部因素的反应--既有暂时的，也有持久的 冲击将采取多种形式，具体取决于方案所处的组织和环境背景 做手术吧。有人担心，黑人/非裔美国人和拉丁裔患者--他们更有可能接受治疗 在更缺乏资源的计划中，获得电子健康技术的机会更少-将获得更差的质量 照顾和更糟糕的结果。我们将采用社会生态框架来研究 纽约州的哪些门诊治疗适应了外源性休克并分析了关系 在新的临床实践(例如，远程保健的使用)和最近的临床实践(例如，保留、使用药物治疗)之间 以及患者结局的远端(例如，过量用药、急诊科就诊)标记。此外，我们还将 审查种族/民族差异，这可能表明护理以及组织和社区方面的差异 可能导致差异的因素。我们提出了一种解释性的序贯混合方法设计来研究 治疗服务和结果的短期和长期变化。我们将首先使用管理 数据--与医疗补助的SUD治疗事件的州登记相结合--以研究治疗的差异 覆盖了545家SOAT诊所和3100家肥胖提供者。我们将研究治疗方法的变化： 临床交付(例如，使用远程医疗、小组咨询与个人咨询的混合)、药物治疗的使用 (例如，远程诱导、美沙酮自我给药的更大灵活性)和保留。到时候我们会的 检查这些做法变化与治疗结果之间的关系，如过量服药， 与物质相关的急诊科就诊和住院治疗。我们将采用定性的方法来 通过检查计划的组织特征，加深对量化结果的理解 代表那些具有最佳保留和治疗结果的人以及执行了 在这些衡量标准中是最糟糕的。这些发现将为治疗系统改革的临床和政策决策提供信息。

Project Summary The COVID-19 public health emergency gave an extraordinary exogenous shock to SUD treatment organizations, forcing rapid changes in how they provide care. Before COVID-19, the treatment model relied heavily on brick-and-mortar clinics to provide in-person medical care and psychosocial treatment, including specialty outpatient addictions treatment (SOAT) and pharmacotherapy provided through medical office-based addictions treatment (OBAT). Due to government mandates for physical distancing and relaxation of restrictions for using telehealth, both SOAT and OBAT providers quickly and fundamentally changed their workflows, including: new forms of medical screening and medication management; greater flexibility in allowing patient self-dosing of medication at home; treatment through individualized and group meetings via telehealth; reduced reliance on drug use screening; and new strategies for treatment engagement. These changes will have unknown effects on treatment retention, use of pharmacotherapy for addictions, and longer- term outcomes. The outpatient treatment system responses—both temporary and enduring—to these external shocks will take many forms depending on the organizational and environmental context in which programs operate. There is concern that Black/African American and Latinx patients—who are more likely to receive care in more poorly resourced programs and have lower access to eHealth technology—will receive poorer quality care and worse outcomes. We will employ a social-ecological framework to examine the conditions under which outpatient treatment across New York State adapted to the exogenous shock and analyze relationships between new clinical practices (e.g., use of telehealth) and proximal (e.g., retention, use of pharmacotherapy) and distal (e.g., overdoses, emergency department visits) markers of patient outcomes. Further, we will examine racial/ethnic variation that may indicate disparities in care as well as organizational and community factors that may account for disparities. We propose an explanatory sequential mixed-methods design to study both short term and longer-term changes to treatment services and outcomes. We will first use administrative data—joining a state registry of SUD treatment episodes with Medicaid—to study variation in treatment practices across 545 SOAT clinics and 3100 OBAT providers. We will examine changes to treatment practice: clinical delivery (e.g., use of telehealth, mix of group versus individual counseling), use of pharmacotherapy (e.g., remote induction, greater flexibility in methadone self-administration), and retention. We will then examine the association between these practice changes and treatment outcomes, such as overdoses, substance-related emergency department visits, and hospitalizations. We will employ qualitative methods to develop an understanding of the quantitative findings by examining organizational characteristics of programs representative of those that have best retention and treatment outcomes as well as programs that performed worst on these measures. The findings will inform clinical and policy decisions on treatment system reforms.