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

项目摘要 COVID-19突发公共卫生事件给SUD治疗带来了非同寻常的外源性冲击 组织，迫使他们迅速改变如何提供护理。在COVID-19之前，治疗模式依赖于 严重依赖实体诊所提供面对面的医疗护理和心理治疗， 专科门诊成瘾治疗和药物治疗，通过医疗办公室提供 成瘾治疗（Obat）。由于政府要求保持身体距离和放松 由于使用远程医疗的限制，SOAT和OBAT提供商都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药物管理; 允许患者在家自行给药;通过个体化和小组会议进行治疗， 远程医疗;减少对药物使用筛查的依赖;以及治疗参与的新策略。这些 这些变化将对治疗保持率、药物治疗成瘾的使用以及更长的时间产生未知的影响。 长期成果。门诊治疗系统对这些外部因素的反应， 冲击将采取多种形式，这取决于项目所处的组织和环境背景 手术。人们担心，黑人/非洲裔美国人和拉丁美洲人的病人-谁更有可能接受治疗， 在资源更少的项目中，电子健康技术的使用率更低， 护理和更糟糕的结果。我们将采用一个社会生态框架来研究 整个纽约州的门诊治疗适应了外源性休克，并分析其关系 在新的临床实践（例如，远程医疗的使用）和近端（例如，保留，使用药物治疗） 和远端（例如，过量、急诊科就诊）患者结果的标记。此外，我们将 检查可能表明护理以及组织和社区差异的种族/民族差异 可能导致差异的因素。我们提出了一个解释性的顺序混合方法设计来研究 治疗服务和结果的短期和长期变化。我们将首先使用行政 将SUD治疗事件的州注册数据与Medicaid数据结合，以研究治疗的变化 545家SOAT诊所和3100家OBAT提供商的实践。我们将研究治疗实践的变化： 临床递送（例如，使用远程保健，团体与个人咨询相结合），使用药物治疗 (e.g.,远程诱导，美沙酮自我给药的更大灵活性）和保留。然后我们将 检查这些做法的变化和治疗结果之间的关联，如过量， 物质相关急诊就诊和住院。我们将采用定性方法， 通过检查项目的组织特征，了解定量结果 具有最佳保留和治疗结果的代表，以及执行 最糟糕的是这些措施。研究结果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.