Developing Quality Measures for Opioid-Exposed Infants

为阿片类药物暴露婴儿制定质量措施

• 批准号: 10452970
• 负责人: Scott A Lorch
• 金额: $ 36.98万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10452970
• 关键词: Academy; Birth; Breast Feeding; Caring; Child Welfare; Clinical; Clinical Data; Clinical effectiveness; Code; Communities; Data; Data Set; Development; Diagnosis; Electronic Health Record; Emergency department visit; Exposure to; Family; Foundations; Geographic state; Goals; Health; Health Personnel; Health system; Healthcare; Hospitals; Infant; Infant Development; Inpatients; Insurance Carriers; Length; Length of Stay; Link; Measures; Medicaid; Medical; Medicine; Methods; Neonatal Abstinence Syndrome; Opioid; Outcome; Outcome Measure; Patients; Performance; Perinatal; Personal Satisfaction; Pharmaceutical Preparations; Pharmacological Treatment; Policy Developments; Policy Maker; Populations at Risk; Pragmatic clinical trial; Pregnant Women; Preventive service; Privatization; Process; Process Measure; Public Policy; Quality of Care; Randomized; Randomized Clinical Trials; Records; Reproducibility; Research; Research Personnel; Risk; Safety; Sampling; System; Time; Validity and Reliability; Variant; Vulnerable Populations; Withdrawal; Withdrawal Symptom; adverse outcome; care outcomes; clinical care; collaborative care; effectiveness measure; effectiveness study; experience; health care quality; improved; improved outcome; infant outcome; innovation; neglect; opioid exposure; opioid use; opioid use disorder; population based; provider behavior; readmission rates; response; standardized care; tool; usability

ABSTRACT Opioid use, diagnoses of opioid use disorder among pregnant women, and diagnoses of neonatal opioid withdrawal syndrome (NOWS) increased dramatically over the past 20 years. In 2017, an estimated 100,000 infants were exposed to opioids, among whom 25,000 infants were diagnosed with NOWS. Opioid-exposed infants, regardless of whether they are diagnosed with NOWS, are more likely to have adverse outcomes compared to similar non-exposed infants, including: longer and more complicated initial hospital stays, higher likelihood of involvement in the child welfare system, higher rates of hospital readmission and emergency department visits and lower use of recommended preventive services. Further, delivery of medical care to opioid-exposed infants remains variable resulting in uneven outcomes among US hospitals and communities. The development of valid and reliable measures for opioid-exposed infants is critical to improving outcomes for this vulnerable population. To fill this existing gap we will: 1) develop candidate measures of quality for opioid- exposed infants and refine these measures by engaging key stakeholders including local, state, and national public policy makers; private and public insurers; health care providers; and families using a modified RAND/UCLA Appropriateness Method; 2) determine the reliability, reproducibility and validity of measures of candidate quality measures while evaluating the usability, validity, and reliability of the measures using two unique sets of data, linked maternal-infant data from the Medicaid Analytic Extract from 2007-2014 and clinically collected data from two large clinical systems and will determine risk-adjusted hospital variation in measures for opioid-exposed infants in a large population-based sample. This R34 will produce quality measures for opioid-exposed infants and preliminary data that will subsequently inform an R01 pragmatic clinical trial that will evaluate how clinician performance on quality measures results in changes to provider behaviors and subsequent alterations in infant outcomes. In addition, these measures can also serve as the outcomes for randomized clinical trials that examine the impact of various treatments on the health and wellbeing of opioid-exposed infants and whether they experience withdrawal symptoms after birth. The ultimate goal of this R34 and subsequent R01s will be to provide innovative tools for clinicians, researchers, policymakers, payers, hospital systems and state perinatal collaboratives to improve care for opioid-exposed infants.

摘要 阿片类药物使用、孕妇中阿片类药物使用障碍的诊断和新生儿阿片类药物使用障碍的诊断 戒断综合征（NOWS）在过去20年中急剧增加。2017年，估计有10万人 婴儿暴露于阿片类药物，其中25，000名婴儿被诊断患有NOWS。阿片类药物暴露 无论婴儿是否被诊断为NOWS， 与类似的非暴露婴儿相比，包括：更长和更复杂的初始住院时间， 参与儿童福利系统的可能性，较高的再入院率和急诊率 对部门的访问和较少使用建议的预防服务。此外，向残疾人提供医疗服务， 阿片类药物暴露的婴儿仍然是可变的，导致美国医院和社区之间的结果不均衡。 为阿片类药物暴露的婴儿制定有效和可靠的措施对于改善 这个弱势群体。为了填补这一现有空白，我们将：1）制定阿片类药物质量的候选指标- 暴露的婴儿，并通过参与关键利益相关者，包括地方，州和国家， 公共政策制定者;私人和公共保险公司;卫生保健提供者;以及使用修改后的 兰德公司/加州大学洛杉矶分校适当的方法; 2）确定测量的可靠性，重现性和有效性， 候选的质量措施，同时评估的可用性，有效性和可靠性的措施，使用两个 独特的数据集，来自2007-2014年医疗补助分析摘录的关联母婴数据， 从两个大型临床系统收集的临床数据，并将确定风险调整后的医院差异， 在一个大的人群为基础的样本中，阿片类药物暴露的婴儿的措施。这款R34将生产高质量的 阿片类药物暴露婴儿的措施和初步数据，随后将告知R 01务实 一项临床试验，将评估临床医生在质量指标方面的表现如何导致供应商的变化 行为和随后的改变婴儿的结果。此外，这些措施还可以作为 随机临床试验的结果，检查各种治疗对健康的影响， 暴露于阿片类药物的婴儿的健康状况以及他们出生后是否会出现戒断症状。最终 R34和后续R 01的目标是为临床医生，研究人员， 政策制定者、支付者、医院系统和国家围产期合作机构，以改善对阿片类药物暴露者的护理 婴儿。