Alternative payment models and alcohol use disorder treatment and consequences

替代支付模式和酒精使用障碍治疗及后果

• 批准号: 10464490
• 负责人: Susan H Busch
• 金额: $ 63.7万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-10 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10464490
• 关键词: Acute; Adult; Alcohols; Americas; Award; Black race; COVID-19; Caring; Chronic; Clinic; Clinical; Communities; Complex; Conflict (Psychology); Cost Savings; County; Crime; Data; Disadvantaged; Evidence based treatment; Grant; Health; Health Services; Health system; Hispanic; Improve Access; Incentives; Individual; Information Systems; Infrastructure; Interdisciplinary Health Team; Investments; Low income; Medicaid; Medical; Mental Health; Methodology; Modeling; Outcome; Outpatients; Patient-Focused Outcomes; Patients; Performance; Physicians; Policies; Primary Health Care; Prospective Payment System; Provider; Public Health; Quasi-experiment; Recovery; Reimbursement Mechanisms; Reporting; Research; Research Personnel; Resources; Savings; Services; Substance Use Disorder; Surgeon; System; Telemedicine; Traffic accidents; Training; Treatment outcome; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; addiction; alcohol use disorder; behavioral health; black patient; cost; design; evidence base; flexibility; health disparity populations; improved; information technology workforce; interest; intimate partner violence; medical specialties; pandemic disease; payment; policy implication; preventable death; programs; public health emergency; screening; service delivery; societal costs; treatment services; vehicular accident

PROJECT SUMMARY Alcohol Use Disorder (AUD) is one of the leading causes of preventable death in the US and has high personal and societal costs. Despite the widespread acceptance that evidence-based treatments exist for AUD, less than one in nine individuals with AUD report receiving specialty treatment. Challenges are particularly acute in disadvantaged communities. Only 60 percent of US counties have a specialty substance use disorder (SUD) treatment clinic that accepts Medicaid, despite Medicaid being the largest payer of addiction treatment services in the US. In 2017, The Centers for Medicare and Medicaid Services initiated the Certified Community Behavioral Health Clinic (CCBHC) demonstration, a program designed to increase access and the receipt of evidence-based care in Medicaid in eight states. As a part of this initiative, CCBHCs were required to provide nine services chosen to improve access; to provide data on quality metrics; and to engage in a prospective payment system. Since the initial 66-clinic demonstration, the CCBHC program has expanded to over 240 clinics in 40 states; A primary distinction between the initial demonstration and the expanded model is that in the expanded model clinics retain traditional reimbursement mechanisms but are awarded a large annual grant (~$2 million). We use a quasi-experimental approach to compare changes in the receipt of AUD services before and after CCBHC program implementation with changes in the receipt of AUD services in a set of matched comparison clinics (or counties). Our project brings together an interdisciplinary team of health services researchers, physicians, and economists with the methodological and substantive expertise to examine this understudied issue and explore its complex public health, clinical, and policy implications. Our specific aims are to assess whether CCBHC implementation was associated with: 1a) Changes in AUD identification and treatment quality; 1b) Differential changes in AUD identification and treatment quality in demonstration versus expansion clinics; 2) Differential changes in AUD treatment receipt and quality during the COVID-19 public health emergency in CCBHC compared to non-CCBHC clinics; and 3) Changes in trajectories of public health outcomes, including county-level reports of crime and alcohol-involved fatal motor vehicle accidents. This grant is responsive to NOT-AA-20-022, “Notice of Special Interest: Advances in Research for the Treatment, Services, and Recovery of Alcohol Use Disorder” and will provide information ‘to bridge the gap between those who need treatment and those who receive treatment.’ In addition, we focus on the Medicaid program, which disproportionately serves NIH-designated US health disparity populations. The significance of this study lies in its focus on how to optimize delivery systems to improve treatment and outcomes associated with AUD, a growing challenge and understudied policy issue.

项目概要 酒精使用障碍 (AUD) 是美国可预防死亡的主要原因之一，并且对个人影响很大 和社会成本。尽管人们普遍认为 AUD 存在基于证据的治疗方法，但较少 超过九分之一的 AUD 患者报告正在接受特殊治疗。挑战尤其严峻 弱势社区。美国只有 60% 的县患有特殊物质使用障碍 (SUD) 尽管医疗补助是成瘾治疗服务的最大支付者，但接受医疗补助的治疗诊所 在美国。 2017 年，医疗保险和医疗补助服务中心发起了认证社区 行为健康诊所 (CCBHC) 示范，这是一个旨在增加访问和接收的计划 八个州医疗补助中的循证护理。作为该举措的一部分，CCBHC 需要提供 选择九项服务来改善准入；提供质量指标数据；并从事前瞻性的 支付系统。自最初的 66 家诊所示范以来，CCBHC 计划已扩展到 240 多家 40 个州的诊所；初始演示和扩展模型之间的主要区别在于 扩大后的示范诊所保留了传统的报销机制，但每年获得大笔补助金 （约 200 万美元）。我们使用准实验方法来比较澳元服务接收的变化 CCBHC 计划实施前后，一组 AUD 服务接收情况发生变化 匹配的比较诊所（或县）。我们的项目汇集了一支跨学科的健康团队 为研究人员、医生和经济学家提供方法论和实质性专业知识服务 研究这个尚未得到充分研究的问题，并探讨其复杂的公共卫生、临床和政策影响。我们的 具体目标是评估 CCBHC 的实施是否与以下因素相关： 1a) 澳元的变化 识别和治疗质量； 1b) AUD 识别和治疗质量的差异变化 示范诊所与扩展诊所； 2）AUD治疗接收和质量的差异变化 与非 CCBHC 诊所相比，CCBHC 的 COVID-19 突发公共卫生事件； 3) 变化 公共卫生结果的轨迹，包括县级犯罪和酒精相关致命运动的报告 车辆事故。这笔赠款是对 NOT-AA-20-022“特别关注的通知：进展 酒精使用障碍的治疗、服务和康复研究”并将提供 信息“以弥合需要治疗的人和接受治疗的人之间的差距。” 此外，我们重点关注医疗补助计划，该计划不成比例地服务于 NIH 指定的美国医疗保健 人口差距。本研究的意义在于关注如何优化递送系统 改善与 AUD 相关的治疗和结果，这是一个日益严峻的挑战，也是未被充分研究的政策问题。