Linking State Data to Identify Unmet Need for Drug Treatment in Women Aged 15-49

描述(由申请人提供)：药物治疗方案知道他们为谁服务，但只能估计他们不为谁服务；无法准确衡量未得到满足的治疗需求，特别是在育龄妇女中，这是制定干预措施以减少与毒品有关的妇女、子女和社会健康后果的关键障碍。该提案描述了一项创新合作，将现有的两个独立的州数据系统连接起来，以创建一个新的、独特的纵向流行病学数据库，将药物治疗数据与医院利用和健康结果数据结合起来，广泛确定与药物有关的问题和未得到满足的治疗需求的流行率，并跟踪马萨诸塞州育龄妇女及其子女与药物有关的健康结果。第一次，需要戒毒治疗服务的未接受治疗的妇女将能够被单独识别，从而能够更好地估计和描述未得到满足的需求。新的关联数据将允许通过多个数据来源评估满足和未满足治疗需求的妇女之间的差异，包括使用经过测试的算法来识别医院数据中的药物诊断。此外，相关数据将允许检查15-49岁妇女随后的健康结果，以及她们孩子的出生结果。将被连接的两个数据来源是：(1)基于人口的MA妊娠到早期生命纵向(PELL)数据系统，其中包括生命记录(出生、胎儿死亡和死亡)；出院、观察停留和急诊科就诊记录；以及MA出生缺陷登记处；以及(2)MA物质滥用服务局(BSAS)治疗数据系统，其中包含每年超过25,000名育龄妇女进入BSAS资助的药物滥用治疗机构的治疗记录。这项研究的三个主要目标是：1.将Pell数据与MDPH-BSAS治疗数据库联系起来，并验证联系。2.制定和试行方法a)在所有生殖年龄的MA妇女中，查明药物滥用或依赖的妇女(2002-2007年)，评估未得到满足的治疗服务需求，并描述治疗使用方面的差异；b)在分娩的MA妇女中(2003-2006年)，描述怀孕前、怀孕期间和怀孕后的药物问题的识别和治疗模式，按时机评估未得到满足的药物治疗需求，并描述妊娠结局；(C)在已发现毒品问题的MA妇女中，建立初步的多变量模型，包括预测接受治疗的诱因和有利因素，以及在分娩的妇女中，预测早产的风险。3.根据为本研究提出的双变量和多变量分析以及NIH/NIAAA的一项串联研究，制定一项R01建议，以描述药物滥用和治疗对妇女和儿童健康的影响。 公共卫生相关性：这一创新的公私合作将现有的两个独立的州数据系统(BSAS和Pell)连接起来，创建一个新的、唯一的纵向流行病学数据库，将药物治疗数据与医院利用和健康结果数据结合在一起，广泛识别与药物相关的问题和未得到满足的治疗需求的流行率，并跟踪马萨诸塞州育龄妇女与药物相关的健康和生育结果。第一次，需要药物治疗服务但没有接受药物治疗的女性将可以被单独识别，从而能够准确地估计和描述未得到满足的需求，这是改善针对育龄女性的国家药物治疗计划的关键一步。

DESCRIPTION (provided by applicant): Drug treatment programs know who they serve, but can only estimate who they do not serve; the inability to accurately measure unmet treatment need, especially among women of reproductive age, is a key barrier to developing interventions to reduce drug-related health consequences for women, their children, and society. This proposal describes an innovative collaboration to link two existing independent state data systems to create a new, unique longitudinal, epidemiologic database that combines drug treatment data with hospital utilization and health outcomes data, to broadly identify drug-related problems and the prevalence of unmet treatment need, and to track drug-related health outcomes among Massachusetts women of reproductive age and their children. For the first time, women in need of drug treatment services who did not receive them will be individually identifiable, allowing for better estimation and description of unmet need. The new linked data will permit assessment of disparities among women with met and unmet treatment need through multiple sources of data, including using a tested algorithm to identify drug diagnoses in hospital data. Moreover, the linked data will allow the examination of subsequent health outcomes among women ages 15-49, and birth outcomes among their children. The two data sources to be linked are: (1) the population-based MA Pregnancy to Early Life Longitudinal (PELL) data system that includes vital records (births, fetal deaths and deaths); hospital discharge, observational stay, and emergency department visit records; and the MA Birth Defects Registry; and (2) the MA Bureau of Substance Abuse Services (BSAS) treatment data system that contains treatment records for over 25,000 annual admissions of women of reproductive age to BSAS-funded substance abuse treatment facilities. The three broad study aims are: 1. Link PELL data to the MDPH-BSAS Treatment Database and verify linkages. 2. Develop and pilot methods a) among all MA women of reproductive age, identify women with drug abuse or dependence (2002-2007), assess unmet need for treatment services, and characterize disparities in treatment use; b) among MA women who had deliveries (2003-2006), describe the pattern of identification and treatment of drug problems in the periods before, during, and after pregnancy, assess unmet need for drug treatment by timing, and characterize pregnancy outcomes; and c) among MA women with an identified drug problem develop preliminary multivariate models with predisposing and enabling factors predicting receipt of treatment, and, among women who delivered, risk for prematurity. 3. Develop an R01 proposal to describe the impact of substance abuse and treatment on women's and children's health, based on bivariate and multivariate analyses proposed for this study and a tandem NIH/NIAAA study. PUBLIC HEALTH RELEVANCE: This innovative public-private collaboration links two existing independent state data systems (BSAS and PELL) to create a new, unique longitudinal and epidemiologic database that combines drug treatment data with hospital utilization and health outcomes data, to broadly identify drug-related problems and the prevalence of unmet treatment need, and to track drug-related health and birth outcomes among Massachusetts women of reproductive age. For the first time, women in need of drug treatment services who did not receive them will be individually identifiable, allowing for accurate estimation and description of unmet need, a critical step to improve state drug treatment programs for women of reproductive age.