The Impact of Health Care Reform on Addiction and HIV Services

说明(由申请人提供)：卫生保健改革立法对药物使用障碍患者，特别是艾滋病毒患者获得服务和扩大福利具有重大影响。这些情况与多种医疗和精神并存以及高昂的医疗费用有关。作为对RFA-DA-13-001的回应，拟议的研究重点是将于2014年实施的《平价医疗法案》(ACA)的主要内容，这可能会增加对SUD和艾滋病毒治疗服务的需求。这项研究评估了ACA对处于非常适合ACA实施研究的护理环境中的肥胖症患者的影响。Kaiser Permanente North California(KPNC)是一个大型医疗保健系统，提供综合的SUD和医疗治疗，并被指定为加州健康保险交易所小团体计划的全州基准。我们的创新方法是基于组织理论和卫生服务利用的综合概念模型。在这项阶段性研究中，R21阶段的目标为分析成员人口统计和临床复杂性、服务使用和成本的变化奠定了基础，使用了一组新登记的患有SUD的ACA前健康计划成员(n=3641)，其中包括同时患有SUDS和HIV的成员。在R33阶段，我们使用事后设计将R21队列与第二个ACA后队列进行比较，这些队列是使用SUD的新登记的KPNC成员，使用先进的差异分析方法来分析2014年开始的ACA相关变化。主要成果包括成员变化、卫生服务利用和成本、SUD治疗的启动和保留以及艾滋病毒管理。ACA后的队列也将在两年多的时间里进行纵向跟踪。通过创新的混合方法，我们使用来自健康计划广泛的电子病历的数据，并辅之以对组织和临床领导人的定性采访，内容涉及与ACA相关的福利计划、服务交付、劳动力以及影响ACA实施的障碍或促进者的变化。研究结果将有助于理解卫生计划如何实施ACA并为新参保的SUD和HIV患者提供服务，并将有助于未来的卫生政策。

DESCRIPTION (provided by applicant): Health care reform legislation has significant implications for access to services and expansion of benefits for those with substance use disorders (SUD), particularly those with HIV. These conditions are associated with multiple medical and psychiatric comorbidities as well as high health care costs. Responding to RFA-DA-13-001, the proposed study focuses on key elements of the Affordable Care Act (ACA) that will be implemented in 2014 and will likely increase demand for SUD and HIV treatment services. The study evaluates the impact of the ACA on individuals with SUDs in a care setting well-suited to ACA implementation research. Kaiser Permanente Northern California (KPNC) is a large health care system providing integrated SUD and medical treatment and has been designated as the statewide benchmark for small group plans in the California health insurance exchange. Our innovative approach is informed by an integrated conceptual model of organizational theory and health service utilization. In this phased study, the Aims of the R21 phase lay the groundwork for analyzing changes in membership demographics and clinical complexity, services use and costs, using a cohort (n=3641) of newly enrolled pre-ACA health plan members with SUDs, including members with both SUDs and HIV. In the R33 phase, we use a pre-post design to compare the R21 cohort to a second, post-ACA cohort of newly enrolled KPNC members with SUDs, using advanced difference-in-difference methods to analyze ACA-related changes that begin in 2014. Key outcomes include membership changes, health services utilization and costs, SUD treatment initiation and retention, and HIV management. The post- ACA cohort will also be followed longitudinally over two years. With an innovative mixed-methods approach, we use data from the health plan's extensive electronic medical record, supplemented by qualitative interviews with organizational and clinical leaders regarding ACA-related changes to benefit plans, service delivery, workforce, and barriers or facilitators that impact ACA implementation. Findings will be highly informative in understanding how health plans implement the ACA and serve newly insured SUD and HIV patient populations, and will contribute to future health policy.