To Test A Payer/Treatment Agency Intervention to Increase Use of Buprenorphine

描述（由申请人提供）：来自威斯康星大学麦迪逊工程学院和俄勒冈州健康与科学大学的一组研究人员将测试临床医生培训和组织变革策略的使用是否足以传播循证实践（EBP），或者组织系统和付款人政策的变化是否会导致更多的EBP使用。证明支付政策作为采用循证做法的驱动力的作用，可以为传播和实施科学做出贡献。本研究将采用由罗伯特·伍德约翰逊基金会资助的促进恢复（AR）计划开发的干预措施。在AR中，12个州的付款人/治疗组织伙伴关系合作消除了采用EBP的系统性障碍，例如药物辅助治疗药物滥用障碍。由此产生的“AR框架”的付款人和组织变革战略将测试其能力，以增加使用成瘾药物丁丙诺啡相比，单独的组织变革战略。丁丙诺啡是一种EBP，用于治疗海洛因成瘾者或非医疗用途的阿片类止痛药。丁丙诺啡的采用率很低，并且不是成瘾治疗的标准组成部分。在研究所在地俄亥俄州，由于意外阿片类药物过量导致的死亡在过去十年中增加了304%，并在2006年超过车祸成为意外死亡的主要原因。选择俄亥俄州进行这项研究是因为阿片类药物滥用的公共卫生意义，也因为俄亥俄州的每个县都是独立的付款人，提供48个独特的合格付款人环境。这项试验将加深对支付者和治疗组织在实施和传播EBP方面所起作用的理解，并将重点关注阿片类药物滥用上升的公共卫生问题。

DESCRIPTION (provided by applicant): A team of researchers from the University of Wisconsin-Madison College of Engineering and Oregon Health & Science University will test whether clinician training and the use of organizational change strategies are sufficient for disseminating an evidence-based practice (EBP), or if changes to both organizational systems and payer policy result in greater EBP use. Demonstrating the role of payment policy as a driver in the adoption of evidence-based practices could provide a contribution to dissemination and implementation science. This study will employ an intervention that was developed through the Robert Wood Johnson Foundation-funded Advancing Recovery (AR) program. In AR, payer/treatment organization partnerships in 12 states collaborated to remove systemic barriers to the adoption of EBPs such as medication-assisted treatment for substance abuse disorders. The resulting "AR Framework" of payer and organizational change strategies will be tested against its ability to increase the use of the addiction medication buprenorphine as compared to organizational change strategies alone. Buprenorphine is an EBP for treating people addicted to heroin or opioid-based pain medications for non-medical use. Buprenorphine has experienced low adoption rates and is not a standard part of addiction treatment. In Ohio, the location of the study, deaths to due to accidental opioid overdoses have increased by 304% over the past decade and surpassed auto accidents as the leading cause of accidental deaths in 2006. Ohio was selected for the study because of the public health significance of opioid abuse and because each county in Ohio acts as a stand-alone payer, offering 48 unique eligible payer environments. This trial will develop a deeper understanding of the role payers and treatment organizations play in implementing and disseminating EBPs and will focus on the public health issue of rising opioid abuse.