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)，或者组织系统和支付者政策的变化是否会导致更多的EBP使用。展示支付政策作为采用循证做法的推动者的作用，可以为传播和执行科学作出贡献。这项研究将采用通过罗伯特·伍德·约翰逊基金会资助的推进复苏(AR)计划开发的干预措施。在AR中，12个州的支付者/治疗组织伙伴关系合作，消除了采用EBPS的系统性障碍，例如药物滥用障碍的药物辅助治疗。与单独的组织变革战略相比，将测试支付者和组织变革战略产生的“AR框架”，以检验其增加成瘾药物丁丙诺啡使用的能力。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，而且不是成瘾治疗的标准部分。在研究的所在地俄亥俄州，由于阿片类药物意外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。之所以选择俄亥俄州进行这项研究，是因为阿片类药物滥用对公共卫生的意义，以及俄亥俄州的每个县都是一个独立的支付者，提供了48个独特的合格支付者环境。这项试验将加深对付款人和治疗组织在执行和传播循证政策方面所发挥的作用的了解，并将重点放在阿片类药物滥用日益严重的公共卫生问题上。

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.