Coaching Performance Driven Practice Change in the Context of Value Based Purchasing Under New York Medicaid

纽约医疗补助下基于价值的采购背景下辅导绩效驱动的实践变革

• 批准号: 10224954
• 负责人: Patricia Lincourt
• 金额: $ 61.98万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10224954
• 关键词: Address; Adherence; Admission activity; Alcoholism; Ambulatory Care; Attitude; Behavior; Caring; Client; Clinic; Clinical; Cost Measures; Country; Cream; Data; Development; Education; Emergency department visit; Health; Health Status; Hepatitis C; Homelessness; Incentives; Industry; Infection; Injections; Insurance Carriers; Intervention; Leadership; Learning; Link; Measurement; Measures; Medicaid; Medicine; Mental Health; Methods; Modeling; Monitor; New York; Outcome; Overdose; Patient Monitoring; Patient Self-Report; Patient-Centered Care; Patients; Performance; Pharmaceutical Preparations; Pharmacotherapy; Phase; Process; Protocols documentation; Provider; Randomized Controlled Trials; Recommendation; Recovery; Reporting; Research; Resources; Rest; Science; Series; Services; Substance abuse problem; System; Testing; Therapeutic; Training; Work; addiction; base; clinical care; clinical practice; cost; experience; follow-up; health care service utilization; improved; intervention cost; meetings; opioid use disorder; patient oriented; payment; programs; randomized trial; reduced substance use; response; retention rate; shared decision making; substance use; support tools; symptom treatment; tool; treatment group; treatment program

Project Summary There is an urgent need for strategies to improve opioid use disorder (OUD) treatment quality: increase use of OUD medication, increase six-month retention rates, and improve recovery outcomes. In response, payers are transitioning to payment models that incentivize better performance on quality measures. However, most addictions treatment clinics are ill-equipped to become `learning systems' that can use quality measures to drive improvements in clinical care. Clinics are challenged by limited resources and a workforce that doesn't have the requisite experience or education in quality improvement methods. The New York State Medicaid program is an example of a payer transitioning to new reimbursement models that link payment to quality measures. Over the past three years, the New York State Office on Alcoholism and Substance Abuse Services (OASAS) has worked with the Center on Addiction to provide technical assistance for treatment clinics to ease the transition to new value-based payment models. After a series of stakeholder meetings involving health insurers and addictions programs, we concluded that clinics need: a) clinic-level performance measures that can guide quality management; b) coaching from external facilitators that help the leadership and direct service staff—with their limited background in management science—create quality driven organizations; and c) tools to guide direct service staff on patient-centered clinical care, specifically for shared decision making and monitoring of patient progress in care. Drawing from these experiences and available research, we have been developing new quality measures and strategies for assisting programs through clinical practice change that will inform this study. We propose to conduct a two phase study to address OUD treatment quality. The first phase will include a series of stakeholder meetings to get input on recommended quality measures, quality improvement strategies, provider support tools, and research strategies for a randomized trial. During this phase, intervention and research protocols for the trial will be finalized and electronic tools for providers will be developed. The second phase will include a stepped-wedge randomized controlled trial with 30 outpatient treatment clinics serving approximately 2,000 OUD clients each year to test whether a clinic-level measurement-driven, quality improvement intervention (MDQI) will improve a) treatment process quality measures (use of OUD medications, in-treatment symptom and therapeutic progress, treatment retention) and b) recovery outcomes (substance use, health, and healthcare utilization).The intervention will use external facilitators to provide guidance to addictions clinics and contain three key components: 1) training on data driven management; 2) training and guidance on patient-centered care and OUD medication; and 3) electronic tools for shared decision making and patient progress monitoring. At the end of the project, we will have developed specific training and coaching protocols as well as electronic clinical support tools to guide quality improvement that can be disseminated within New York and the rest of the country.

项目摘要 迫切需要改善阿片使用障碍(OUD)治疗质量的战略：增加使用 通过药物治疗，增加六个月的保留率，改善康复结果。作为回应，付款人是 过渡到激励质量指标更好表现的支付模式。然而，大多数 成瘾治疗诊所装备不足，无法成为可以使用质量措施来 推动改善临床护理。诊所面临着资源有限和劳动力不足的挑战 在质量改进方法方面有必要的经验或教育。纽约州医疗补助计划 计划是付款人过渡到将付款与质量联系起来的新报销模式的一个例子 措施。在过去的三年里，纽约州酒精中毒和药物滥用服务办公室 (OASAS)已与成瘾中心合作，为治疗诊所提供技术援助，以缓解 向新的基于价值的支付模式过渡。在一系列涉及健康的利益相关者会议之后 保险公司和成瘾项目，我们得出结论，诊所需要：a)诊所层面的绩效衡量标准， 能够指导质量管理；b)来自外部促进者的指导，帮助领导和直接服务 工作人员--他们在管理科学方面的背景有限--创建质量驱动的组织；以及c)工具 指导直接服务人员以病人为中心的临床护理，特别是共同决策和 监测病人在护理中的进展。根据这些经验和现有的研究，我们一直在 开发新的质量措施和战略，以通过临床实践变化来帮助项目 将为这项研究提供信息。我们建议进行两个阶段的研究，以解决OUD治疗质量问题。第一 阶段将包括一系列利益相关者会议，以获得对建议的质量措施、质量 随机试验的改进策略、提供者支持工具和研究策略。在此期间 将最终确定试验的阶段、干预和研究方案，并将为提供者提供电子工具 发展起来的。第二阶段将包括30名门诊患者的阶梯式楔形随机对照试验 治疗诊所每年为大约2,000名OUD客户提供服务，以测试诊所级别 测量驱动、质量改进干预(MDQI)将改善a)治疗过程质量 措施(药物的使用、治疗中的症状和治疗进展、治疗保留)和 B)恢复结果(物质使用、健康和医疗保健利用)。干预将使用外部 辅导员向成瘾诊所提供指导，包括三个关键部分：1)数据培训 驱动型管理；2)以患者为中心的护理和OUD药物的培训和指导；3)电子化 用于共享决策和患者进程监控的工具。在项目结束时，我们将拥有 制定了具体的培训和指导方案以及电子临床支持工具，以指导质量 可以在纽约和全国其他地区传播的改进。