Delivery of Addiction Treatment for Medicaid Enrollees with Serious Injection-Related Infections

为患有严重注射相关感染的医疗补助参与者提供成瘾治疗

• 批准号: 10801798
• 负责人: Shashi Kapadia
• 金额: $ 75.29万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10801798
• 关键词: Abscess; Address; Affect; Antibiotics; Area; Attitude; Bacterial Infections; Behavior Therapy; Caring; Cessation of life; Clinical; Consultations; Data; Disparity; Drug user; Effectiveness; Endocarditis; Ethnic Origin; Evidence based treatment; Gender; Health; Health Care Costs; Health Care Sector; Health Services; Healthcare; Hepatitis C; Hispanic; Hospitalization; Hospitals; Infection; Injecting drug user; Injections; Inpatients; Institution; Insurance Carriers; Intervention; Interview; Knowledge; Length of Stay; Measures; Medicaid; Methods; Mycoses; Operative Surgical Procedures; Osteomyelitis; Outcome; Outpatients; Patient Admission; Patients; Persons; Policies; Population; Positioning Attribute; Predisposition; Provider; Public Health; Qualitative Methods; Race; Sampling; Severities; Spinal; Substance Use Disorder; System; Training; Training Programs; United States; Urbanicity; Variant; Vertebral column; access disparities; addiction; cost; design; economic outcome; evidence base; experience; follow-up; health care delivery; health care service utilization; hospital readmission; improved; improved outcome; indexing; infection risk; injection drug use; interest; intervention delivery; medical specialties; medication for opioid use disorder; member; men; mortality; programs; recruit; recurrent infection; substance use treatment; theories; treatment and outcome; treatment disparity; treatment program; uptake

PROJECT ABSTRACT: Rising rates of injection drug use in the United States have led to a crisis of serious injection-related infections (SIRI) affecting people who inject drugs (PWID), such as endocarditis, osteomyelitis, and spinal abscess. SIRI are associated with high severity and mortality, often needing long hospitalizations, and need for intensive health services. Addiction treatment interventions, such as addiction specialty consultation or initiation of medications for opioid use disorder, have shown benefit in smaller studies and in commercially insured populations. Evidence generated in Medicaid populations is needed to inform Medicaid program policies. In this proposal, our overall objective is to comprehensively understand addiction treatment delivery for patients with SIRI, including variation and disparities in treatment intervention delivery, and the associations of those interventions with clinical and economic outcomes. Specifically, we aim to 1) Use national Medicaid administrative data from 2015-21 to determine if delivery of addiction treatment interventions to PWID hospitalized with SIRI is associated with clinical and economic outcomes, 2) how hospital- and area-level capacity to provide addiction treatment explains the variation in treatment delivery, and 3) use qualitative methods to determine the factors that promote or hinder addiction treatment interventions in hospital settings. To improve outcomes for PWID with SIRI, we first need to understand the current landscape of healthcare delivery, and the motivating factors that will transform healthcare practices to better meet the needs of PWID. Understanding the gaps in evidence-based healthcare delivery for SIRI in the United States are critical first steps for implementing system change to improve care for PWID with SIRI.

项目摘要： 美国注射吸毒率上升导致严重注射相关感染危机 (SIRI) 影响注射吸毒者 (PWID)，例如心内膜炎、骨髓炎和脊柱脓肿。西瑞 与高严重性和死亡率相关，通常需要长期住院治疗，并且需要重症监护 卫生服务。成瘾治疗干预措施，例如成瘾专业咨询或启动 治疗阿片类药物使用障碍的药物，已在小型研究和商业保险中显示出益处 人口。需要在医疗补助人群中产生的证据来为医疗补助计划政策提供信息。在 这个提案，我们的总体目标是全面了解患者的成瘾治疗服务 与 SIRI 的关系，包括治疗干预措施的变化和差异，以及这些之间的关联 具有临床和经济结果的干预措施。具体来说，我们的目标是 1) 使用国家医疗补助 2015-21 年的行政数据，以确定是否向吸毒者提供成瘾治疗干预措施 因 SIRI 住院与临床和经济结果相关，2) 医院和地区级别如何 提供成瘾治疗的能力解释了治疗实施的差异，以及 3）使用定性 确定促进或阻碍医院环境中成瘾治疗干预措施的因素的方法。 为了通过 SIRI 改善注射吸毒者的治疗结果，我们首先需要了解当前的医疗保健状况 交付，以及将改变医疗保健实践以更好地满足注射吸毒者需求的激励因素。 首先了解美国 SIRI 循证医疗保健服务方面的差距至关重要 实施系统变革的步骤，以通过 SIRI 改善对注射吸毒者的护理。