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

项目摘要： 美国注射毒品使用率的上升导致了严重的注射相关感染危机 （SIRI）影响注射毒品的人（PWID），如心内膜炎，骨髓炎和脊柱脓肿。Siri 与高严重性和死亡率相关，通常需要长期住院，并需要强化治疗。 保健服务成瘾治疗干预措施，如成瘾专业咨询或启动 阿片类药物使用障碍的药物，已显示出在较小的研究和商业保险的好处， 人口数量。需要在医疗补助人群中产生的证据来告知医疗补助计划政策。在 我们的总体目标是全面了解为患者提供成瘾治疗的情况， 与SIRI，包括治疗干预交付的变化和差异，以及这些 临床和经济结果的干预措施。具体而言，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PWID提供成瘾治疗干预措施 SIRI住院与临床和经济结果相关，2）医院和地区水平 提供成瘾治疗的能力解释了治疗提供的变化，3）使用定性 方法，以确定促进或阻碍成瘾治疗干预在医院设置的因素。 为了改善SIRI的PWID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PWID需求的激励因素。 首先，了解美国SIRI循证医疗服务的差距至关重要 实施系统变更的步骤，以改善SIRI对PWID的护理。

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.