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上升导致严重注射相关感染危机 (Siri)影响注射毒品者(PWID)，如心内膜炎、骨髓炎和脊髓脓肿。Siri 与高严重性和高死亡率相关，通常需要长时间住院，并需要重症监护 医疗服务。成瘾治疗干预措施，如成瘾专科咨询或启动 治疗阿片类药物使用障碍的药物在较小规模的研究和商业保险中显示出好处 人口。需要在医疗补助人群中产生的证据为医疗补助计划政策提供信息。在……里面 这项建议，我们的总体目标是全面了解戒毒治疗对患者的影响 使用Siri，包括治疗干预提供方面的差异和差异，以及它们之间的关联 具有临床和经济结果的干预措施。具体地说，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PWID提供成瘾治疗干预措施 使用Siri住院与临床和经济结果有关，2)医院和地区层面 提供成瘾治疗的能力解释了治疗提供的差异，以及3)使用定性的 方法确定在医院环境下促进或阻碍成瘾治疗干预的因素。 为了改善使用Siri治疗PWID的结果，我们首先需要了解医疗保健的现状 提供，以及将改变医疗实践以更好地满足PWID需求的激励因素。 首先，了解美国Siri在提供循证医疗服务方面的差距是至关重要的 实施系统变革以改善对使用Siri的PWID的护理的步骤。

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.