Person-centered quality measurement and management in a system for addictions treatment in New York State

项目摘要 2021年，纽约吸毒过量人数持续上升，4,946人死亡涉及阿片类药物。 合成阿片类药物正在推动增长，因为这些药物与吸毒者服用的其他物质混合在一起 （PWUD）。令人震惊的是，黑人和拉丁裔人的过量死亡率上升得更快， 加剧了卫生不平等。负责管理成瘾治疗的纽约州机构-- 成瘾服务和支持（OASAS）-监督一个每年为35万人提供服务的系统， 物质使用障碍（SUD）。在该系统内，门诊诊所提供大部分治疗服务 阿片类药物使用障碍（OUD）为了应对持续的阿片类药物危机，OASAS呼吁 新的方法，包括以人为本的护理，以证据为基础的做法，公平对待，伤害 减少原则。OASAS设想了一个修订后的治疗系统，更好地保留客户的治疗， 减轻不良医疗事件并减少死亡。为了推动变革，OASAS将投资于质量 衡量和管理（QM 2）战略，提供绩效反馈以激活领导力 和诊所的工作人员，以改善做法，并宣传质量措施，以确保公众问责。 OASAS QM 2战略以多纳贝迪安框架为指导，将包括一套结构性（例如， 客户/顾问比率），过程（例如，用于OUD的药物的使用），和结果（例如，住院 解毒）质量措施。为了支持该战略，OASAS还将提供资金，以确保所有 诊所拥有电子健康记录（EHR），能够捕获和报告质量指标。的 OASAS战略将解决QM 2工作的常见障碍，包括： 诊所，缺乏有效的SUD治疗质量措施，劳动力中的数据素养有限， 工作人员在变革管理方面的专业知识不足，诊所领导层因担心 在考虑客户的临床复杂性时的公平性。此外，OASAS认识到， 直接从患者那里收集数据对于评估他们的目标和需求是否得到满足至关重要， 以人为本的护理体系OASAS将与学术伙伴合作，制定措施，并提供 支持诊所解决这些障碍。这个QM 2研究中心（QM 2-RC）的建议来自一个 学术与政府的伙伴关系，有着长期的合作研究历史，以提高 治疗SUD。广泛的目标是建立然后测试一个以科学为基础的以人为本的QM 2战略。 治疗该项目将利用OASAS在其新的QM 2战略和政策领导方面的投资。的 学术合作伙伴将提供测量验证，风险调整， 因果推理，将解决一些障碍，以QM 2，以及建立证据基础的好处， 战略。该小组还将评估诊所和其他医疗机构，患者、付款人-合并 QM 2战略应用于实践改进、合同谈判和选择诊所。

Project Summary In 2021, the number of drug overdoses in New York continued to rise, with 4,946 deaths involving opioids. Synthetic opioids are driving the rise as these are mixed with other substances taken by people who use drugs (PWUD). Alarmingly, the rates of overdose deaths are rising faster for Black and Latinx individuals, exacerbating health inequities. The New York State agency that regulates addictions treatment—the Office of Addiction Services and Supports (OASAS)—oversees a system that annually serves 350,000 individuals with substance use disorders (SUD). Within the system, outpatient clinics provide the majority of treatment services for individuals with opioid use disorders (OUD). In response to the continuing opioid crisis, OASAS is calling for new approaches that embrace person-centered care, evidence-based practices, equitable treatment, and harm reduction principles. OASAS envisions a revised treatment system that better retains clients in treatment, mitigates adverse healthcare events, and reduces deaths. To drive change, OASAS will invest in a quality measurement and management (QM2) strategy that provides performance feedback to activate leadership and staff of clinics to improve practice as well as publicizes quality measures to ensure public accountability. Using the Donabedian framework as a guide, the OASAS QM2 strategy will include a suite of structural (e.g., client/counselor ratios), process (e.g., use of medications for OUD), and outcome (e.g., hospitalization for detoxification) quality measures. In support of the strategy, OASAS will also provide funding to ensure all clinics have electronic health records (EHR) that have capacity to capture and report on quality measures. The OASAS strategy will address common barriers to QM2 efforts, including: inadequate technological capacity at clinics, dearth of validated quality measures for SUD treatment, limited data literacy in the workforce, insufficient expertise in change management among staff, and clinic leadership resistance due to concerns about fairness in accounting for the clinical complexity of their clients. In addition, OASAS recognizes that gathering data directly from patients is essential to assessing whether their goals and needs are addressed in a person-centered system of care. OASAS will work with academic partners to develop measures and provide support to clinics to address these barriers. This QM2 research center (QM2-RC) proposal comes from an academic-government partnership that has a longstanding history of collaborating on studies to improve treatment for SUD. The broad aim is to build then test a science-based QM2 strategy for person-centered treatment. The project will leverage OASAS's investment in its new QM2 strategy and policy leadership. The academic partners will offer expertise in statistical methods for measurement validation, risk adjustment, and causal inference that will address some obstacles to QM2 as well as build the evidence base for the benefits of the strategy. The team will also assess how clinics and other stakeholders—e.g., patients, payers—incorporate the QM2 strategy into practice improvement, contract negotiations, and choosing clinics.