Health Systems Node of the NIDA Clinical Trials Network

项目摘要 在阿片类药物过量的持续公共卫生危机中，阿片类药物使用障碍（OUD）的发生率 增加和基于药物的治疗OUD仍然没有得到充分利用。虽然较长的OUD治疗 持续时间通常与改善患者结局相关，维持持续的健康保险 覆盖率是持续获得治疗的一个重大挑战。OUD患者可能 易受健康保险不稳定的影响，导致获得OUD治疗的障碍。高- 风险护理过渡或中断治疗可能会增加复发、过量和死亡的风险。尽管 保险不稳定的可能性对OUD治疗的连续性造成重大障碍，目前 由于捕获和评估的挑战，有关其健康和死亡率影响的知识有限 从卫生系统除名后的患者结局。为了弥补这一知识差距， 临床试验网络（CTN）的研究概念旨在研究健康保险不稳定性的关联 在一项多中心队列研究中， 利用处方阿片类药物登记处（POR）的数据，包括四个不同的卫生系统 参与CTN健康系统节点。本研究的目的是：（1）查明事实和原因 国家死亡指数的死亡;（2）检查丁丙诺啡治疗期间的保险不稳定性， OUD和相关的患者和健康计划因素;（3）评估保险不稳定性和风险之间的关联 全因、阿片类药物过量和其他物质相关的过量死亡率;以及（4）将来自一个 研究中心收集所有付款人索赔数据和刑事司法数据，以探索与退出相关的事件 健康计划。拟议的研究概念将有助于理解死亡率的后果 与OUD治疗患者的保险不稳定相关。它还将为卫生战略提供信息 系统，以确保治疗的连续性，并防止有风险的患者的不良结果， 保险覆盖中断。

PROJECT ABSTRACT In the ongoing public health crisis of opioid overdoses, the incidence of opioid use disorder (OUD) has increased and medication-based treatment for OUD remain underutilized. While longer OUD treatment duration is generally associated with improved patient outcomes, maintaining continuous health insurance coverage represents a significant challenge to sustaining access to treatment. Patients with OUD may be vulnerable to experiencing health insurance instability that results in barriers to OUD treatment access. High- risk care transitions or disruptions to treatment may increase risk of relapse, overdose, and mortality. Despite the potential for insurance instability to create significant barriers to OUD treatment continuity, current knowledge regarding its health and mortality impacts is limited due to the challenge of capturing and evaluating patient outcomes after disenrollment from health systems. To address this knowledge gap, the proposed Clinical Trials Network (CTN) research concept seeks to examine the association of health insurance instability and mortality risk among patients receiving buprenorphine treatment for OUD in a multi-site cohort study, leveraging data from the Prescription Opioid Registry (POR) that include four diverse health systems participating in the CTN Health Systems Node. The aims of the study are: (1) Ascertain fact and cause of death from the National Death Index; (2) Examine insurance instability during buprenorphine treatment for OUD and associated patient and health plan factors; (3) Assess the association of insurance instability and risk of all-cause, opioid overdose, and other substance-related overdose mortality; and (4) Link data from one study site to all-payer claims data and criminal justice data to explore events associated with disenrollment from health plans. The proposed research concept will contribute to understanding the mortality consequences associated with insurance instability for patients in treatment for OUD. It will also inform strategies in health systems to ensure continuity of treatment access and to prevent poor outcomes in patients at risk of experiencing insurance coverage disruptions.