Identifying Disparities in the Cascade of Care for Medicaid-Enrolled Youth with Opioid Use Disorder

项目摘要/摘要： 三分之二的阿片使用障碍(OUD)患者在25岁之前首次滥用阿片类药物。早期干预 在生活过程中是至关重要的，并要求青少年和年轻人(下称“青年”)获得高- 连续护理中的高质量护理。在这一连续过程中的每个阶段优化临床护理是至关重要的，并且 在持续存在种族和族裔差异的情况下，无法实现这一目标。为提高质量奠定基础 在全国范围内改善医疗补助计划-美国有色人种青年的主要保险公司-这一项目 将把级联关怀框架应用于青年的识别和治疗。《瀑布》 描述了一系列的5个阶段，即：(I)确定了多少患有OUD的青年(“诊断”)，(Ii)开始 治疗(“启动”)，(3)开始阿片使用障碍的药物治疗(“Moud”)，(4)继续治疗 短期(“参与”)和(V)长期治疗(“保留”)。分析将使用新的 发布了美国各州的医疗补助数据，链接到许多国家数据库，以提供关键的县- 和州级信息。中心目标是为以下项目提供一个全面的梯级图 13-25岁的青年OUD，自始至终关注差异。具体目标是：(1)应用级联 对有OUD的青少年的关怀框架，并估计每个阶段的种族和民族差异，使用系统的 揭示造成差异的潜在可干预机制的办法；(2)确定 Moud收据是否与后续治疗参与和保留相关，以及与较小的 种族和民族差异，从而告知穆德是否可能是减少乌德不平等的一项战略 治疗；以及(3)确定级联是否与急诊科使用和 住院治疗，从而确定当年轻人离开级联时，现实世界的临床结果是否会恶化， 以及有色人种年轻人是否经历了这样的结果。自始至终，种族就是 被概念化为社会(而不是生物)结构，该项目寻求确定运营的方式 医疗保健系统以及法律和监管环境造成健康差距，以便最终 引导政策转变。研究小组汇集了青年、OUD治疗、健康差距、 社区参与、卫生服务研究和相关的统计方法。该项目将是 由不同的青年和家庭咨询委员会指导，为礼仪的制定、分析、解释提供信息， 和传播调查结果，目的是最大限度地提高对青年和家庭的相关性和交付成果， 以及全国范围内的主要利益攸关方。

PROJECT SUMMARY/ABSTRACT: Two-thirds of individuals with opioid use disorder (OUD) first misuse opioids before age 25. Intervention early in the life course is critical, and requires that adolescents and young adults (hereafter, “youth”) receive high- quality care in a continuum of care. Optimizing clinical care at every stage in this continuum is critical, and cannot be achieved alongside persistent racial and ethnic disparities. To lay the groundwork for quality improvement nationwide in Medicaid programs—the primary insurers for youth of color in the US—this project will apply the Cascade of Care framework to OUD identification and treatment in youth. The Cascade describes a series of 5 stages, i.e., how many youth with OUD (i) are identified (“diagnosis”), (ii) begin treatment (“initiation”), (iii) start medications for opioid use disorder (“MOUD”), (iv) stay in treatment in the short-term (“engagement”), and (v) stay in treatment in the long term (“retention”). Analyses will use newly released Medicaid data from across US states linked to numerous national databases to provide key county- and state-level information. The central objective is to provide a comprehensive picture of the Cascade for youth aged 13-25 with OUD, throughout focusing on disparities. Specific Aims are to: (1) Apply the Cascade of Care framework to youth with OUD and estimate racial and ethnic disparities at each stage, using a systematic approach to uncover underlying, potentially intervenable mechanisms contributing to disparities; (2) Determine whether MOUD receipt is associated with subsequent treatment engagement and retention, and with smaller racial and ethnic disparities, thus informing whether MOUD might be a strategy to reduce inequities in OUD treatment; and (3) Determine whether the Cascade is associated with emergency department use and hospitalizations, thus identifying whether real-world clinical outcomes worsen when youth leave the Cascade, and whether such outcomes are disproportionately experienced by youth of color. Throughout, race is conceptualized as a social (not biological) construct, and the project seeks to identify ways that the operation of healthcare systems and legal and regulatory climates contribute to health disparities, in order to ultimately guide policy change. The research team brings together expertise in youth, OUD treatment, health disparities, community engagement, health services research, and relevant statistical approaches. The project will be guided by a diverse Youth and Family Advisory Board to inform protocol development, analysis, interpretation, and dissemination of findings, with a goal of maximizing relevance and delivery of results to youth and families, as well as key stakeholders nationally.