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

项目总结/摘要： 三分之二的阿片类药物使用障碍（OUD）患者在25岁之前首次滥用阿片类药物。介入早 在生命过程中是至关重要的，并要求青少年和年轻的成年人（以下简称“青年”）接受高- 在持续的护理中提供优质护理。在这一连续体的每个阶段优化临床护理至关重要， 在持续存在种族和族裔不平等的情况下无法实现。为质量奠定基础 在全国范围内改善医疗补助计划-主要保险公司的青年在美国的颜色-这个项目 将把护理级联框架应用于青少年OUD的识别和治疗。级联 描述了一系列的5个阶段，即，有多少青少年患有OUD（i）被确定（“诊断”），（ii）开始 治疗（“开始”），（iii）开始阿片类药物使用障碍（“MOUD”）的药物治疗，（iv）在治疗期间保持治疗。 短期（“参与”），以及（v）长期坚持治疗（“保留”）。分析将使用新的 发布了来自美国各州的医疗补助数据，这些数据与众多国家数据库相关联， 国家级信息。中心目标是全面介绍小瀑布的情况， 13-25岁的青少年，在整个过程中重点关注差距。具体目标是：（1）应用级联 护理框架，以青少年与OUD和估计种族和民族的差距，在每个阶段，使用系统的 找出造成差异的潜在可干预机制的方法;（2）确定 MOUD接收是否与随后的治疗参与和保留相关， 种族和民族差异，从而告知MOUD是否可能是减少OUD不平等的战略 治疗;和（3）确定级联是否与急诊科使用相关， 住院，从而确定当年轻人离开Cascade时，现实世界的临床结果是否会恶化， 以及有色人种青年是否不成比例地经历了这些结果。在整个过程中， 概念化为一个社会（而不是生物）结构，该项目旨在确定运作的方式， 卫生保健系统的缺陷以及法律的和监管环境导致了健康差距， 引导政策转变。该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统计方法。该项目将 在多元化的青年和家庭咨询委员会的指导下，为协议的制定、分析、解释提供信息， 和传播调查结果，目标是最大限度地提高成果对青年和家庭的相关性， 以及国内的主要利益相关者。

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.