Opioid Use Disorder and Residential Treatment in Medicaid

阿片类药物使用障碍和医疗补助中的住院治疗

• 批准号: 10738178
• 负责人: Carrie Elizabeth Fry
• 金额: $ 17.24万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738178
• 关键词: Accident and Emergency department; Address; Adult; Affect; Ambulatory Care; American; Categories; Collaborations; Continuity of Patient Care; Cost Sharing; Coupled; Data; Doctor of Philosophy; Elements; Eligibility Determination; Emergency department visit; Equipment and supply inventories; Evaluation; Evidence based treatment; Future; Glean; Goals; Grant; Health; Health Policy; Health Services; Health Services Accessibility; Health Status; Improve Access; Incidence; Interview; K-Series Research Career Programs; Knowledge; Low income; Managed Care; Measurement; Measures; Medicaid; Medicine; Mental disorders; Mentors; Modality; Monitor; Outcome; Overdose; Patients; Pattern; Personal Satisfaction; Persons; Policies; Policy Maker; Policy Making; Population; Prevalence; Quasi-experiment; Regulation; Research; Research Personnel; Residential Treatment; Risk; Role; Sampling; Scientist; Social outcome; Structure; Substance Use Disorder; Surveys; System; Time; Training; United States; Universities; Variant; Work; addiction; beneficiary; care seeking; career; comorbidity; cost; evidence base; experience; federal policy; flexibility; follow-up; health care availability; improved; informant; innovation; insight; interest; learning network; marginalization; marginalized community; medical schools; medication for opioid use disorder; opioid use disorder; overdose death; professor; programs; skills; substance use; tool; treatment services; waiver

ABSTRACT Carrie E. Fry PhD, MEd is an Assistant Professor in the Department of Health Policy in the Vanderbilt School of Medicine. She is a health services and policy researcher whose portfolio is focused on improving health and social outcomes for Americans with a substance use disorder (SUD) or mental illness through rigorous observational and quasi-experimental methods. This training grant will support Dr. Fry’s career goal of becoming an independent researcher with expertise in evaluation strategies to inform policy affecting marginalized Americans. This type of expertise is in high demand: the incidence and prevalence of opioid use disorder (OUD) has significantly increased since the mid-2010s with related harms, including emergency room visits and fatal overdoses, increasing at a similar pace. Access to evidence-based OUD treatments, especially among Medicaid enrollees, has not increased at the same rate. For these reasons, understanding the Medicaid policy levers to increase access to treatment is crucial to combatting the broader SUD crises in the US. One way state Medicaid programs have responded is by expanding the continuum of care to include residential treatment. Historically, Medicaid programs not been allowed to provide residential SUD treatment for most adults. Following guidance issued in 2015, states could apply for time-limited, demonstration waivers to expand coverage for residential treatment to adults between 21-64 years old. Since then, 32 states have received approval for and implemented a Section 1115 waiver to provide residential SUD treatment. States have flexibility regarding the specific provisions of these waivers potentially leading to mixed outcomes, and the impact of expanded residential treatment coverage in Medicaid is largely unknown. The research proposed in this K01 will address these gaps to inform future policy. Aim 1 will survey Medicaid officials in the 13 states participating in the Medicaid Distributed Research Network (MODRN) to identify variation in Medicaid residential treatment coverage. Then, I will conduct semi-structured interviews with Medicaid and other state officials from six MODRN states to further explore these differences. Aim 2 will use Medicaid claims data from three states to produce reliable and generalizable evidence on the effect of expanded coverage for residential treatment on beneficiary-level health and utilization outcomes. Details gleaned from these survey and interviews will be used to appropriately contextualize Aim 2’s results; the evaluation proposed in Aim 2 can be completed regardless of these findings. Finally, Aim 3 will produce the first generalizable estimates of co-morbid SUD among Medicaid enrollees with OUD, a subpopulation more likely to access residential treatment. Results from these aims will provide extensive preliminary data for an R01 evaluating these coverage expansions among sub-populations identified in Aim 3 and inform future Medicaid policy around residential treatment. With the assistance of her mentors, Dr. Fry has identified training objectives in addiction medicine, state health policy, and measurement issues in administrative claims data that will further her progress toward becoming a leading, independent researcher in the field of SUD and Medicaid policy.

摘要 凯莉·E弗莱博士，医学博士是范德比尔特大学卫生政策系的助理教授。 药她是一名健康服务和政策研究员，其投资组合专注于改善健康和 通过严格的措施，为患有药物使用障碍（SUD）或精神疾病的美国人带来社会结果 观察和准实验方法。这项培训补助金将支持弗莱博士的职业目标， 具有评价战略专门知识的独立研究员，为影响边缘化的政策提供信息 美国人这种类型的专业知识需求量很大：阿片类药物使用障碍（OUD）的发病率和患病率 自2010年代中期以来，这一数字显着增加，相关危害包括急诊室就诊和死亡。 吸毒过量，以相似的速度增加。获得基于证据的OUD治疗，特别是在医疗补助中 但没有以同样的速度增长。由于这些原因，了解医疗补助政策杠杆， 增加获得治疗的机会对于对抗美国更广泛的SUD危机至关重要。单程国家医疗补助 方案的回应是扩大护理的连续性，包括住院治疗。从历史上看， 医疗补助计划不允许为大多数成年人提供住宅SUD治疗。以下指南 在2015年发布的，各州可以申请有时限的示范豁免，以扩大对住宅的覆盖面。 治疗对象为21-64岁的成年人。自那时以来，32个州已获得批准，并实施 a第1115条豁免提供住宅SUD待遇。各国在具体问题上有灵活性。 这些豁免的规定可能导致混合的结果，以及扩大住宅的影响， 医疗补助的治疗覆盖率在很大程度上是未知的。本K 01中提出的研究将解决这些差距 为未来的政策提供信息。Aim 1将调查参与Medicaid Distributed的13个州的Medicaid官员 研究网络（MODRN），以确定医疗补助住宅治疗覆盖范围的变化。那么，我将进行 与来自六个MODRN州的医疗补助和其他州官员进行了半结构化访谈，以进一步探讨这些问题。 差异目标2将使用来自三个州的医疗补助索赔数据来产生可靠和可推广的证据 关于扩大住院治疗覆盖范围对受益人层面健康和利用结果的影响。 从这些调查和访谈中收集的细节将用于适当地将目标2的结果置于背景之中; 无论这些结果如何，目标2中提议的评价都可以完成。最后，Aim 3将产生第一个 OUD的医疗补助登记者中合并SUD的可推广估计，这是一个更有可能 获得住院治疗。这些目标的结果将为R 01提供广泛的初步数据 评估目标3中确定的子人群的覆盖范围扩大情况，并为未来的医疗补助计划提供信息 围绕居住治疗。在导师的帮助下，Fry博士确定了培训目标 在成瘾医学，国家卫生政策和测量问题的行政索赔数据，将进一步 她朝着成为一个领先的，独立的研究人员在南加州大学和医疗补助政策领域的进展。