Organizational factors associated with quality of care for opioid use disorders among transition-age adults in Medicaid

与医疗补助中过渡年龄成人阿片类药物使用障碍护理质量相关的组织因素

• 批准号: 10563455
• 负责人: CHARLES J NEIGHBORS
• 金额: $ 75.22万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-15 至 2028-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10563455
• 关键词: Adherence; Adult; Adverse event; Age; Biological; Brain; Budgets; Buprenorphine; COVID-19; Caring; Characteristics; Client; Clinical; Communities; Complex; Counseling; Development; Diagnosis; Dose; Early treatment; Ecology; Event; Family; Government; Homelessness; Hospitals; Incentives; Individual; Informal Social Control; Lead; Longitudinal Studies; Medicaid; Mental Health; Methadone; Modeling; Naltrexone; Neurologic; Organizational Change; Outcome; Overdose; Patients; Pharmaceutical Preparations; Pharmacotherapy; Policies; Population; Poverty; Prevalence; Process; Process Measure; Provider; Public Health; Quality of Care; Registries; Rewards; Role; Social Change; Structure; Substance Use Disorder; System; Telemedicine; Time; Variant; age group; clinical care; clinical decision-making; cohort; community-level factor; comorbidity; contextual factors; critical developmental period; effective therapy; efficacious treatment; ethnic disparity; improved; indexing; medication for opioid use disorder; multiple data sources; opioid use disorder; organizational structure; parental monitoring; peer; programs; psychologic; public health emergency; racial disparity; response; social; social expectations; social health determinants; social vulnerability; structural determinants; telehealth; treatment program; young adult

Project Summary Transition-age (TA) adulthood—between ages 18 to 25—is a distinct and critical developmental period where unique biological, psychological, and social changes are occurring. Brain development continues into the latter part of this period, with neurological structures associated with reward sensitivity and self-regulation continuing to form. Social roles are in flux, with reduced parental monitoring and shifts in societal expectations that presage lifetime functioning at the personal, familial, and community levels. Substance use disorders (SUD) and mental health conditions are more prevalent in this age group than at other ages, 14.4% and 29.4% respectively in 2019. Effective treatment at this age has the potential for large long-term payoffs. Over the past decade, there has been a large rise in the prevalence of opioid use disorders (OUD) among TA adults. Yet, the treatment system for OUD performs poorly for TA adults: they are less likely to obtain scientifically supported treatment and more likely to leave treatment early. Although the most efficacious treatment for OUD is pharmacotherapy, naturalistic studies demonstrate that there are large gaps in receipt of medications for opioid use disorder (MOUD), low adherence to these medications, and poor outcomes for most TA adults who enter treatment. Few current studies of quality in OUD treatment programs account for individual, organizational, and contextual factors that vary over time. In particular, variation in the quality of treatment programs occurs within the complex interplay of social and ecological factors related to communities, treatment programs, and characteristics of the patient. Specifically, social determinants of health, such as poverty and racial/ethnic disparities, create added barriers to obtaining and sustaining scientifically supported treatments. A better understanding of the program characteristics associated with higher quality care for TA adults with OUD will inform organizational changes, payer incentives, and government policies to improve treatment for this poorly served population. Because of rapid organizational changes caused by the COVID-19 public health emergency, there is an opportunity to explore whether new forms of SUD treatment delivery—telehealth, liberalization in provision of pharmacotherapy—lead to improved treatment engagement and outcomes for TA adults. The proposed longitudinal study will combine data from multiple sources, including Medicaid and a state registry of SUD treatment episodes, to examine three aspects of OUD treatment quality for approximately 65,000 TA adults entering treatment for OUD between 2012 and 2025: 1) access to MOUD; 2) adherence to pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). To guide our study, we propose a conceptual model that draws from the Donabedian quality of care framework (Organizational Structure>Clinical Process>Outcome) and from social ecology to examine program quality of OUD treatment for TA adults while accounting for individual and community level factors associated with the ability of these programs to deliver care.

项目概要 过渡年龄 (TA) 成年期（18 岁至 25 岁）是一个独特且关键的发展时期， 独特的生物、心理和社会变化正在发生。大脑发育持续到后者 在此期间的一部分，与奖励敏感性和自我调节相关的神经结构持续 形成。社会角色在不断变化，父母监督的减少和社会期望的变化 预示着一生在个人、家庭和社区层面的运作。物质使用障碍 (SUD) 该年龄段的心理健康问题比其他年龄段更普遍，分别为 14.4% 和 29.4% 分别在 2019 年。这个年龄段的有效治疗有可能带来巨大的长期回报。过去的事 十年来，TA 成年人中阿片类药物使用障碍 (OUD) 的患病率大幅上升。然而， OUD 治疗系统对 TA 成人表现不佳：他们不太可能获得科学支持 治疗，更有可能提前结束治疗。尽管 OUD 最有效的治疗方法是 药物治疗、自然主义研究表明，阿片类药物的接受情况存在很大差距 对于大多数进入 TA 的成年人来说，使用障碍（MOUD）、对这些药物的依从性低以及结果不佳 治疗。目前很少有关于 OUD 治疗计划质量的研究考虑到个人、组织和 随时间变化的背景因素。特别是，治疗方案的质量变化发生在 与社区、治疗方案和相关的社会和生态因素的复杂相互作用 患者的特征。具体而言，健康的社会决定因素，例如贫困和种族/民族 差异，为获得和维持科学支持的治疗造成了更多障碍。更好的 了解与为患有 OUD 的 TA 成人提供更高质量护理相关的计划特征将 告知组织变革、支付者激励措施和政府政策，以改善对这种贫困人口的治疗 服务人口。由于 COVID-19 公共卫生事件导致组织迅速发生变化 紧急情况下，我们有机会探索新形式的 SUD 治疗提供方式——远程医疗、 药物治疗的自由化——提高 TA 的治疗参与度和结果 成年人。拟议的纵向研究将结合多个来源的数据，包括医疗补助和 SUD 治疗事件的国家登记处，以检查 OUD 治疗质量的三个方面大约 2012 年至 2025 年间，有 65,000 名成人 TA 接受 OUD 治疗：1) 获得 MOUD； 2）坚持 药物治疗和保留治疗； 3) 不良事件（例如用药过量）。为了指导我们的学习，我们 提出一个概念模型，该模型借鉴了多纳贝迪护理质量框架（组织 结构>临床过程>结果）并从社会生态学来检验OUD治疗的项目质量 为成人助教，同时考虑与这些人的能力相关的个人和社区层面的因素 提供护理的计划。