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.

项目摘要 过渡年龄(TA)成年期--从18岁到25岁--是一个独特和关键的发育时期 独特的生物、心理和社会变化正在发生。大脑发育一直延续到后者 这一时期的一部分，与奖赏敏感性和自我调节相关的神经结构仍在继续 形成。随着父母监督的减少和社会期望的转变，社会角色正在变化 预示着在个人、家庭和社区层面上的终生功能。物质使用障碍(SUD) 心理健康问题在这个年龄段比其他年龄段更普遍，分别为14.4%和29.4% 分别在2019年。在这个年龄段进行有效的治疗有可能获得巨大的长期回报。在过去的时间里 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的治疗系统对TA成年人表现不佳：他们更不可能获得科学支持 接受治疗的可能性更大，更有可能提前离开治疗。尽管治疗OUD最有效的方法是 药物治疗，自然主义研究表明，在接受阿片类药物治疗方面存在很大差距 使用障碍(Moud)，对这些药物的依从性低，对于大多数进入TA的成年人来说结果很差 治疗。目前对OUD治疗计划质量的研究很少考虑到个人、组织和 随着时间的推移而变化的背景因素。特别是，治疗方案的质量在以下方面发生变化 社会和生态因素与社区、治疗计划和 病人的特征。具体地说，健康的社会决定因素，如贫困和种族/族裔 差距，给获得和维持得到科学支持的治疗造成了额外的障碍。更好的 了解与为有OUD意愿的TA成人提供更高质量护理相关的计划特点 告知组织变化、付款人激励和政府政策，以改善对这种不良的治疗 服务人群。由于新冠肺炎公共卫生引发的快速组织变革 紧急情况下，有机会探索新形式的SUD治疗提供-远程保健， 提供药物治疗的自由化--改善TA的治疗参与度和结果 成年人。拟议的纵向研究将结合来自多个来源的数据，包括医疗补助和一项 国家SUD治疗事件登记，以检查OUD治疗质量的三个方面，大约 2012至2025年间，65,000名TA成人接受OUD治疗：1)获得Moud；2)坚持 药物治疗和治疗中的滞留；以及3)不良事件(如过量用药)。为了指导我们的学习，我们 提出一个概念性模型，借鉴多纳贝迪安护理质量框架(组织 结构和临床过程及结果)和从社会生态角度审视OUD治疗方案的质量 对于成人助教来说，同时考虑到与这些能力相关的个人和社区层面的因素 提供护理服务的计划。