Policy Dissemination Strategies to Improve the Use of Research Evidence in Medicaid Benefits for Opioid Use Disorder Treatment

项目摘要/摘要 本次拟设立的K01导师研究职业发展奖旨在支持申请者 在发展和最大限度地发挥她的研究技能，以便在 在安全网人群中传播和实施循证药物使用治疗。安全问题 净人口，特别是由医疗补助和儿童健康保险提供公共保险的个人 计划(芯片)受到了美国阿片类药物流行的不成比例的影响。尽管有重要的需求 在治疗方面，治疗阿片类药物使用障碍(Moud)的救命药物在这一人群中使用不足。低 Moud的使用是由无数错位的联邦、州、医疗补助/芯片机构和管理型医疗保健推动的 由不同级别的证据提供信息的组织效益和利用管理政策。联邦政策 要求将所有三种Moud(丁丙诺啡、美沙酮、纳曲酮)作为强制性医疗补助州包括在内 计划福利，但并不是所有的州都遵守了，医疗保险和医疗补助服务中心 承认强制实施保险是不可行的。即使当医疗补助/芯片机构覆盖所有这三个 Moud，他们可以通过首选药品清单限制访问，失败-首先、优先和重新授权要求-因此 将可能危及生命的护理延迟强加给受益人。管理型医疗组织(MCO) 许多签约管理福利的国家机构可以制定额外的使用管理政策，这些政策 限制Moud访问。需要进行研究，以促进医疗补助/芯片和MCO政策制定者使用科学 设计Moud时的证据是有好处的。在Gregory Aarons博士(赞助商和导师)的指导下 和专家指导团队，申请者将接受以下方面的培训：(1)调查设计，(2)多元统计 分析，包括潜在类分析和有限混合建模；(3)政策传播策略 发展，包括为政策制定者包装和传达证据，以及(4)开展研究 与政策相关的决策者建立伙伴关系。这些培训目标将有助于完成研究 目标是：(1)为医疗补助/芯片机构和MCO政策制定者制定和管理一项全国性调查，以 确定影响其证据使用行为的决定因素、机制和中介；(2) 根据医疗补助/芯片机构和MCO的经验确定和描述不同的子组 证据使用行为在设计Moud时的益处；(3)设计和试点测试可接受性， 针对每个潜在阶层量身定做的传播战略的适当性和可行性，以促进 政策制定者关于穆德利益的循证决策。这项建议与NIDA的建议一致 评估与物质使用障碍有关的联邦、州和系统政策的影响的战略目标 关于公共卫生，并确定旨在改善的战略中介机构和政策执行战略 证据在政策中的使用。计划中的K01活动将有效地定位申请者以实现独立的 研究生涯的重点是改善获得循证药物使用治疗的机会。

PROJECT SUMMARY/ABSTRACT The purpose of this proposed K01 Mentored Research Career Development Award is to support the applicant in advancing and maximizing her research skills in order to launch an independent research career in the dissemination and implementation of evidence-based substance use treatment for safety net populations. Safety net populations, especially individuals who are publicly insured by Medicaid and the Children’s Health Insurance Program (CHIP), have been disproportionately impacted by the U.S. opioid epidemic. Despite a significant need for treatment, lifesaving medications for opioid use disorder (MOUD) are underused by this population. Low MOUD use is driven by a myriad of misaligned federal, state, Medicaid/CHIP agency and managed care organization benefit and utilization management policies informed by varying levels of evidence. Federal policy requires all three MOUD (i.e., buprenorphine, methadone, naltrexone) be included as mandatory Medicaid state plan benefits, but not all states have complied, and the Centers for Medicare and Medicaid Services acknowledges that enforcing coverage is not feasible. Even when Medicaid/CHIP agencies cover all three MOUD, they can restrict access via preferred drug lists, fail-first, prior and re-authorization requirements – thus imposing potentially life-threatening care delays on beneficiaries. Managed care organizations (MCOs) that many state agencies contract to administer benefits can enact additional utilization management policies that limit MOUD access. Research is needed to promote Medicaid/CHIP and MCO policymakers’ use of scientific evidence when designing MOUD benefits. Under the mentorship of Dr. Gregory Aarons (sponsor and mentor) and an expert mentoring team, the applicant will pursue training in: (1) survey design, (2) multivariate statistical analysis, including latent class analysis and finite mixture modeling, (3) policy dissemination strategy development, including packaging and communicating evidence for policymakers, and (4) developing research partnerships with policy-relevant decision-makers. These training goals will facilitate accomplishing research aims to: (1) develop and administer a national survey to Medicaid/CHIP agency and MCO policymakers to identify determinants, mechanisms, and intermediaries that influence their evidence use behaviors; (2) empirically identify and describe distinct subgroups of Medicaid/CHIP agencies and MCOs based on their evidence use behaviors when designing MOUD benefits; (3) design and pilot test the acceptability, appropriateness and feasibility of dissemination strategies, tailored to each latent class, for promoting policymakers’ evidence-based decision-making regarding MOUD benefits. This proposal is aligned with NIDA’s strategic objectives to assess the impact of substance use disorder-related federal, state and systems policies on public health, and to identify strategic intermediaries and policy implementation strategies aimed at improving evidence use in policy. The planned K01 activities will effectively position the applicant to achieve an independent research career focused on improving access to evidence-based substance use treatment.