Linking State Data to Identify Unmet Need for Drug Treatment in Women Aged 15-49

描述（由申请人提供）：药物治疗方案知道他们为谁服务，但只能估计他们不为谁服务;无法准确衡量未满足的治疗需求，特别是育龄妇女，是制定干预措施以减少妇女，其子女和社会的药物相关健康后果的关键障碍。该提案描述了一项创新合作，将两个现有的独立州数据系统连接起来，创建一个新的、独特的纵向流行病学数据库，该数据库将药物治疗数据与医院利用和健康结果数据相结合，以广泛识别与药物相关的问题和未满足的治疗需求的流行率，并跟踪马萨诸塞州育龄妇女及其子女与药物相关的健康结果。这是第一次，需要戒毒治疗服务但未得到服务的妇女将被单独识别，从而能够更好地估计和描述未得到满足的需要。新的关联数据将允许通过多种数据来源评估满足和未满足治疗需求的妇女之间的差异，包括使用经过测试的算法来确定医院数据中的药物诊断。此外，关联数据将允许检查15-49岁妇女随后的健康结果及其子女的生育结果。要链接的两个数据源是：（1）基于人口的MA妊娠至生命早期纵向（PELL）数据系统，包括生命记录（出生、胎儿死亡和死亡）;出院、观察性住院和急诊室访视记录;以及MA出生缺陷登记处;以及（2）MA药物滥用服务局（BSAS）治疗数据系统，其中包含超过25年的治疗记录，每年有1000名育龄妇女被收进由社会服务局资助的药物滥用治疗机构。三个主要的研究目标是：1。将PELL数据链接到MDPH-BSAS治疗数据库并验证链接。2. a）在所有获得千年评估的育龄妇女中，查明有药物滥用或药物依赖的妇女（2002-2007年），评估未得到满足的治疗服务需求，并说明治疗使用方面的差异; B）在已分娩的MA妇女中（2003-2006年），描述了在怀孕前、怀孕期间和怀孕后发现和治疗毒品问题的模式，通过时机评估未满足的药物治疗需求，并描述妊娠结局; c）在已确定药物问题的MA女性中，开发初步的多变量模型，其中包含预测接受治疗的诱发因素和促成因素，以及分娩女性中的早产风险。3.根据本研究和NIH/NIAAA串联研究提出的双变量和多变量分析，制定R 01提案，以描述药物滥用和治疗对妇女和儿童健康的影响。 公共卫生相关性：这种创新的公私合作将两个现有的独立国家数据系统（BSAS和PELL）联系起来，创建一个新的，独特的纵向和流行病学数据库，将药物治疗数据与医院利用和健康结果数据相结合，以广泛识别与药物有关的问题和未满足的治疗需求的流行率，并跟踪马萨诸塞州育龄妇女与药物有关的健康和生育结果。这是第一次，需要戒毒治疗服务但未得到服务的妇女将被单独识别，从而能够准确估计和描述未满足的需求，这是改善国家育龄妇女戒毒治疗方案的关键一步。

DESCRIPTION (provided by applicant): Drug treatment programs know who they serve, but can only estimate who they do not serve; the inability to accurately measure unmet treatment need, especially among women of reproductive age, is a key barrier to developing interventions to reduce drug-related health consequences for women, their children, and society. This proposal describes an innovative collaboration to link two existing independent state data systems to create a new, unique longitudinal, epidemiologic database that combines drug treatment data with hospital utilization and health outcomes data, to broadly identify drug-related problems and the prevalence of unmet treatment need, and to track drug-related health outcomes among Massachusetts women of reproductive age and their children. For the first time, women in need of drug treatment services who did not receive them will be individually identifiable, allowing for better estimation and description of unmet need. The new linked data will permit assessment of disparities among women with met and unmet treatment need through multiple sources of data, including using a tested algorithm to identify drug diagnoses in hospital data. Moreover, the linked data will allow the examination of subsequent health outcomes among women ages 15-49, and birth outcomes among their children. The two data sources to be linked are: (1) the population-based MA Pregnancy to Early Life Longitudinal (PELL) data system that includes vital records (births, fetal deaths and deaths); hospital discharge, observational stay, and emergency department visit records; and the MA Birth Defects Registry; and (2) the MA Bureau of Substance Abuse Services (BSAS) treatment data system that contains treatment records for over 25,000 annual admissions of women of reproductive age to BSAS-funded substance abuse treatment facilities. The three broad study aims are: 1. Link PELL data to the MDPH-BSAS Treatment Database and verify linkages. 2. Develop and pilot methods a) among all MA women of reproductive age, identify women with drug abuse or dependence (2002-2007), assess unmet need for treatment services, and characterize disparities in treatment use; b) among MA women who had deliveries (2003-2006), describe the pattern of identification and treatment of drug problems in the periods before, during, and after pregnancy, assess unmet need for drug treatment by timing, and characterize pregnancy outcomes; and c) among MA women with an identified drug problem develop preliminary multivariate models with predisposing and enabling factors predicting receipt of treatment, and, among women who delivered, risk for prematurity. 3. Develop an R01 proposal to describe the impact of substance abuse and treatment on women's and children's health, based on bivariate and multivariate analyses proposed for this study and a tandem NIH/NIAAA study. PUBLIC HEALTH RELEVANCE: This innovative public-private collaboration links two existing independent state data systems (BSAS and PELL) to create a new, unique longitudinal and epidemiologic database that combines drug treatment data with hospital utilization and health outcomes data, to broadly identify drug-related problems and the prevalence of unmet treatment need, and to track drug-related health and birth outcomes among Massachusetts women of reproductive age. For the first time, women in need of drug treatment services who did not receive them will be individually identifiable, allowing for accurate estimation and description of unmet need, a critical step to improve state drug treatment programs for women of reproductive age.