Integrating Addiction Treatment and Medical Care in a Commercial Health Plan

将成瘾治疗和医疗保健纳入商业健康计划

• 批准号: 8187812
• 负责人: DENNIS MCCARTY
• 金额: $ 75.1万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8187812
• 关键词: Accident and Emergency department; Address; Admission activity; Adoption; Alcohol abuse; Alcohol dependence; Alcohols; Attitude; Biological Models; Buprenorphine; Businesses; California; Caring; Collaborations; Contracts; Data; Databases; Emergency Situation; Emergency medical service; Evidence based practice; Expenditure; Funding; Health; Health Planning; Health Sciences; Health Services; Inpatients; Insurance and Payment Issues; Intake; Intervention; Interview; Lead; Leadership; Medical; Modeling; Naltrexone; Opiate Addiction; Opioid; Oregon; Overdose; Patients; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Policies; Process; Professional counselor; Provider; Public Health; Recovery; Regulation; Research; Research Institute; San Francisco; Services; Site; Support System; System; Techniques; Testing; Training; United States Substance Abuse and Mental Health Services Administration; Universities; Visit; Wisconsin; Work; Writing; addiction; alcohol use disorder; behavioral health; cost; evidence base; experience; health care service utilization; innovation; meetings; member; opioid abuse; preconditioning; prescription opioid; treatment center; treatment planning; treatment program

DESCRIPTION (provided by applicant): Twelve addiction treatment centers and Aetna Behavioral Health collaborate using the Advancing Recovery systems change model to increase the proportion of patients with medication-assisted treatment for alcohol or opioid dependence. The addiction treatment centers participate in a 22-month test of the system change strategy to enhance access to medication for patients dependent on opioids or alcohol. The proposal has three specific aims: 1) facilitate adoption of medications, 2) assess impacts on healthcare utilization and expenditures, and 3) conduct qualitative interviews and document implementation barriers and change strategies. Analyses of Aetna's databases track use of health and behavioral health services to assess medication impacts on the utilization and cost of care. Specific Aim 1: Use the Advancing Recovery model of system change to accelerate the implementation of medication-assisted treatment and integration with medical care; assign 12 addiction treatment centers to Advancing Recovery and compare to 12 matched comparison sites. 7 H1A: The proportion of opioid and alcohol admissions with prescriptions for addiction medications is greater in centers using the Advancing Recovery system change model. 7 H1B: Advancing Recovery sites form linkages with more prescribers and have more physicians writing prescriptions for patients. Specific Aim 2: Assess impacts on the utilization of and expenditures for inpatient, emergency and residential care using Aetna's utilization and expenditures data. 7 H2A: Utilization of and expenditures for inpatient medical care, emergency services, and residential addiction treatment will be lower among patients treated in sites participating in Advancing Recovery. 7 H2B: Utilization of and expenditures for inpatient medical care, emergency services, and residential addiction treatment will be lower among patients treated with addiction medications. 7 H2C: Utilization of and expenditures for inpatient medical care, emergency services, and residential addiction treatment will be lower among patients with more consecutive months of medication prescriptions. Specific Aim 3: Conduct qualitative interviews to document implementation barriers and effective implementation strategies for medication assisted treatment. 7 H3A: Provider training and attitudes are more problematic barriers to adoption than payment and reimbursement issues. 7 H3B: Centers with no experience with buprenorphine will be more likely to use extended release naltrexone for treatment of opioid dependence. PUBLIC HEALTH RELEVANCE: More than 18 million US residents meet criteria for alcohol dependence or abuse and 2 million are dependent on non-medical use of prescription opioids (Substance Abuse and Mental Health Services Administration, 2010); rates of current use, moreover, appear to be increasing (Compton & Volkow, 2006) and are associated with more overdose fatalities (Hall et al., 2008) and visits to emergency departments (Novak & Ball, 2006). Patients and practitioners seek better treatments but counselor and patient reluctance to use medication-assisted treatments and weak linkages with medical care lead to an underutilization of pharmacotherapy. The Medications Research Partnership uses the Advancing Recovery implementation model to make system changes and support increased access to medication-assisted therapy for patients covered by a commercial health plan.

描述（由申请人提供）：十二个成瘾治疗中心和安泰行为健康合作使用推进恢复系统改变模型，以增加药物辅助治疗酒精或阿片类药物依赖的患者比例。成瘾治疗中心参加了为期22个月的系统变革战略测试，以增加依赖阿片类药物或酒精的患者获得药物的机会。该提案有三个具体目标：1）促进药物的采用，2）评估对医疗保健利用和支出的影响，3）进行定性访谈并记录实施障碍和变革策略。对安泰数据库的分析跟踪了健康和行为健康服务的使用，以评估药物对护理利用和成本的影响。具体目标1：运用系统变革的推进康复模式，加快实施药物辅助治疗和医疗保健一体化;将12个成瘾治疗中心分配到推进康复中心，并与12个匹配的对照点进行比较。 7 H1A：使用成瘾药物处方的阿片类药物和酒精入院的比例在使用推进恢复系统变化模型的中心更大。 7 H1B：Advancing Recovery站点与更多的处方医生建立联系，并有更多的医生为患者开具处方。具体目标二：使用安泰的利用率和支出数据评估对住院、急诊和住院护理的利用率和支出的影响。 7 H2A：在参与推进康复的研究中心接受治疗的患者中，住院医疗护理、急诊服务和住院成瘾治疗的利用率和支出将较低。 7 H2B：在接受成瘾药物治疗的患者中，住院医疗护理、急诊服务和住院成瘾治疗的利用率和支出将较低。 7 H2C：在连续用药数月的患者中，住院医疗护理、急诊服务和住院成瘾治疗的利用率和支出将较低。具体目标3：进行定性访谈，以记录实施障碍和有效的实施策略，药物辅助治疗。 7 H3 A：提供者的培训和态度比支付和报销问题更容易成为采用的障碍。 7 H3 B：没有丁丙诺啡经验的中心更有可能使用缓释纳洛酮治疗阿片类药物依赖。 公共卫生关系：超过1800万美国居民符合酒精依赖或滥用的标准，200万人依赖于处方阿片类药物的非医疗使用（物质滥用和精神卫生服务管理局，2010年）;此外，目前的使用率似乎正在增加（Compton & Mental，2006年），并与更多的过量死亡有关（Hall等人，2008）和急诊科就诊（Novak & Ball，2006）。病人和医生寻求更好的治疗，但辅导员和病人不愿意使用药物辅助治疗和薄弱的联系与医疗保健导致药物治疗的利用不足。药物研究合作伙伴关系使用推进康复实施模型来进行系统更改并支持增加商业健康计划覆盖的患者获得药物辅助治疗的机会。