Buprenorphine Treatment and Health Reform: Availability, Utilization, and Quality

丁丙诺啡治疗和健康改革：可用性、利用和质量

• 批准号: 8836996
• 负责人: Hannah Knudsen
• 金额: $ 50.67万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-01 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8836996
• 关键词: Address; Adoption; Behavior; Buprenorphine; Caring; Characteristics; Clinical; Cognitive; Collection; Data; Data Analyses; Data Collection; Decision Making; Development; Disease; District of Columbia; Drug Utilization; Feasibility Studies; Future; Generations; Growth; Guidelines; HIV; HIV risk; Health; Health Care Reform; Healthcare; Individual; Insurance; Intervention; Interview; Knowledge; Licensing; Link; Longitudinal Studies; Longitudinal Surveys; Mainstreaming; Measurement; Measures; Medicaid; Methodology; Modeling; Monitor; Opiate Addiction; Opioid; Outcome; Patient Selection; Patients; Persons; Pharmaceutical Preparations; Phase; Physicians; Policies; Procedures; Protocols documentation; Quality of Care; Relative (related person); Research; Sampling; Services; Source; Statutes and Laws; Substance Use Disorder; Supreme Court Decisions; Surveys; System; Technology; Testing; Time; Variant; base; clinical care; clinical decision-making; clinical practice; court; design; improved; innovation; longitudinal design; medical specialties; payment; theories

Although its implementation is likely to vary across states due to the recent Supreme Court decision, passage of the Affordable Care Act (ACA) is expected to dramatically impact the delivery of substance use disorder (SUD) treatment through changes to treatment financing and greater integration of mainstream health care and SUD treatment. The evolving system of buprenorphine treatment for opioid use disorders (OUDs) is a prime example of integration. While this system has grown substantially in the past decade, research is limited regarding how physicians are implementing this lifesaving treatment and whether they are delivering HIVrelated services. It is unknown how the ACA will impact the delivery of buprenorphine treatment. The proposed study seeks 1 year of R21 support to establish study feasibility and 4 years of R33 support to conduct a longitudinal study of buprenorphine implementation that integrates multi-level data on state-level variations in ACA implementation with longitudinal surveys of buprenorphine-prescribing physicians. The primary aim of the R21 phase is to determine the feasibility of conducting a longitudinal study that integrates physician-level and state-level data collection, through research procedures linked to 4 milestones encompassing the construction of the physician sample, survey development through qualitative and cognitive interviews, and generation of a protocol for longitudinal collection of state-level data on ACA implementation. The three specific aims of the proposed R33 study are: (1) To estimate cross-sectional and longitudinal models of buprenorphine utilization as well as the implementation of high-quality clinical practice behaviors (CPBs) and HIV-related services in buprenorphine treatment in the context of states implementation of the ACA; (2) To examine the relative importance of patient payment source (e.g., Medicaid, private insurance, or out-of-pocket) and other patient characteristics on physician decision-making during buprenorphine treatment; and (3) To model the state-level associations between the implementation of the ACA and two state-level outcomes: utilization of buprenorphine within Medicaid and the number of physicians holding the X-license for prescribing buprenorphine. These aims will be accomplished through ongoing collection of policy and administrative data at the state-level with 4 annual surveys of a nationally representative sample of 1,200 physicians who hold the X-license to prescribe buprenorphine. This longitudinal survey design will support fielding four unique conjoint analyses, each addressing a key domain of physician decision-making, while also collecting data on CPBs over time. Data analysis will include cross-sectional multivariate models of decision-making and multi-level longitudinal analyses of CPB adoption and implementation to test theory-driven hypotheses. By measuring the quality, availability, and utilization of buprenorphine treatment in the US, this research may identify treatment gaps for which interventions may be developed to improve treatment quality for OUDs while contributing to scientific knowledge regarding the impact of the ACA on US treatment services.

尽管由于最高法院最近的裁决，其实施可能会因州而异，但通过 平价医疗法案 (ACA) 预计将极大地影响药物滥用障碍的发生 （SUD）通过改变治疗融资以及主流医疗保健和医疗保健的更大整合来进行治疗 SUD治疗。丁丙诺啡治疗阿片类药物使用障碍 (OUD) 的不断发展的系统是一个主要的 集成的例子。尽管该系统在过去十年中得到了大幅发展，但研究仍然有限 关于医生如何实施这种挽救生命的治疗以及他们是否提供与艾滋病毒相关的治疗 服务。目前尚不清楚 ACA 将如何影响丁丙诺啡治疗的实施。拟议的 研究寻求 1 年的 R21 支持来确定研究可行性，并寻求 4 年的 R33 支持来开展研究 丁丙诺啡实施的纵向研究，整合了州一级变化的多级数据 通过对丁丙诺啡处方医生进行纵向调查来实施 ACA。该组织的主要目标是 R21阶段是确定进行整合医生水平和水平的纵向研究的可行性 通过与包含建设在内的 4 个里程碑相关的研究程序收集国家级数据 医生样本，通过定性和认知访谈开展调查，并生成 纵向收集 ACA 实施情况的州级数据的协议。的三个具体目标 拟议的 R33 研究是： (1) 估计丁丙诺啡利用的横截面和纵向模型 以及实施高质量的临床实践行为 (CPB) 和艾滋病毒相关服务 在各州实施 ACA 的背景下进行丁丙诺啡治疗； （二）考察亲属 患者付款来源（例如医疗补助、私人保险或自付费用）和其他患者的重要性 丁丙诺啡治疗期间医生决策的特点； (3) 建立国家级模型 ACA 的实施与两个州级成果之间的关联：利用 医疗补助中的丁丙诺啡以及持有 X 处方处方的医生数量 丁丙诺啡。这些目标将通过不断收集政策和行政数据来实现 在州一级，对拥有全国代表性的 1,200 名医生进行了 4 次年度调查 开丁丙诺啡的 X 许可证。这种纵向调查设计将支持部署四种独特的联合行动 分析，每个分析都涉及医生决策的关键领域，同时还收集有关 CPB 的数据 随着时间的推移。数据分析将包括决策和多层次的横截面多元模型 对 CPB 采用和实施的纵向分析，以检验理论驱动的假设。通过测量 丁丙诺啡治疗在美国的质量、可用性和利用，这项研究可能会确定治疗方法 可以针对这些差距制定干预措施，以提高 OUD 的治疗质量，同时有助于 关于《平价医疗法案》对美国治疗服务影响的科学知识。