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

尽管由于最高法院最近的裁决，它的实施可能会在各州有所不同，通过 平价医疗法案(ACA)的实施预计将极大地影响物质使用障碍的交付 (SUD)通过改变治疗筹资和更多地整合主流保健和 苏德疗法。丁丙诺啡治疗阿片类药物使用障碍(Ouds)的不断发展的系统是一个主要的 整合的例子。虽然这个系统在过去的十年里有了很大的发展，但研究还很有限。 关于医生如何实施这种挽救生命的治疗，以及他们是否正在提供与艾滋病毒相关的 服务。目前尚不清楚ACA将如何影响丁丙诺啡治疗的交付。建议数 研究寻求1年的R21支持以确定研究可行性，并寻求4年的R33支持以实施 丁丙诺啡实施的纵向研究，整合了关于州水平变化的多水平数据 对丁丙诺啡处方医生进行纵向调查的ACA实施。该计划的主要目标是 R21阶段是确定进行一项纵向研究的可行性，该研究将医生层面和 国家一级的数据收集，通过与围绕建设的4个里程碑相联系的研究程序 医生样本，通过定性和认知访谈进行调查开发，并生成 用于纵向收集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)估计丁丙诺啡使用的横断面和纵向模型 以及实施高质量的临床实践行为(CPB)和艾滋病毒相关服务 丁丙诺啡治疗在国家实施ACA的背景下；(2)审查亲属 患者支付来源(例如，医疗补助、私人保险或自付)和其他患者的重要性 丁丙诺啡治疗中医生决策的特点；(3)国家层面的建模 执行ACA与两个州一级成果之间的联系：利用 医疗补助计划中的丁丙诺啡和持有X执照开处方的医生数量 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，对具有全国代表性的1200名医生进行了4次年度调查 开丁丙诺啡处方的X许可证。这种纵向测量设计将支持现场四个独特的连接 分析，每个分析涉及医生决策的一个关键领域，同时还收集关于CPBS的数据 随着时间的推移。数据分析将包括横截面多变量决策模型和多层次模型 CPB采纳和实施的纵向分析，以检验理论驱动的假设。通过测量 在美国丁丙诺啡治疗的质量、可获得性和利用率，这项研究可能确定治疗 可以制定干预措施以提高OUD治疗质量的差距，同时有助于 关于ACA对美国治疗服务的影响的科学知识。

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.