Developing Quality Measures for Opioid-Exposed Infants

摘要 阿片类药物使用，孕妇阿片类药物使用障碍的诊断，以及新生儿阿片类药物的诊断 戒断综合征(NOWS)在过去20年中急剧增加。2017年，估计有10万人 婴儿接触阿片类药物，其中25,000名婴儿被诊断为NOWS。阿片类药物暴露 婴儿，无论他们是否被诊断为NOWS，都更有可能产生不良后果 与类似的非暴露婴儿相比，包括：更长和更复杂的首次住院时间，更高 参与儿童福利制度的可能性、较高的再住院率和紧急情况 部门就诊和较少使用推荐的预防性服务。此外，向以下人员提供医疗服务 接触阿片类药物的婴儿仍然存在变数，导致美国医院和社区之间的结果参差不齐。 为接触阿片类药物的婴儿制定有效和可靠的措施是改善预后的关键 这些脆弱的人群。为了填补这一现有的空白，我们将：1)开发阿片类药物的候选质量指标- 并通过让包括地方、州和国家在内的关键利益攸关方参与来改进这些措施 公共政策制定者；私营和公共保险公司；医疗保健提供者；以及使用改进的 Rand/UCLA适宜性方法；2)确定测量的可靠性、重复性和效度 候选质量度量，同时使用以下两种方法评估度量的可用性、有效性和可靠性 2007-2014年医疗补助分析摘录中独特的数据集、关联的母婴数据和 从两个大型临床系统收集临床数据，并将确定风险调整后的医院变异 在基于人群的大样本中对接触阿片类药物的婴儿采取的措施。这辆R34将生产出高质量的产品 阿片类药物暴露婴儿的措施和初步数据，随后将提供R01务实 将评估临床医生在质量指标上的表现如何导致供应商发生变化的临床试验 行为和随后婴儿结局的改变。此外，这些措施还可以作为 检验各种治疗对健康和健康的影响的随机临床试验的结果 接触阿片类药物的婴儿的健康状况以及他们出生后是否出现戒断症状。终极的 此R34和后续R01的目标将是为临床医生、研究人员、 政策制定者、付款人、医院系统和国家围产期合作改善阿片类药物暴露的护理 婴儿。

ABSTRACT Opioid use, diagnoses of opioid use disorder among pregnant women, and diagnoses of neonatal opioid withdrawal syndrome (NOWS) increased dramatically over the past 20 years. In 2017, an estimated 100,000 infants were exposed to opioids, among whom 25,000 infants were diagnosed with NOWS. Opioid-exposed infants, regardless of whether they are diagnosed with NOWS, are more likely to have adverse outcomes compared to similar non-exposed infants, including: longer and more complicated initial hospital stays, higher likelihood of involvement in the child welfare system, higher rates of hospital readmission and emergency department visits and lower use of recommended preventive services. Further, delivery of medical care to opioid-exposed infants remains variable resulting in uneven outcomes among US hospitals and communities. The development of valid and reliable measures for opioid-exposed infants is critical to improving outcomes for this vulnerable population. To fill this existing gap we will: 1) develop candidate measures of quality for opioid- exposed infants and refine these measures by engaging key stakeholders including local, state, and national public policy makers; private and public insurers; health care providers; and families using a modified RAND/UCLA Appropriateness Method; 2) determine the reliability, reproducibility and validity of measures of candidate quality measures while evaluating the usability, validity, and reliability of the measures using two unique sets of data, linked maternal-infant data from the Medicaid Analytic Extract from 2007-2014 and clinically collected data from two large clinical systems and will determine risk-adjusted hospital variation in measures for opioid-exposed infants in a large population-based sample. This R34 will produce quality measures for opioid-exposed infants and preliminary data that will subsequently inform an R01 pragmatic clinical trial that will evaluate how clinician performance on quality measures results in changes to provider behaviors and subsequent alterations in infant outcomes. In addition, these measures can also serve as the outcomes for randomized clinical trials that examine the impact of various treatments on the health and wellbeing of opioid-exposed infants and whether they experience withdrawal symptoms after birth. The ultimate goal of this R34 and subsequent R01s will be to provide innovative tools for clinicians, researchers, policymakers, payers, hospital systems and state perinatal collaboratives to improve care for opioid-exposed infants.