Addiction Treatment in Medicaid Health Homes

 描述(由申请人提供)：根据《平价医疗法案》成立的健康之家(HHS)代表着为患有慢性健康状况的医疗补助受益人提供医疗服务方面的一项重大创新，提供以人为中心的护理协调，重点是行为健康护理以及社会支持和服务。卫生保健制度有可能改善成瘾治疗和使用的接受情况以及成瘾相关疾病的急性护理费用。然而，还需要研究来确定HHS在识别和治疗成瘾方面是否成功，如果是的话，什么做法在这方面最有效。识别和识别和 治疗成瘾的方法在不同的州HH模型中有很大不同。这个K01应用程序的总体目标是提供强化的、受监督的职业发展培训，使我能够评估用于识别和治疗成瘾的国家HH模式实践对接受成瘾治疗的影响，以及急性ARC护理的使用和费用。拟议的导师研究科学家发展奖将使我能够通过以下方面的高级培训来补充我在卫生服务研究方面的专业知识：计量经济学、组织理论以及调查设计和管理。我将由我的主要导师约翰·布鲁克斯博士以及共同导师彼得·弗里德曼、医学博士、公共卫生硕士、托马斯·德奥诺博士和贾尼斯·普罗布斯特博士指导。我的培训计划包括有组织地指导布鲁克斯博士，并与他一起研究如何使用计量经济学方法使用观察数据来评估治疗效果，包括使用倾向得分匹配和工具变量估计器；D‘Aunno博士，组织理论；D’Aunno博士和Friedmann博士，设计一项试点调查，以衡量HH提供者组织中的成瘾治疗整合和服务协调；Probst博士，有效管理，并使用复杂的公共保险索赔数据构建衡量标准。我还将完成这些领域的正式课程。从2012-2014年的医疗补助分析摘录(MAX)数据中，我将使用通过这些培训活动获得的知识和技能来：(1)检查HH结构与2012-2014年期间参加HHS的医疗补助参与者接受治疗成瘾的概率的关系；(2)评估2012-2014年期间参加HH的医疗补助参与者接受治疗成瘾的影响；以及(3)设计并试行一项关于HHS为识别和治疗成瘾障碍而采用的组织结构和做法的调查。总之，拟议的K01奖将为我提供所需的资源、培训和指导，以启动我的长期独立研究计划，进行研究，以提高HHS识别和治疗成瘾的能力。

 DESCRIPTION (provided by applicant): Established under the Affordable Care Act, health homes (HHs) represent a major innovation in health service delivery for Medicaid beneficiaries with chronic health conditions, offering person-centered care coordination with a strong focus on behavioral health care and social supports and services. HHs have potential to improve receipt of addiction treatment and use and costs of acute care for addiction-related conditions (ARCs). However, research is needed to determine if HHs are successful in identifying and treating addiction, and if so, what practices are most effective in doing so. Strategies for identifying and treating addiction differ significantly across state HH models. The overall goal of this K01 application is to provide intensive, supervised career-development training to enable me to assess the impact of state HH model practices for identification and treatment of addiction on receipt of addiction treatment, and use and costs of acute care for ARCs. The proposed Mentored Research Scientist Development Award will allow me to supplement my expertise in health services research with advanced training in: econometrics, organizational theory, and survey design and administration. I will be guided by my primary mentor, John Brooks, PhD, and co-mentors Peter Friedmann, MD, MPH, Thomas D'Aunno, PhD, and Janice Probst, PhD. My training plan includes structured mentoring and study with Dr. Brooks, on use of econometric methods to estimate treatment effects using observational data, including use of propensity score matching and instrumental variable estimators; Dr. D'Aunno, on organizational theory; Dr. D'Aunno and Dr. Friedmann, on designing a pilot survey to measure addiction treatment integration and service coordination in HH provider organizations, and Dr. Probst, on effective management and construct measurement using complex public insurance claims data. I will also complete formal coursework in each of these areas. Drawing from Medicaid Analytic Extract (MAX) data from 2012-2014, I will use the knowledge and skills acquired through these training activities to: (1) examine the relationship of HH structure to the probability of addictio treatment receipt among Medicaid enrollees who participated in HHs during the period 2012-2014; (2) assess the effect of addiction treatment receipt on use and cost of acute care for ARCs among Medicaid enrollees participating in HH during the period 2012-2014; and (3) design and pilot a survey of organizational structures and practices employed by HHs to identify and treat addictive disorders. In sum, the proposed K01 Award will provide me with the resources, training, and mentoring needed to initiate my long-term independent research program to conduct research that can improve the capacity of HHs to identify and treat addiction.