Examining the quality of opioid use disorder treatment in a Medicaid research network

项目概要/摘要 国家医疗补助计划在资助药物和非药物治疗方面发挥着关键作用， 阿片类药物使用障碍（OUD），因为它们为10个OUD患者中的4个提供覆盖。改善获得服务的努力 医疗补助中高质量的OUD治疗受到不一致和不完整测量的阻碍 质量和成果。各国目前正在采取各种方法来解决阿片类药物危机， 改变他们监管医疗服务提供者、支付医疗费用和覆盖医疗补助中循证治疗的方式。 然而，没有分析基础设施来了解国家政策实验对 由于各州没有共享数据或测量工具的机制，因此开放式发展的治疗和结果。到 克服这些挑战，我们利用医疗补助分布式研究网络的基础上，学术状态， 在肯塔基州、马里兰州、密歇根州、北卡罗来纳州、俄亥俄州、宾夕法尼亚州、弗吉尼亚州、西弗吉尼亚州和 威斯康星州。这些州有1500万（20%）的医疗补助注册者， 完整和最新的医疗补助数据。本申请的目的是提供一个全面的 评估医疗补助中的OUD治疗质量和结果，并为覆盖范围的政策决策提供信息 并支付医疗补助中基于证据的OUD治疗费用。首先，我们将构建并报告15个 在9个州的OUD治疗性能的标准化措施。其次，我们将医疗补助申请与 生命统计以检查OUD治疗质量之间的关联（例如，适当的引发， 连续性、随访、监测、接受心理社会护理、筛查）以及致命和非致命药物 吸毒过量第三，使用准实验研究设计，我们将研究医疗补助之间的关联， 覆盖政策，OUD治疗质量和过量结果。我们专注于实施的政策变化 最近扩大医疗补助覆盖面，减少药物治疗OUD的障碍， 扩大住院治疗的支付。我们的网络具有独特的优势，可以将我们的发现传播给 国家政策制定者可以采取行动。我们的网络可扩展。我们将采用强大的传播 我们的战略是将我们开发的分析工具分发给其他国家。最后，我们的网络是便携式的， 不仅要解决阿片类药物危机，还要解决美国未来面临的毒品流行病。

Project summary/abstract State Medicaid programs play a critical role in financing pharmacologic and non-pharmacologic treatments for opioid use disorder (OUD) as they provide coverage for 4 in 10 individuals with OUD. Efforts to improve access to high-quality OUD treatment in Medicaid have been hampered by inconsistent and incomplete measurement of quality and outcomes. States are currently taking myriad approaches to addressing the opioid crisis by changing the way they regulate providers, pay for care, and cover evidence-based treatments in Medicaid. However, there exists no analytic infrastructure for learning about the impact of state policy experimentation on OUD treatment and outcomes as states have no mechanism for sharing data or measurement tools. To overcome these challenges, we harness a Medicaid Distributed Research Network based on academic-state partnerships in Kentucky, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Virginia, West Virginia, and Wisconsin. These states account for 15 million (20% of) Medicaid enrollees, and the partnerships have access to complete and recent Medicaid data. The objectives of this application are to provide a comprehensive assessment of OUD treatment quality and outcomes in Medicaid, and to inform policy decisions on coverage and payment for evidence-based OUD treatments in Medicaid. First, we will construct and report on 15 standardized measures of OUD treatment performance in the 9 states. Second, we will link Medicaid claims to vital statistics to examine the association between the quality of OUD treatment (e.g., adequate initiation, continuity, follow-up, monitoring, receipt of psychosocial care, screening) and fatal and non-fatal drug overdoses. Third, using quasi-experimental study designs, we will examine associations between Medicaid coverage policies, OUD treatment quality and overdose outcomes. We focus on policy changes implemented recently to expand Medicaid coverage of and reduce barriers to pharmacologic treatment for OUD and to expand payment for residential treatment. Our network is uniquely positioned to disseminate our findings to state policy makers who can act on them. Our network is scalable. We will employ a robust dissemination strategy to distribute the analytic tools we develop to other states. Finally, our network is portable and can be harnessed to address not only the opioid crisis but future drug epidemics facing the US.