Methadone Benefit Elimination--Oregon Health Plan

描述（由申请人提供）： 俄勒冈州健康计划（OHP）的重大变化创造了一个独特的机会，调查对参加美沙酮维持服务的患者的影响时，俄勒冈州州议会取消支付美沙酮维持和门诊化学依赖服务的医疗补助扩展，俄勒冈州健康计划标准。在这些削减之前，俄勒冈州大约有5 000名客户参加了美沙酮服务，3 000人接受了OHP标准。因此，自2003年3月1日起，有3，000名病人需要自费才能继续接受美沙酮服务。这项研究目前正在跟踪2003年2月和3月招募的151名美沙酮客户，并随机选择参加该项目。样本选择是对三组客户的随机准实验研究，（a）那些失去利益并非自愿地从美沙酮中移除的人，（B）那些试图自掏腰包购买美沙酮的人，（两者都根据OHP标准获得利益）和（c）那些通过医疗补助（OHP Plus）保留利益的人。第一波数据收集于2003年2月开始;第二波数据收集于2003年4月的头几个星期;第三波数据收集点定于2003年6月。成瘾严重程度指数、治疗服务审查和健康风险行为调查的访谈以及临床数据的图表审查构成了前三波数据收集。本申请寻求为期一年的后续面试（第4波）的资金，作为由罗伯特·伍德约翰逊基金会和俄勒冈州实践改进协作资助的早期工作的延续。研究开始一年后，来自客户临床记录的数据和来自四个俄勒冈州行政数据库的数据摘要将完成本项目的数据收集，这些数据库监测法律的、就业、成瘾服务和医疗补助报销。所有四个完成的访谈将提供成瘾严重程度指数量表（药物使用，酒精使用，法律的问题，医疗问题，家庭问题，就业问题和精神问题），参与心理健康，成瘾治疗和医疗保健服务（治疗服务审查）和艾滋病毒风险行为（风险行为调查）的时间序列数据。这些数据的分析将显示美沙酮客户的特征，这三个群体之间的差异。将提供ASI综合评分的平均值、标准差和范围，以检查表征样本的成瘾行为水平。人口统计学变量，包括年龄，性别，成瘾时间，剂量水平也将在所有四个波。此外，将介绍有多少OHP标准患者能够成功地自行支付美沙酮治疗费用。分析的主要部分将由结构方程模型组成，这些模型将用于隔离成瘾行为随时间的斜率和截距，检查三个客户群体之间的任何差异以及这些增长曲线的中介和调节因素。

DESCRIPTION (provided by applicant): Significant changes in the Oregon Health Plan (OHP) have created a unique opportunity to investigate impacts on patients enrolled in methadone maintenance services when the Oregon State Legislature eliminated payment for methadone maintenance and outpatient chemical dependency services for those under the Medicaid expansion, Oregon Health Plan-Standard. Approximately 5,000 clients in Oregon were enrolled in methadone services and 3,000 were receiving OHP Standard prior to these cuts. Thus, beginning March 1, 2003, 3,000 patients were required to self-pay in order to continue receiving methadone services. This study is currently following 151 methadone clients recruited in February and March 2003 and randomly selected to participate in this project. The sample selection was a randomized quasi-experimental study of three groups of clients, (a) those who lost their benefits and were removed from methadone involuntarily, (b) those who attempted to pay out of pocket for methadone, (both received benefits under the OHP Standard) and (c) those who retained their benefits through Medicaid (OHP-Plus). The first wave of data collection began in February 2003; with a second wave in the first weeks of April 2003; and a third data collection point is scheduled for June 2003. Interviews with the Addiction Severity Index, Treatment Services Review and Health Risk Behavior Survey and a chart review of clinical data constitute the first three waves of data collection. This application seeks funding for a one-year follow up interview (Wave 4) as a continuation of earlier work funded by the Robert Wood Johnson Foundation and the Oregon Practice Improvement Collaborative. Data from clients' clinical records one year following the beginning of the study and abstraction of data from four Oregon administrative databases that monitor legal, employment, addiction services and Medicaid reimbursements will round out the data collection for this project. All four completed interviews will provide time series data on the Addiction Severity Index scales (drug use, alcohol use, legal problems, medical problems, family problems, employment problems, and psychiatric problems), participation in mental health, addiction treatment and health care services (Treatment Services Review), and HIV risk behaviors (Risk Behavior Survey). The analysis for these data will present characteristics of methadone clients with respect to differences between the three groups. Means, standard deviations and ranges of the ASI composite scores will be presented examining the levels of addiction behaviors that characterize the sample. Demographic variables including age, gender, length of addiction, dosing levels will also be presented at all four waves. Also, a description of how many OHP-Standard patients were able to successfully self-pay for their methadone treatment on their own will be presented. The main part of the analysis will consist of structural equation models that will be used to isolate slopes and intercepts for addiction behaviors over time, examining any differences between the three client groups and the mediators and moderators of these growth curves.