Improving quality and equity of opioid use disorder treatment using a multi-state Medicaid research network

项目摘要 医疗补助覆盖了大多数需要阿片类药物使用障碍(OUD)治疗和 不成比例地涵盖小规模人口和具有社会经济风险因素的人口。改进OUD 因此，医疗补助中的治疗质量可以达到大量的数字，并有助于纠正医疗保健中的不平等现象。 州医疗补助计划已经改变了政策，扩大了连续护理，消除了治疗障碍， 提高妇幼保育的质量。然而，各州采取这些行动是有质量的。 不发达的衡量系统限制了有针对性的干预和稳健的机会 政策效果评估。目前的大学教育质量衡量标准在三个关键方面受到限制。第一，音质 尽管临床医生、实践和设施 是质量改进计划最有可能的干预场所。第二，很少有措施纳入 OUD患者报告的结果或护理经验。第三，质量衡量标准通常不会由 人口亚群，因此没有发现基于种族和族裔的待遇不平等 政策和方案的变化。 医疗补助结果分布式研究网络(MODRN)支持医疗补助机构努力 通过制定新的治疗质量措施和检查治疗效果来提高治疗质量 关于过量用药的质量。MODRN将为医疗补助计划发展公平性和质量改进 (装备)并利用我们在占美国24%的12个州建立的强大的大学和州之间的合作伙伴关系 医疗补助人口。我们的首要目标是开发出可在 提供商级、纳入患者体验和中心健康公平。高效、可持续的OUD质量 MODRN-EQUIP制定和实施的措施将指导质量改进倡议和 医疗补助政策决定。我们的目标将通过三个综合研究项目来实现，旨在：1) 使用医疗补助管理数据制定提供者级别的OUD质量衡量标准；2)测量OUD患者- 报告结果并检查与基于索赔的质量措施的关联，以指导质量和公平性 改进，以及3)实施和检查实践级质量改进的有效性 为OUD提供干预。 一个由医疗补助领导人组成的州指导委员会将利用基础设施监督MODRN-Equipp 由先前的NIDA拨款(R01DA055585和R01DA048029)支持。这些研究项目将被执行 由一个协调中心、一个方法核心和一个参与和传播核心借鉴 医疗补助受益人、提供者、管理医疗组织和政策制定者的专业知识 质量测量和管理系统，以改变物质使用治疗。我们将传播 我们的发现通过州政策网络延伸到我们12个州以外的其他医疗补助项目。

Project Summary Medicaid covers the majority of individuals who need opioid use disorder (OUD) treatment and disproportionately covers minoritized populations and those with socioeconomic risk factors. Improving OUD treatment quality in Medicaid thus can reach large numbers and inform efforts to redress inequities in care. State Medicaid programs have changed policy to expand the continuum of care, remove barriers to treatment, and improve the quality of OUD care. However, states have taken these actions amidst OUD quality measurement systems that are underdeveloped limiting opportunities for targeted intervention and robust evaluation of policy effects. Current OUD quality measures are limited in three key ways. First, OUD quality measures are seldom constructed at the provider-level, despite the fact that clinicians, practices, and facilities are the most likely locus of intervention for quality improvement programs. Second, few measures incorporate OUD patient-reported outcomes or experiences of care. Third, quality measures are typically not reported by population sub-group and thus fail to identify inequities in treatment based on race and ethnicity amenable to policy and programmatic changes. The Medicaid Outcomes Distributed Research Network (MODRN) has supported Medicaid agency efforts to improve OUD treatment by developing novel measures of treatment quality and examining effects of treatment quality on overdose. MODRN will develop Equity and QUality Improvement for Medicaid Programs (EQUIP) and draw on our robust university-state partnerships in 12 states accounting for 24% of the US Medicaid population. Our overarching goal is to develop OUD quality measures that can be constructed at the provider-level, incorporate patient experience, and center health equity. Efficient and sustainable OUD quality measures developed and implemented by MODRN-EQUIP will guide quality improvement initiatives and Medicaid policy decisions. Our goal will be achieved through three integrated research projects aiming to: 1) develop provider-level OUD quality measures using Medicaid administrative data; 2) measure OUD patient- reported outcomes and examine associations with claims-based quality measures to guide quality and equity improvement, and 3) implement and examine the effectiveness of a practice-level quality improvement intervention for OUD. A State Steering Committee of Medicaid leaders will oversee MODRN-EQUIP, drawing on infrastructure supported by prior NIDA grants (R01DA055585 and R01DA048029). These research projects will be executed by a Coordinating Center, a Methods Core and an Engagement and Dissemination Core that draws on the expertise of Medicaid beneficiaries, providers, managed care organizations and policymakers to develop quality measurement and management systems to transform substance use treatment. We will disseminate our findings through state policy networks to reach beyond our 12 states to other Medicaid programs.