Stemming the Tide: The Role of Payment and Delivery System Reform in Combating the Opioid Epidemic

项目摘要 阿片类药物滥用，成瘾和过量的危机对社区产生了毁灭性的影响， 1999年至2017年间，超过40万人死于与阿片类药物有关的过量用药。因为阿片类药物 流行病是一个复杂和多样的问题，需要公共和私营部门采取有效的对策 利益相关者，以及医疗保健系统和社区。医疗保健系统发挥了部分作用 通过自由使用处方阿片类药物治疗疼痛，医疗保健提供者和 各组织在缓和危机方面可发挥独特和重要的作用。通过关注两者的二分体 阿片类药物处方以及阿片类药物使用障碍治疗，医疗保健组织和政策制定者可能 能够有效地抗击这一全国性疫情。然而，为了做到这一点，有必要首先了解 各种组织特征如何影响阿片类药物使用患者的处方实践和护理 在连续体中的无序。在这项拟议的研究中，我们将使用多个波的国家调查， ACO和全国医疗保健组织和系统调查，与国家医疗保险和 医疗补助索赔，以及美国医院协会年度调查数据，以评估医疗保健的作用 组织，特别是支付和交付改革，关于预防类阿片使用障碍， 治疗在进行另一次调查波以创建关于阿片类药物相关问题的纵向响应后，我们 将1）估计潜在危险处方、阿片类药物使用监测和过量相关的变化 与组织特征，包括替代支付模式的参与，以及2）估计变化 与组织特征和合同安排相关的阿片类药物使用障碍治疗。 通过将组织对阿片类药物危机的反应调查与行政索赔数据相结合，我们将 揭示卫生系统的具体行动与可能影响阿片类药物使用的结果之间的关联 精神障碍和物质使用障碍。随着政策制定者和供应商寻求新的方法， 确保阿片类药物得到深思熟虑的处方，并通过以下方式有效地护理阿片类药物使用障碍患者： 传统的医疗保健提供系统，我们的研究结果将帮助提供者选择最有效的 打击阿片类药物流行病的组织战略。

PROJECT SUMMARY The crisis of opioid misuse, addiction, and overdose has had a devastating impact on communities, with more than 400,000 people killed from an opioid-related overdose between 1999 and 2017. Because the opioid epidemic is a complex and heterogeneous issue, effective responses are required from public and private stakeholders, as well as healthcare systems and communities. The healthcare system has played a partial role in creating the crisis through liberal use of prescription opioids for pain, and healthcare providers and organizations have a unique and important role to play in tempering the crisis. By focusing on the dyad of both opioid prescribing as well as opioid use disorder treatment, healthcare organizations and policymakers may be able to effectively combat this national epidemic. In order to do so, however, it is necessary to first understand how various organizational characteristics impact prescribing practices and care for patients with opioid use disorder across the continuum. In this proposed research, we will use multiple waves of the National Survey of ACOs and the National Survey of Healthcare Organizations and Systems, linked to national Medicare and Medicaid claims, as well as American Hospital Association Annual Survey data to assess the role of healthcare organizations in general, and payment and delivery reforms specifically, on opioid use disorder prevention and treatment. After fielding another survey wave to create longitudinal responses on opioid related questions, we will 1) estimate changes in potentially hazardous prescribing, opioid use monitoring, and overdose associated with organizational characteristics, including alternative payment model participation, and 2) estimate changes in opioid use disorder treatment associated with organizational characteristics and contractual arrangements. By combining surveys on organizational response to the opioid crisis with administrative claims data, we will uncover associations between specific actions by health systems and outcomes that could influence opioid use disorder and substance use disorders more broadly. As policymakers and providers seek out new methods to ensure opioids are thoughtfully prescribed and to effectively care for patients with opioid use disorder through the traditional health care delivery system, our findings will help providers choose the most effective organizational strategies to combat the opioid epidemic.