Health Systems Node of the NIDA Clinical Trials Network

项目摘要 在持续的阿片类药物过量的公共健康危机中，阿片使用障碍(OUD)的发生率 增加以药物为基础的OUD治疗仍然没有得到充分利用。而更长的乌德治疗 持续时间通常与改善患者结局、维持持续健康保险有关 覆盖面对维持获得治疗的机会是一项重大挑战。OUD患者可能是 容易受到医疗保险不稳定的影响，导致获得治疗的障碍。高- 风险护理过渡或中断治疗可能会增加复发、过量用药和死亡的风险。尽管 保险不稳定的可能性对我们治疗的连续性造成重大障碍，目前 由于捕获和评估的挑战，有关其对健康和死亡率影响的知识有限 从卫生系统退保后的患者结果。为了解决这一知识差距，拟议的 临床试验网络(CTN)的研究概念寻求检查健康保险不稳定的关联 在一项多点队列研究中，接受丁丙诺啡治疗的OUD患者的死亡风险， 利用处方阿片类药物登记处(POR)的数据，其中包括四个不同的医疗系统 参与CTN Health Systems节点。研究的目的是：(1)查明事实和原因 来自国家死亡指数的死亡；(2)检查丁丙诺啡治疗期间的保险不稳定性 (3)评估保险不稳定性与风险之间的关系。 所有原因、阿片类药物过量和其他物质相关过量死亡的数据；以及(4)来自 研究网站，以研究所有付款人索赔数据和刑事司法数据，以探索与退保相关的事件 从健康计划中脱身。拟议的研究概念将有助于理解死亡后果。 与治疗OUD患者的保险不稳定有关。它还将为卫生方面的战略提供信息 确保持续获得治疗的制度，并防止有风险的患者出现不良结果 经历保险覆盖中断。

PROJECT ABSTRACT In the ongoing public health crisis of opioid overdoses, the incidence of opioid use disorder (OUD) has increased and medication-based treatment for OUD remain underutilized. While longer OUD treatment duration is generally associated with improved patient outcomes, maintaining continuous health insurance coverage represents a significant challenge to sustaining access to treatment. Patients with OUD may be vulnerable to experiencing health insurance instability that results in barriers to OUD treatment access. High- risk care transitions or disruptions to treatment may increase risk of relapse, overdose, and mortality. Despite the potential for insurance instability to create significant barriers to OUD treatment continuity, current knowledge regarding its health and mortality impacts is limited due to the challenge of capturing and evaluating patient outcomes after disenrollment from health systems. To address this knowledge gap, the proposed Clinical Trials Network (CTN) research concept seeks to examine the association of health insurance instability and mortality risk among patients receiving buprenorphine treatment for OUD in a multi-site cohort study, leveraging data from the Prescription Opioid Registry (POR) that include four diverse health systems participating in the CTN Health Systems Node. The aims of the study are: (1) Ascertain fact and cause of death from the National Death Index; (2) Examine insurance instability during buprenorphine treatment for OUD and associated patient and health plan factors; (3) Assess the association of insurance instability and risk of all-cause, opioid overdose, and other substance-related overdose mortality; and (4) Link data from one study site to all-payer claims data and criminal justice data to explore events associated with disenrollment from health plans. The proposed research concept will contribute to understanding the mortality consequences associated with insurance instability for patients in treatment for OUD. It will also inform strategies in health systems to ensure continuity of treatment access and to prevent poor outcomes in patients at risk of experiencing insurance coverage disruptions.