Unpacking Disparities in Opioid Use Disorder Treatment Quality

项目总结 据估计，现在有200多万人患有阿片类药物使用障碍(OUD)。美国的医疗保健系统是 努力应对这一挑战，因为对OUD治疗的需求远远超过了合格临床医生的供应 世卫组织可以为阿片类药物使用障碍(MOUD)开处方和监测药物。Moud能有效地减少 过量死亡和改善预后，但极大地未得到充分利用，只有25%-40%的成年人患有OUD 接见穆德。在参加医疗补助的人中，OUD的比率特别高，而医疗补助是最大的 乌德治疗服务的付款人。研究表明，种族、民族、地理和年龄差异 过量死亡率、阿片类药物的使用模式和OUD，以及治疗模式。然而，很少有研究表明 采取更细致入微的方法来检查OUD护理的质量，同时考虑到差异 这可能会在种族、性别和年龄组等维度上产生复合，称为交叉性。 观察到的差异可能反映了可用治疗提供者的地区限制以及 上游诊断和治疗途径(例如，过量服药后的护理、获得初级保健的机会)。 使用北卡罗来纳州的实时医疗补助报销数据，并辅之以联邦医疗保险和私人报销 保险(这些来源加起来占北卡罗来纳州所有居民的四分之三以上)将 使我们能够描述每个提供者在付款人之间提供的OUD护理的质量。我们将研究 通过不同的横断面状态分析不同护理质量的差异，并检查这些差异的主要驱动因素。我们的第一次 目的是通过交叉状态来评估OUD护理质量的差异。我们还将研究是否 其他慢性行为健康和医疗条件的存在缓和了OUD护理中的这些差异 按交叉点状态划分的质量。我们的第二个目标是评估在多大程度上 按不同部门的状况提供高质量的OUD护理是由于提供服务的提供者的可用性不同 高质量的OUD治疗，按地理区域划分。最后，我们的第三个目标是通过 在北卡罗来纳州过渡之前、期间和之后接受高质量OUD护理的交叉状况 其医疗补助计划于2021年7月从按服务收费改为按人头计价。我们将使用国家医疗补助数据来 将北卡罗来纳州的妇幼保育质量模式与全国整体进行比较。我们还将探索如何使用 电子健康记录数据，通过以下方式提供对OUD护理质量的替代评估 临床医生的记录、命令和实验室测试。通过横断面调查了解儿科护理质量的差异 地位以及潜在和推动这些差异的因素对于实现公平、高质量的 医疗保健系统。我们的结果将指导政策和实践，旨在改善卫生保健参与度和 所有人都有质量。

PROJECT SUMMARY Over 2 million people are now estimated to have an opioid use disorder (OUD). The U.S. health care system is struggling to meet this challenge, as the need for OUD treatment far exceeds the supply of qualified clinicians who can prescribe and monitor medications for opioid use disorder (MOUD). MOUD are effective at reducing overdose deaths and improving outcomes, but are vastly underused, with only 25-40% of adults with OUD receiving MOUD. Rates of OUD are particularly high among Medicaid enrollees, and Medicaid is the largest payor of OUD treatment services. Studies have demonstrated racial, ethnic, geographic, and age differences in overdose death rates, patterns of opioid drug use and OUD, and patterns of treatment. Yet, few studies have undertaken more nuanced approaches to examining the quality of OUD care that take into account differences that may compound across dimensions such as race, gender, and age groups, referred to as intersectionality. Observed disparities may reflect regional limitations in available treatment providers as well as differences in upstream pathways to diagnosis and treatment (e.g., care after an overdose, access to primary care). Using real-time Medicaid claims data from North Carolina, supplemented by claims from Medicare and private insurance (with these sources together accounting for over three-quarters of all North Carolina residents) will allow us to characterize the quality of OUD care delivered by each provider across payers. We will examine differences in OUD care quality by intersectional status and examine key drivers of those differences. Our first aim is to assess differences in the quality of OUD care by intersectional status. We will also examine whether the presence of other chronic behavioral health and medical conditions moderate these disparities in OUD care quality by intersectional status. Our second aim is to assess the extent to which differences in the receipt of high-quality OUD care by intersectional status are due to differences in the availability of providers who provide high-quality OUD treatment, by geographic areas. Finally, our third aim is to compare differences by intersectional status in the receipt of high-quality OUD care before, during, and after North Carolina transitions its Medicaid program from fee-for-service to capitation in July 2021. We will use national Medicaid data to compare patterns of OUD care quality in North Carolina to the country as a whole. We will also explore the use of electronic health record data to provide an alternative assessment of OUD quality of care by examining clinician notes, orders, and lab tests. Understanding the differences in OUD care quality by intersectional status and the factors underlying and driving those differences is critical to attaining an equitable, high-quality health care system. Our results will guide policy and practice aimed at improving OUD care engagement and quality for all individuals.