Influence of social vulnerability on buprenorphine treatment and opioid overdoses after an opioid-related emergency department visit among commercially insured and Medicare Advantage beneficiaries

项目摘要/摘要 阿片类药物过量继续增加，并不成比例地影响经历 社会风险因素较大。丁丙诺啡是治疗阿片使用障碍(OUD)的一线药物 这减少了阿片类药物过量，特别是在急诊科(ED)启动时- 一个高容量的护理点。然而，丁丙诺啡治疗内外存在不平等 以及方法学上的挑战，使得识别脆弱人群变得困难 他们可能受益于改善丁丙诺啡治疗的机会和质量。 由疾病控制和预防中心开发的社会脆弱性指数(SVI) 预防(CDC)是一种通过捕捉社会风险来识别弱势人群的措施 一个地区影响健康的因素。综合得分是基于某一地区的：1) 社会经济地位；2)家庭结构和残疾；3)少数民族地位和语言； 4)住房和交通。研究考察了地区层面的社会风险的影响 丁丙诺啡治疗和阿片类药物过量的因素是国家特有的或仅限于 县级措施。还没有研究考察社会脆弱性对 丁丙诺啡治疗与阿片类药物相关ED就诊后阿片类药物过量 拥有商业或医疗保险优势(老年人和残疾人)健康保险的人。 本研究将在住宅邮政编码级别部署SVI，以调查 丁丙诺啡治疗和阿片类药物过量的社会脆弱性 使用索赔数据(OpumLabs®Data Warehouse)从商业或 联邦医疗保险优势医疗保险。目标1将使用COX风险回归分析来 评估社会脆弱性是否与启动丁丙诺啡治疗的时间有关。 目的2将评估社会脆弱性对丁丙诺啡治疗保留的影响 至少180天，以及丁丙诺啡治疗质量的其他八项措施 美国成瘾医学会(ASAM)，使用广义估计方程(GEE)。 目标3将使用GEE评估处方做法对阿片类药物过量的影响。这个 这项研究的结果将作为未来研究的模型，并为有针对性的政策和 临床杠杆，改善丁丙诺啡治疗的机会和质量，以及阿片类药物- 相关结果，在经历较大社会风险因素的OUD患者中。

PROJECT SUMMARY/ABSTRACT Opioid overdoses continue to increase and disproportionately influence people experiencing greater social risk factors. Buprenorphine is a first-line treatment for opioid use disorder (OUD) that decreases opioid overdoses, especially when initiated in the emergency department (ED)— a high volume point-of-care. However, buprenorphine treatment inequities exist in and outside of the ED, and methodological challenges make it difficult to identify vulnerable populations with OUD who may benefit from improved access to, and quality of, buprenorphine treatment. The social vulnerability index (SVI), developed by the Centers for Disease Control and Prevention (CDC), is a measure that identifies vulnerable populations by capturing social risk factors in a region that influence health. A composite score is derived based on an area’s: 1) socioeconomic status; 2) household composition and disability; 3) minority status and language; 4) housing and transportation. Studies that examined the influence of area-level social risk factors on buprenorphine treatment and opioid overdoses were state specific or limited to county-level measures. No studies have examined the influence of social vulnerability on buprenorphine treatment and opioid overdoses following an opioid-related ED visit in people with OUD who have commercial or Medicare Advantage (aged and disabled) health insurance. This study will deploy the SVI at the residential zip-code level to investigate the influence of social vulnerability on buprenorphine treatment and opioid overdoses following an opioid-related ED visit using claims data (OptumLabs® Data Warehouse) from people with commercial or Medicare Advantage health insurance. Aim 1 will employ Cox hazard regression analysis to assess whether social vulnerability is associated with time to initiating buprenorphine treatment. Aim 2 will estimate the effect of social vulnerability on buprenorphine treatment retention for at least 180 days, as well as eight other buprenorphine treatment quality measures from the American Society of Addiction Medicine (ASAM), using generalized estimating equations (GEE). Aim 3 will estimate the effect of prescribing practices on opioid overdoses using GEE. The results from this study will serve as a model for future research and inform targeted policy and clinical levers that improve access to, and quality of, buprenorphine treatment, as well as opioid- related outcomes, among people with OUD experiencing greater social risk factors.