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

遏制浪潮：支付和交付系统改革在抗击阿片类药物流行中的作用

• 批准号: 10393004
• 负责人: Terri D Lewinson
• 金额: $ 59.67万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10393004
• 关键词: Accident and Emergency department; Accountability; Acute; Address; Affect; American Hospital Association; Attention; Behavior Therapy; Black race; Buprenorphine; Caring; Cessation of life; Characteristics; Clinical; Communities; Complex; Contracts; Data; Development; Disabled Persons; Dose; Effectiveness; Ensure; Epidemic; Ethnic Origin; Expenditure; Goals; Growth; Guidelines; Health Care Surveys; Health Personnel; Health system; Healthcare Systems; Hispanic; Incentives; Inpatients; Link; Medicaid; Medicare/Medicaid; Methods; Modeling; Monitor; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Pain; Participant; Patient Care; Patient-Focused Outcomes; Patients; Persons; Pharmacy facility; Play; Prevention; Privatization; Provider; Research; Resources; Role; Specialist; Substance Use Disorder; Surveys; System; Testing; Toxicology; Urine; addiction; base; biological sex; black patient; bundled payment; care costs; care episode; combat; cost effective intervention; design; disorder prevention; evidence base; federal policy; health care delivery; health care service organization; healthcare community; indexing; innovation; medication-assisted treatment; novel; opioid epidemic; opioid misuse; opioid overdose; opioid use; opioid use disorder; payment; population health; prescription opioid; prevent; response; screening; stem; success; systems research; theories; therapy adherence; treatment organization

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.

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，更多 超过40万人在1999年至2017年之间因阿片类药物相关的过量而丧生。因为阿片类药物 流行病是一个复杂且异构的问题，公共和私人需要有效的回应 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来造成危机，以及医疗保健提供者和 组织在缓解危机中起着独特而重要的作用。通过专注于两者的二元 阿片类药物处方以及阿片类药物使用障碍治疗，医疗机构和决策者可能是 能够有效与这种民族流行病作斗争。但是，为了这样做，有必要先了解 各种组织特征如何影响使用阿片类药物患者的处方实践和护理 连续体的混乱。在这项拟议的研究中，我们将使用全国调查的多个浪潮 ACOS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 一般组织，以及针对阿片类药物使用障碍的付款和交付改革， 治疗。在提出了另一个调查浪潮以对阿片类药物相关的问题产生纵向反应后，我们 1）估计可能危险处方，阿片类药物使用监测和相关用药的变化 具有组织特征，包括替代付款模型参与和2）估计变更 在阿片类药物使用障碍治疗中与组织特征和合同安排相关的治疗。 通过将组织对阿片类药物危机的组织反应与行政索赔数据结合起来，我们将 发现卫生系统的特定行动与可能影响阿片类药物使用的结果之间的关联 疾病和物质使用障碍更广泛。随着政策制定者和提供商寻求新的方法 确保对阿片类药物进行周到的规定，并通过 传统的医疗保健提供系统，我们的发现将帮助提供者选择最有效的 对抗阿片类药物流行的组织策略。