Improving racial equity in opioid use disorder treatment in Medicaid

改善医疗补助中阿片类药物使用障碍治疗的种族平等

• 批准号: 10415670
• 负责人: JULIE Marie DONOHUE
• 金额: $ 157.62万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10415670
• 关键词: Accounting; Address; Adopted; Affect; Automobile Driving; Benchmarking; Black Populations; Black race; Buprenorphine; COVID-19 pandemic; Characteristics; Code; Contracts; Criminal Justice; Data; Death Rate; Drug Prescriptions; Ethnic Origin; Ethnic group; Evidence based treatment; Formulation; Funding; Gender; Geographic Locations; Geography; Goals; Healthcare; Hispanic Populations; Housing; Improve Access; Incentives; Individual; Infrastructure; Institutes; Knowledge; Learning; Linguistics; Managed Care; Managed Care Programs; Marketing; Measurement; Measures; Medicaid; Methadone; Minority; Naltrexone; National Institute of Drug Abuse; Outcome; Outcome Study; Ownership; Patients; Performance; Persons; Pharmaceutical Preparations; Plant Roots; Policies; Policy Developments; Positioning Attribute; Provider; Quality of Care; Race; Racial Equity; Research; Research Personnel; Role; Services; Single-Payer System; Social Work; Source; Structural Racism; System; Time; Travel; Universities; Variant; barrier to care; base; behavioral health; development policy; differences in access; ethnic minority population; financial incentive; improved; medical specialties; mortality; multilevel analysis; opioid epidemic; opioid overdose; opioid treatment program; opioid use disorder; overdose death; overdose prevention; payment; prevention service; programs; provider networks; racial and ethnic; racial and ethnic disparities

Abstract Access to medications for opioid use disorder (MOUD) is not equitable. Black and Hispanic individuals are substantially less likely to receive MOUD and other overdose prevention services. The overdose death rate has risen nearly twice as fast for Black individuals as for White individuals in recent years, a disparity that appears to have widened during the COVID-19 pandemic. Racial/ethnic inequities in receipt of MOUD are rooted in the structural racism ingrained in policies governing healthcare, housing, social services, criminal justice and other systems. As the largest single payer for MOUD and a key source of coverage for racial/ethnic minority groups, Medicaid is well-positioned to address inequities in MOUD. Although they have not done so to date, Medicaid agencies can adopt policies to alter (a) financial incentives for MOUD providers, and (b) contracts with managed care plans to improve equity in MOUD. Medicaid programs could institute requirements for provider networks; invest in building capacity for minority-serving Medicaid providers to deliver MOUD; include equity measures in provider performance measurement; and alter managed care contracts to incentivize plans to address inequities in MOUD. There is, however, little evidence on which of these levers is most likely to be effective. To inform Medicaid policy development, we harness the Medicaid Outcomes Distributed Research Network (MODRN), which is made up of university partnerships with Medicaid agencies in 11 states representing 22% of all US Medicaid enrollees. MODRN is currently funded by NIDA to study the quality of opioid use disorder treatment in Medicaid and has developed analytic infrastructure to conduct multi-state analyses of treatment with MOUD in Medicaid. We propose analyses that examine the role of place, providers, plans and policies in driving racial/ethnic inequities in MOUD. First, we examine racial/ethnic inequities in geographic access to MOUD providers among Medicaid enrollees. Second, we examine the contribution of provider- and plan-level factors to racial/ethnic equity in MOUD. Third, we estimate the association between state policies aimed at (a) changing delivery system reforms, and (b) managed care contracts, and equity in MOUD. Study outcomes are any use of MOUD and continuity of MOUD, both of which are associated with reduced mortality. We will use geospatial analyses, multi-level modeling, and difference-in difference analyses to accomplish our specific aims. Long-standing relationships with state Medicaid officials allow us to share findings directly with policymakers who can act on them. MODRN facilitates rapid knowledge transfer from researchers to policymakers, allows state Medicaid agencies to benchmark their performance on racial/ethnic equity in MOUD against other states, and supports state agencies learning from one another about the most effective policy levers for improving equity in MOUD.

抽象的 获得阿片类药物使用障碍（MOUD）的药物不公平。黑人和西班牙裔人是 接受MOUD和其他过量预防服务的可能性大大降低。过量的死亡率 近年来，黑人人的速度几乎是白人的两倍，这是一个差距 在19日大流行期间，似乎已经扩大了。接收穆德的种族/民族不平等是 植根于结构性种族主义，根深蒂固于管理医疗保健，住房，社会服务，刑事的政策 正义和其他系统。作为MOUD的最大付款人，也是种族/种族的关键覆盖范围 少数群体，医疗补助有很好的位置，可以解决穆德的不平等现象。尽管他们没有这样做 日期，医疗补助机构可以采用政策来改变（a）MOUD提供商的经济激励措施，以及（b） 与托管护理计划的合同，以提高穆德的股权。医疗补助计划可以成立 提供商网络的要求；投资于少数派服务医疗补助提供商的建筑能力 传递穆德；在提供者绩效衡量中包括股权度量；并改变托管护理 合同激励计划解决穆德不平等的计划。但是，几乎没有证据表明哪个 这些杠杆最有效。为了告知医疗补助政策制定，我们利用医疗补助 成果分布式研究网络（MODRN），该网络由与医疗补助的大学合作伙伴关系组成 11个州的机构占美国医疗补助所有参与者的22％。 Modrn目前由NIDA资助 研究医疗补助中阿片类药物使用障碍治疗的质量，并开发了分析基础设施 在医疗补助中对MOUD进行多州治疗分析。我们提出了研究角色的分析 在穆德推动种族/族裔不平等方面的提供者，计划和政策。首先，我们检查 在医疗补助参与者中，与MOUD提供者的地理访问中的种族/民族不平等。第二，我们 检查提供者和计划级别因素对MOUD种族/种族公平的贡献。第三，我们估计 旨在（a）不断变化的交付系统改革的国家政策与（b）管理护理之间的关联 合同，穆德的权益。研究结果是对moud的任何使用和穆德的连续性 与死亡率降低有关。我们将使用地理空间分析，多级建模和差异 差异分析以实现我们的具体目标。与州医疗补助官员的长期关系 允许我们直接与可以对其采取行动的决策者分享发现。 modrn促进了快速知识 从研究人员转移到政策制定者，允许州医疗补助机构基准其绩效 穆德（Moud）对其他国家的种族/种族公平性，并支持国家机构相互学习 关于改善穆德股权的最有效的政策杠杆。