Developing Quality Measures for Opioid-Exposed Infants

为阿片类药物暴露婴儿制定质量措施

基本信息

批准号：
10452970
负责人：
Scott A Lorch
金额：
$ 36.98万
依托单位：
VANDERBILT UNIVERSITY MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10452970
关键词：
Academy Birth Breast Feeding Caring Child Welfare Clinical Clinical Data Clinical effectiveness Code Communities Data Data Set Development Diagnosis Electronic Health Record Emergency department visit Exposure to Family Foundations Geographic state Goals Health Health Personnel Health system Healthcare Hospitals Infant Infant Development Inpatients Insurance Carriers Length Length of Stay Link Measures Medicaid Medical Medicine Methods Neonatal Abstinence Syndrome Opioid Outcome Outcome Measure Patients Performance Perinatal Personal Satisfaction Pharmaceutical Preparations Pharmacological Treatment Policy Developments Policy Maker Populations at Risk Pragmatic clinical trial Pregnant Women Preventive service Privatization Process Process Measure Public Policy Quality of Care Randomized Randomized Clinical Trials Records Reproducibility Research Research Personnel Risk Safety Sampling System Time Validity and Reliability Variant Vulnerable Populations Withdrawal Withdrawal Symptom adverse outcome care outcomes clinical care collaborative care effectiveness measure effectiveness study experience health care quality improved improved outcome infant outcome innovation neglect opioid exposure opioid use opioid use disorder population based provider behavior readmission rates response standardized care tool usability

项目摘要

ABSTRACT Opioid use, diagnoses of opioid use disorder among pregnant women, and diagnoses of neonatal opioid withdrawal syndrome (NOWS) increased dramatically over the past 20 years. In 2017, an estimated 100,000 infants were exposed to opioids, among whom 25,000 infants were diagnosed with NOWS. Opioid-exposed infants, regardless of whether they are diagnosed with NOWS, are more likely to have adverse outcomes compared to similar non-exposed infants, including: longer and more complicated initial hospital stays, higher likelihood of involvement in the child welfare system, higher rates of hospital readmission and emergency department visits and lower use of recommended preventive services. Further, delivery of medical care to opioid-exposed infants remains variable resulting in uneven outcomes among US hospitals and communities. The development of valid and reliable measures for opioid-exposed infants is critical to improving outcomes for this vulnerable population. To fill this existing gap we will: 1) develop candidate measures of quality for opioid- exposed infants and refine these measures by engaging key stakeholders including local, state, and national public policy makers; private and public insurers; health care providers; and families using a modified RAND/UCLA Appropriateness Method; 2) determine the reliability, reproducibility and validity of measures of candidate quality measures while evaluating the usability, validity, and reliability of the measures using two unique sets of data, linked maternal-infant data from the Medicaid Analytic Extract from 2007-2014 and clinically collected data from two large clinical systems and will determine risk-adjusted hospital variation in measures for opioid-exposed infants in a large population-based sample. This R34 will produce quality measures for opioid-exposed infants and preliminary data that will subsequently inform an R01 pragmatic clinical trial that will evaluate how clinician performance on quality measures results in changes to provider behaviors and subsequent alterations in infant outcomes. In addition, these measures can also serve as the outcomes for randomized clinical trials that examine the impact of various treatments on the health and wellbeing of opioid-exposed infants and whether they experience withdrawal symptoms after birth. The ultimate goal of this R34 and subsequent R01s will be to provide innovative tools for clinicians, researchers, policymakers, payers, hospital systems and state perinatal collaboratives to improve care for opioid-exposed infants.

抽象的阿片类药物的使用、孕妇阿片类药物使用障碍的诊断以及新生儿阿片类药物的诊断过去 20 年来，戒断综合症 (NOWS) 急剧增加。 2017 年，估计有 100,000 婴儿接触阿片类药物，其中 25,000 名婴儿被诊断患有 NOWS。阿片类药物暴露婴儿，无论是否被诊断出患有NOWS，都更有可能出现不良后果与类似的非暴露婴儿相比，包括：初次住院时间更长、更复杂、更高参与儿童福利系统的可能性、再入院率和急诊率更高部门访问和减少使用推荐的预防服务。此外，向接触阿片类药物的婴儿仍然存在差异，导致美国医院和社区的结果参差不齐。针对阿片类药物暴露婴儿制定有效且可靠的措施对于改善结果至关重要这个弱势群体。为了填补这一现有空白，我们将：1）制定阿片类药物质量候选指标暴露的婴儿，并通过让包括地方、州和国家在内的主要利益相关者参与来完善这些措施公共政策制定者；私人和公共保险公司；医疗保健提供者；以及使用改良版的家庭兰德/加州大学洛杉矶分校适当性方法； 2) 确定措施的可靠性、再现性和有效性候选质量指标，同时使用两个指标评估指标的可用性、有效性和可靠性独特的数据集，来自 2007-2014 年医疗补助分析摘录的关联母婴数据，以及从两个大型临床系统中临床收集的数据将确定风险调整后的医院差异在大量人口样本中针对阿片类药物暴露婴儿的措施。这 R34 将产生质量针对阿片类药物暴露婴儿的措施和初步数据，随后将为 R01 实用主义提供信息临床试验将评估临床医生在质量措施方面的表现如何导致提供者的变化行为和随后婴儿结局的改变。此外，这些措施还可以作为随机临床试验的结果，检查各种治疗对健康和健康的影响接触阿片类药物的婴儿的健康状况以及他们出生后是否出现戒断症状。终极 R34 和后续 R01 的目标是为临床医生、研究人员、政策制定者、付款人、医院系统和国家围产期合作机构，以改善阿片类药物暴露者的护理婴儿。