Addictions treatment organizational response to COVID-19: impact on disparities in quality of care

成瘾治疗组织对 COVID-19 的反应：对护理质量差异的影响

基本信息

批准号：
10594509
负责人：
CHARLES J NEIGHBORS
金额：
$ 73.16万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
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：
2022-04-01 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10594509
关键词：
African American Ambulatory Care Black race COVID-19 COVID-19 impact Calendar Caring Characteristics Client Clinic Clinical Communities Counseling Data Disparity Distal Dose Drug Screening Emergency department visit Ethnic Origin Gender Government Group Meetings Health Personnel Home Hospitalization Individual Latinx Latinx population Measures Medicaid Medical Medication Management Methadone Methods Modeling New York Outcome Outpatients Overdose Patient Care Patient-Focused Outcomes Patients Persons Pharmaceutical Preparations Pharmacotherapy Policies Provider Public Health Qualitative Methods Quality of Care Race Reduce health disparities Registries Relaxation Research Resources Self Administration Shock Social Distance Substance Use Disorder System Technology Telemedicine Testing Time Treatment outcome Variant access disparities addiction clinical practice community-level factor design drug use screening eHealth ethnic health disparity flexibility group counseling health care disparity health care quality improved medical specialties methadone treatment novel therapeutic intervention opioid use disorder programs psychosocial public health emergency racial health disparity response screening social telehealth treatment organization treatment services vulnerable community

项目摘要

Project Summary The COVID-19 public health emergency gave an extraordinary exogenous shock to SUD treatment organizations, forcing rapid changes in how they provide care. Before COVID-19, the treatment model relied heavily on brick-and-mortar clinics to provide in-person medical care and psychosocial treatment, including specialty outpatient addictions treatment (SOAT) and pharmacotherapy provided through medical office-based addictions treatment (OBAT). Due to government mandates for physical distancing and relaxation of restrictions for using telehealth, both SOAT and OBAT providers quickly and fundamentally changed their workflows, including: new forms of medical screening and medication management; greater flexibility in allowing patient self-dosing of medication at home; treatment through individualized and group meetings via telehealth; reduced reliance on drug use screening; and new strategies for treatment engagement. These changes will have unknown effects on treatment retention, use of pharmacotherapy for addictions, and longer- term outcomes. The outpatient treatment system responses—both temporary and enduring—to these external shocks will take many forms depending on the organizational and environmental context in which programs operate. There is concern that Black/African American and Latinx patients—who are more likely to receive care in more poorly resourced programs and have lower access to eHealth technology—will receive poorer quality care and worse outcomes. We will employ a social-ecological framework to examine the conditions under which outpatient treatment across New York State adapted to the exogenous shock and analyze relationships between new clinical practices (e.g., use of telehealth) and proximal (e.g., retention, use of pharmacotherapy) and distal (e.g., overdoses, emergency department visits) markers of patient outcomes. Further, we will examine racial/ethnic variation that may indicate disparities in care as well as organizational and community factors that may account for disparities. We propose an explanatory sequential mixed-methods design to study both short term and longer-term changes to treatment services and outcomes. We will first use administrative data—joining a state registry of SUD treatment episodes with Medicaid—to study variation in treatment practices across 545 SOAT clinics and 3100 OBAT providers. We will examine changes to treatment practice: clinical delivery (e.g., use of telehealth, mix of group versus individual counseling), use of pharmacotherapy (e.g., remote induction, greater flexibility in methadone self-administration), and retention. We will then examine the association between these practice changes and treatment outcomes, such as overdoses, substance-related emergency department visits, and hospitalizations. We will employ qualitative methods to develop an understanding of the quantitative findings by examining organizational characteristics of programs representative of those that have best retention and treatment outcomes as well as programs that performed worst on these measures. The findings will inform clinical and policy decisions on treatment system reforms.

项目概要 COVID-19突发公共卫生事件给SUD治疗带来了非同寻常的外源性冲击组织，迫使他们快速改变提供护理的方式。在 COVID-19 之前，所依赖的治疗模式。大量依靠实体诊所提供面对面的医疗护理和心理社会治疗，包括通过医疗办公室提供的专业门诊成瘾治疗 (SOAT) 和药物治疗由于政府要求保持身体距离并放松戒瘾治疗（OBAT）。 SOAT 和 OBAT 提供商迅速从根本上改变了使用远程医疗的限制工作流程，包括：新形式的医疗筛查和药物管理；允许患者在家中通过个性化和小组会议自行用药；远程医疗；减少对药物使用筛查的依赖；以及新的治疗参与策略。变化将对治疗保留、成瘾药物治疗的使用以及长期治疗产生未知的影响。门诊治疗系统对这些外部因素的反应（包括暂时的和持久的）冲击将采取多种形式，具体取决于项目所在的组织和环境背景人们担心黑人/非裔美国人和拉丁裔患者更有可能接受护理。在资源匮乏的项目中，获得电子医疗技术的机会较少——将获得较差的质量我们将采用社会生态框架来检查条件。纽约州的门诊治疗适应了外源性冲击并分析了关系新临床实践（例如，使用远程医疗）和近端临床实践（例如，保留、使用药物治疗）之间此外，我们还将评估患者预后的远端指标（例如用药过量、急诊就诊）。检查可能表明护理以及组织和社区方面差异的种族/民族差异我们提出了一种解释性顺序混合方法设计来研究。我们将首先使用行政手段来改变治疗服务和结果。数据——通过医疗补助加入 SUD 治疗事件的州登记处——以研究治疗的变化 545 个 SOAT 诊所和 3100 个 OBAT 提供者的实践我们将检查治疗实践的变化：临床交付（例如，使用远程医疗、团体咨询与个人咨询的混合）、药物治疗的使用（例如，远程诱导、美沙酮自我管理的更大灵活性）以及保留。检查这些实践改变与治疗结果之间的关联，例如药物过量、我们将采用定性方法来确定与物质相关的急诊就诊和住院治疗。通过检查项目的组织特征来了解定量结果代表那些具有最佳保留和治疗结果的项目以及执行的项目这些研究结果将为治疗系统改革的临床和政策决策提供信息。