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.

项目概要 阿片类药物滥用、成瘾和过量的危机对社区造成了毁灭性影响， 1999 年至 2017 年间，超过 40 万人因阿片类药物相关过量死亡。 流行病是一个复杂且异质性的问题，需要公共和私营部门采取有效应对措施 利益相关者以及医疗保健系统和社区。医疗体系发挥了部分作用 通过自由使用处方阿片类药物来缓解疼痛，以及医疗保健提供者和 组织在缓解危机方面可以发挥独特而重要的作用。通过关注两者的二元关系 阿片类药物处方以及阿片类药物使用障碍治疗、医疗保健组织和政策制定者可能会 能够有效抗击这场全国性的疫情。然而，为了做到这一点，有必要首先了解 不同的组织特征如何影响阿片类药物使用患者的处方实践和护理 整个连续体的混乱。在这项拟议的研究中，我们将使用多波全国调查 ACO 和国家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，用于评估医疗保健的作用 一般组织，特别是支付和交付改革，关于阿片类药物使用障碍的预防和 治疗。在进行另一波调查以对阿片类药物相关问题进行纵向回答后，我们 1) 估计潜在危险处方、阿片类药物使用监测和相关过量用药的变化 具有组织特征，包括替代支付模式的参与，以及 2) 估计变化 阿片类药物使用障碍治疗与组织特征和合同安排相关。 通过将组织对阿片类药物危机反应的调查与行政索赔数据相结合，我们将 揭示卫生系统的具体行动与可能影响阿片类药物使用的结果之间的关联 障碍和更广泛的物质使用障碍。随着政策制定者和提供者寻求新方法 确保精心开具阿片类药物处方，并通过以下方式有效护理阿片类药物使用障碍患者 与传统的医疗保健提供系统相比，我们的研究结果将帮助提供者选择最有效的 打击阿片类药物流行的组织战略。