Policy Dissemination Strategies to Improve the Use of Research Evidence in Medicaid Benefits for Opioid Use Disorder Treatment

政策传播策略，以改善阿片类药物使用障碍治疗的医疗补助福利中研究证据的使用

• 批准号: 10506614
• 负责人: Erika Lynn Crable
• 金额: $ 18.02万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10506614
• 关键词: 18 year old; Academy; Address; Adult; Advocacy; American; Authorization documentation; Behavior; Buprenorphine; Caring; Child; Child Health; Communities; Contracts; Data; Decision Making; Development; Dissemination and Implementation; Enrollment; FDA approved; Goals; Health; Health Insurance; Improve Access; Individual; Injectable; K-Series Research Career Programs; Laws; Level of Evidence; Life; Link; Managed Care; Mediator of activation protein; Medicaid; Mentors; Mentorship; Methadone; Methods; Modeling; Naltrexone; National Institute of Drug Abuse; Opioid; Oral; Outcome; Patients; Pediatrics; Pharmaceutical Preparations; Policies; Population; Positioning Attribute; Process; Public Health; Recovery; Relapse; Reporting; Research; Services; Source; Statistical Data Interpretation; Subgroup; Substance Use Disorder; Surveys; System; Testing; Training; United States Centers for Medicare and Medicaid Services; United States Food and Drug Administration; Youth; base; behavioral health; beneficiary; career; design; disorder prevention; dissemination science; dissemination strategy; effectiveness testing; evidence base; federal policy; flexibility; health inequalities; implementation strategy; improved; opioid epidemic; opioid overdose; opioid use disorder; pilot test; preference; prevent; programs; safety net; skills; standard care; substance use treatment; young adult

PROJECT SUMMARY/ABSTRACT The purpose of this proposed K01 Mentored Research Career Development Award is to support the applicant in advancing and maximizing her research skills in order to launch an independent research career in the dissemination and implementation of evidence-based substance use treatment for safety net populations. Safety net populations, especially individuals who are publicly insured by Medicaid and the Children’s Health Insurance Program (CHIP), have been disproportionately impacted by the U.S. opioid epidemic. Despite a significant need for treatment, lifesaving medications for opioid use disorder (MOUD) are underused by this population. Low MOUD use is driven by a myriad of misaligned federal, state, Medicaid/CHIP agency and managed care organization benefit and utilization management policies informed by varying levels of evidence. Federal policy requires all three MOUD (i.e., buprenorphine, methadone, naltrexone) be included as mandatory Medicaid state plan benefits, but not all states have complied, and the Centers for Medicare and Medicaid Services acknowledges that enforcing coverage is not feasible. Even when Medicaid/CHIP agencies cover all three MOUD, they can restrict access via preferred drug lists, fail-first, prior and re-authorization requirements – thus imposing potentially life-threatening care delays on beneficiaries. Managed care organizations (MCOs) that many state agencies contract to administer benefits can enact additional utilization management policies that limit MOUD access. Research is needed to promote Medicaid/CHIP and MCO policymakers’ use of scientific evidence when designing MOUD benefits. Under the mentorship of Dr. Gregory Aarons (sponsor and mentor) and an expert mentoring team, the applicant will pursue training in: (1) survey design, (2) multivariate statistical analysis, including latent class analysis and finite mixture modeling, (3) policy dissemination strategy development, including packaging and communicating evidence for policymakers, and (4) developing research partnerships with policy-relevant decision-makers. These training goals will facilitate accomplishing research aims to: (1) develop and administer a national survey to Medicaid/CHIP agency and MCO policymakers to identify determinants, mechanisms, and intermediaries that influence their evidence use behaviors; (2) empirically identify and describe distinct subgroups of Medicaid/CHIP agencies and MCOs based on their evidence use behaviors when designing MOUD benefits; (3) design and pilot test the acceptability, appropriateness and feasibility of dissemination strategies, tailored to each latent class, for promoting policymakers’ evidence-based decision-making regarding MOUD benefits. This proposal is aligned with NIDA’s strategic objectives to assess the impact of substance use disorder-related federal, state and systems policies on public health, and to identify strategic intermediaries and policy implementation strategies aimed at improving evidence use in policy. The planned K01 activities will effectively position the applicant to achieve an independent research career focused on improving access to evidence-based substance use treatment.

项目概要/摘要 拟议的 K01 指导研究职业发展奖的目的是支持申请人 提高和最大限度地提高她的研究技能，以便在该领域开展独立的研究生涯 传播和实施针对安全网人群的循证药物使用治疗。 净人口，特别是接受医疗补助和儿童健康保险公共保险的个人 尽管需求很大，但计划 (CHIP) 仍受到美国阿片类药物流行病的严重影响。 在治疗方面，该人群未充分使用治疗阿片类药物使用障碍 (MOUD) 的救生药物 低。 MOUD 的使用是由无数不一致的联邦、州、医疗补助/CHIP 机构和管理式医疗推动的 组织效益和利用管理政策由不同程度的联邦政策提供依据。 要求将所有三种 MOUD（即丁丙诺啡、美沙酮、纳曲酮）纳入强制性医疗补助州 计划福利，但并非所有州都遵守，并且医疗保险和医疗补助服务中心 承认即使 Medicaid/CHIP 机构涵盖所有这三项，强制覆盖也是不可行的。 MOUD，他们可以通过首选药物清单、失败优先、事先和重新授权要求来限制访问 - 因此 对受益人造成可能危及生命的护理延误。 许多管理福利的国家机构可以制定额外的利用管理政策， 需要进行研究来限制 MOUD 的访问，以促进医疗补助/CHIP 和 MCO 政策制定者对科学的使用 在 Gregory Aarons 博士（发起人和导师）的指导下设计 MOUD 福利时的证据。 和专家指导团队，申请人将接受以下方面的培训：（1）调查设计，（2）多元统计 分析，包括潜在类别分析和有限混合建模，（3）政策传播策略 发展，包括为政策制定者包装和传达证据，以及（4）开展研究 与政策相关决策者的伙伴关系将有助于完成研究。 旨在：(1) 制定和管理一项针对医疗补助/CHIP 机构和 MCO 政策制定者的全国调查， (2) 识别影响其证据使用行为的决定因素、机制和中介因素； 根据医疗补助/CHIP 机构和 MCO 的经验，识别和描述不同的亚组 设计 MOUD 效益时的证据使用行为；（3）设计并试点测试可接受性； 针对每个潜在类别量身定制的传播策略的适当性和可行性，以促进 该提案与 NIDA 的政策一致。 评估与物质使用障碍相关的联邦、州和系统政策影响的战略目标 公共卫生，并确定旨在改善公共卫生的战略中介机构和政策实施战略 计划中的 K01 活动将有效地帮助申请人实现独立性。 研究生涯的重点是改善获得循证药物滥用治疗的机会。