Integrating Addiction Treatment and Medical Care in a Commercial Health Plan

将成瘾治疗和医疗保健纳入商业健康计划

• 批准号: 8675816
• 负责人: DENNIS MCCARTY
• 金额: $ 64.84万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8675816
• 关键词: Accident and Emergency department; Address; Admission activity; Adoption; Alcohol abuse; Alcohol dependence; Alcohols; Attitude; Biological Models; Buprenorphine; Businesses; California; Caring; Collaborations; Contracts; Data; Databases; Emergency Situation; Emergency medical service; Evidence based practice; Expenditure; Funding; Health; Health Planning; Health Sciences; Health Services; Inpatients; Insurance and Payment Issues; Intake; Intervention; Interview; Lead; Leadership; Medical; Modeling; Naltrexone; Opiate Addiction; Opioid; Oregon; Overdose; Patients; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Policies; Process; Professional counselor; Provider; Public Health; Recovery; Regulation; Research; Research Institute; San Francisco; Services; Site; Support System; System; Techniques; Testing; Training; United States Substance Abuse and Mental Health Services Administration; Universities; Visit; Wisconsin; Work; Writing; addiction; alcohol use disorder; behavioral health; cost; evidence base; experience; health care service utilization; innovation; meetings; member; opioid abuse; preconditioning; prescription opioid; treatment center; treatment planning; treatment program

DESCRIPTION (provided by applicant): Twelve addiction treatment centers and Aetna Behavioral Health collaborate using the Advancing Recovery systems change model to increase the proportion of patients with medication-assisted treatment for alcohol or opioid dependence. The addiction treatment centers participate in a 22-month test of the system change strategy to enhance access to medication for patients dependent on opioids or alcohol. The proposal has three specific aims: 1) facilitate adoption of medications, 2) assess impacts on healthcare utilization and expenditures, and 3) conduct qualitative interviews and document implementation barriers and change strategies. Analyses of Aetna's databases track use of health and behavioral health services to assess medication impacts on the utilization and cost of care. Specific Aim 1: Use the Advancing Recovery model of system change to accelerate the implementation of medication-assisted treatment and integration with medical care; assign 12 addiction treatment centers to Advancing Recovery and compare to 12 matched comparison sites. 7 H1A: The proportion of opioid and alcohol admissions with prescriptions for addiction medications is greater in centers using the Advancing Recovery system change model. 7 H1B: Advancing Recovery sites form linkages with more prescribers and have more physicians writing prescriptions for patients. Specific Aim 2: Assess impacts on the utilization of and expenditures for inpatient, emergency and residential care using Aetna's utilization and expenditures data. 7 H2A: Utilization of and expenditures for inpatient medical care, emergency services, and residential addiction treatment will be lower among patients treated in sites participating in Advancing Recovery. 7 H2B: Utilization of and expenditures for inpatient medical care, emergency services, and residential addiction treatment will be lower among patients treated with addiction medications. 7 H2C: Utilization of and expenditures for inpatient medical care, emergency services, and residential addiction treatment will be lower among patients with more consecutive months of medication prescriptions. Specific Aim 3: Conduct qualitative interviews to document implementation barriers and effective implementation strategies for medication assisted treatment. 7 H3A: Provider training and attitudes are more problematic barriers to adoption than payment and reimbursement issues. 7 H3B: Centers with no experience with buprenorphine will be more likely to use extended release naltrexone for treatment of opioid dependence.

描述（由申请人提供）：使用前进的恢复系统更改模型进行了十二个成瘾治疗中心和AETNA行为健康合作，以增加对酒精或阿片类药物依赖性药物辅助治疗的患者的比例。成瘾治疗中心参与了22个月的系统变化策略的测试，以增强依赖阿片类药物或酒精的患者的药物使用。该提案具有三个具体的目的：1）促进采用药物，2）评估对医疗保健利用和支出的影响，以及3）进行定性访谈，并记录实施障碍和变更策略。对AETNA数据库的分析跟踪健康和行为健康服务的使用，以评估药物对护理利用率和成本的影响。特定目的1：使用系统变化的前进恢复模型来加速用药辅助治疗和与医疗护理的整合；分配12个成瘾治疗中心以提高恢复并与12个匹配的比较站点进行比较。 7 H1A：使用前进的恢复系统变化模型，中心的阿片类药物和酒精入院的比例更大。 7 H1B：推进恢复站点与更多的处方者形成联系，并让更多的医生为患者写处方。具体目标2：评估对使用Aetna的利用率和支出数据对住院，紧急和住宅护理的利用和支出的影响。 7 H2A：在参与恢复康复的现场治疗的患者中，住院医疗，紧急服务和住院成瘾治疗的利用和支出将较低。 7 H2B：在接受成瘾药物治疗的患者中，住院医疗，紧急服务和住院成瘾治疗的利用和支出将较低。 7 H2C：在住院医疗服务，紧急服务和住院成瘾治疗的使用和支出的使用和支出将在连续数月的药物处方的患者中较低。特定目标3：进行定性访谈以记录实施障碍和有效的药物辅助治疗策略。 7 H3A：提供者培训和态度比付款和报销问题更有问题的障碍。 7 H3B：没有丁丙诺啡经验的中心更有可能使用扩展的释放纳曲酮来治疗阿片类药物依赖性。