Oregon's Coordinated Care Organizations Integrate Care for Drug Use Disorders

俄勒冈州的协调护理组织整合了吸毒障碍护理

基本信息

批准号：
9256455
负责人：
Bonnie Lind
金额：
$ 52.75万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-05-01 至 2020-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9256455
关键词：
Accident and Emergency department Accountability Admission activity Advocacy Affect Alcohol consumption Assertiveness Award Behavioral Budgets Caring Code Communities Counseling Data Databases Diagnosis Disease Management Drug Use Disorder Drug Utilization Drug usage Emergency Situation Emergency department visit Emergency medical service Expenditure Goals Grant HIV Health Health Care Coalitions Health Care Costs Health Care Reform Health Planning Health Services Accessibility Healthcare Home environment Hospitals Improve Access Individual Inpatients Interview Investigation Managed Care Measures Medicaid Medical Mental Health Methods Modeling Monitor Oregon Outcome Patient Care Patients Pharmaceutical Preparations Pharmacotherapy Preventive Primary Health Care Process Provider Quality of Care Recording of previous events Resources Risk Rural Rural Community Savings Services Site Statutes and Laws Substance Use Disorder System Testing Tobacco use United States Centers for Medicare and Medicaid Services Variant Visit addiction alcohol services alcohol use disorder behavioral health cost health care service utilization implementation research improved informant innovation inpatient service opioid use disorder patient home care patient oriented physical conditioning routine care screening service utilization

项目摘要

The innovative Oregon Health Plan (Medicaid) is a national leader in healthcare reform. State legislation (passed with bipartisan support) authorized Coordinated Care Organizations (CCOs) to manage care for Medicaid recipients. In May 2012, Oregon received a five year $1.9 billion federal/state demonstration grant to transform care and the Centers for Medicare and Medicaid Services approved the changes in the Oregon Health Plan July 5, 2012. Eight CCOs began August 1, 2012 and six more September 1, 2012. Oregon is an ideal setting to assess the impact of healthcare reform on treatment for drug and alcohol use disorders. CCOs integrate physical and behavioral health care in a single point of accountability (a patient centered primary care home) to increase access to care, control healthcare costs and improve health outcomes. Assertive preventive and disease management services seek to reduce unnecessary emergency and hospital care. Global budgets and shared savings promote quality of care. A major goal is to improve access to and utilization of services for alcohol and drug use disorders through integration with primary care. The study compares and contrasts the integration of addiction treatment services within CCOs. Variations in integration and financing strategies are described and coded to assess associations with healthcare utilization. Oregons All Payer All Claims (APAC) database provides a comprehensive description of utilization and permits counts of the numbers of patients a) screened, b) counseled, c) prescribed medications for alcohol or opioid use disorders, and d) tested with HIV rapid testing. The APAC data, moreover, record emergency visits and inpatient admissions. The study has three specific aims. Specific Aim 1: Year 1review and code approved CCO applications, interview CCO stakeholders to assess a) behavioral health integration strategies, b) outcomes monitoring, and c) system redesign for behavioral healthcare, and select eight CCOs for intensive study during Years 2 through 5; the 8 study sites serve urban and rural communities and vary in integration and financing strategies. Specific Aim 2: Extract utilization data from the APAC data and a) compare CCOs, b) track change in spending and utilization on study measures (i.e., screening, counseling, pharmacotherapy prescriptions for substance use disorders, HIV rapid testing), and outcomes (i.e., use of emergency and inpatient care among individuals with diagnoses of drug and alcohol use disorders), and c) assess relationships between spending on and utilization of drug and alcohol services and expenditures for and rates of emergency and inpatient care. Specific Aim 3: Complete a mixed methods assessment integrating qualitative (e.g., key informant interviews, observations) and quantitative data (utilization rates and expenditures) to identify individual, organizational, and contextual variables associated with use of addiction treatment services in patient centered primary care homes.

创新的俄勒冈州健康计划（Medicaid）是医疗改革的国家领导者。州立法（在两党支持的情况下通过）授权协调的护理组织（CCO）来管理护理医疗补助接收者。 2012年5月，俄勒冈州获得了五年的19亿美元联邦/州示威赠款转变护理和医疗保险和医疗补助服务中心批准了俄勒冈州的变化健康计划2012年7月5日。八个CCO开始于2012年8月1日开始，2012年9月1日又有六个。俄勒冈州是一个评估医疗改革对药物和酒精使用障碍治疗的影响的理想场所。 CCO在一个责任感中整合身体和行为保健（患者以患者为中心）初级护理之家）增加获得护理的机会，控制医疗保健成本并改善健康结果。自信的预防和疾病管理服务旨在减少不必要的紧急和医院关心。全球预算和共同的储蓄促进了护理质量。一个主要目标是改善进入和通过与初级保健相结合来利用酒精和药物使用障碍。该研究比较和对比成瘾治疗服务在CCO中的整合。变化描述和编码整合和融资策略，以评估与医疗保健利用的关联。俄勒冈州所有付款人所有索赔（APAC）数据库提供了有关利用率和允许患者人数的计数a）筛查，b）咨询，c）开处方的酒精药物或阿片类药物使用障碍，d）通过HIV快速测试进行了测试。此外，Apac数据还记录了紧急访问和住院入院。该研究具有三个特定的目标。具体目标1：1年级审查和代码批准的CCO申请，采访CCO利益相关者评估 a）行为健康整合策略，b）结果监测，c）行为重新设计医疗保健，并在第2至5年内选择八个CCO进行密集研究； 8个研究网站为城市服务以及农村社区，在整合和融资策略方面有所不同。特定目的2：从APAC数据中提取利用数据，a）比较CCO，b）轨迹变化研究措施的支出和利用（即筛查，咨询，药物治疗处方药物使用障碍，艾滋病毒快速测试）和结果（即在紧急情况和住院治疗诊断药物和酒精使用障碍的人）和c）评估支出之间的关系毒品和酒精服务以及紧急和住院护理率的支出。特定目的3：完成混合方法评估，整合定性（例如，关键线人）访谈，观察值）和定量数据（利用率和支出）以识别个人，与患者使用成瘾治疗服务相关的组织和上下文变量居中的初级卫星。