Developing Quality Measures for Opioid-Exposed Infants

为阿片类药物暴露婴儿制定质量措施

• 批准号: 10651711
• 负责人: Scott A Lorch
• 金额: $ 31.66万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10651711
• 关键词: Academy; Birth; Breast Feeding; Caring; Child Welfare; Clinical; Clinical Data; Clinical effectiveness; Code; Communities; Data; Data Set; Development; Diagnosis; Electronic Health Record; Emergency department visit; Equity; Exposure to; Family; Foundations; Goals; Health; Health Personnel; Health system; Healthcare; Hospitals; Infant; Inpatients; Insurance Carriers; Length; Length of Stay; Link; Measures; Medicaid; Medical; Medicine; Methods; Neonatal Abstinence Syndrome; Opioid; Outcome; Outcome Measure; Performance; Perinatal; Personal Satisfaction; Pharmaceutical Preparations; Pharmacological Treatment; Policy Developments; Policy Maker; Populations at Risk; Pragmatic clinical trial; Pregnant Women; Preventive service; Privatization; Process; Process Measure; Public Policy; Quality of Care; Randomized; Recommendation; Records; Reproducibility; Research; Research Personnel; Risk Adjustment; Safety; Sampling; System; US State; Validity and Reliability; Variant; Vulnerable Populations; Withdrawal; Withdrawal Symptom; adverse outcome; clinical care; collaborative care; effectiveness measure; effectiveness study; experience; health care quality; improved; improved outcome; infant outcome; innovation; neglect; opioid exposure; opioid use; opioid use disorder; patient oriented; population based; provider behavior; randomized, clinical trials; readmission rates; response; standardized care; tool; usability

ABSTRACT Opioid use, diagnoses of opioid use disorder among pregnant women, and diagnoses of neonatal opioid withdrawal syndrome (NOWS) increased dramatically over the past 20 years. In 2017, an estimated 100,000 infants were exposed to opioids, among whom 25,000 infants were diagnosed with NOWS. Opioid-exposed infants, regardless of whether they are diagnosed with NOWS, are more likely to have adverse outcomes compared to similar non-exposed infants, including: longer and more complicated initial hospital stays, higher likelihood of involvement in the child welfare system, higher rates of hospital readmission and emergency department visits and lower use of recommended preventive services. Further, delivery of medical care to opioid-exposed infants remains variable resulting in uneven outcomes among US hospitals and communities. The development of valid and reliable measures for opioid-exposed infants is critical to improving outcomes for this vulnerable population. To fill this existing gap we will: 1) develop candidate measures of quality for opioid- exposed infants and refine these measures by engaging key stakeholders including local, state, and national public policy makers; private and public insurers; health care providers; and families using a modified RAND/UCLA Appropriateness Method; 2) determine the reliability, reproducibility and validity of measures of candidate quality measures while evaluating the usability, validity, and reliability of the measures using two unique sets of data, linked maternal-infant data from the Medicaid Analytic Extract from 2007-2014 and clinically collected data from two large clinical systems and will determine risk-adjusted hospital variation in measures for opioid-exposed infants in a large population-based sample. This R34 will produce quality measures for opioid-exposed infants and preliminary data that will subsequently inform an R01 pragmatic clinical trial that will evaluate how clinician performance on quality measures results in changes to provider behaviors and subsequent alterations in infant outcomes. In addition, these measures can also serve as the outcomes for randomized clinical trials that examine the impact of various treatments on the health and wellbeing of opioid-exposed infants and whether they experience withdrawal symptoms after birth. The ultimate goal of this R34 and subsequent R01s will be to provide innovative tools for clinicians, researchers, policymakers, payers, hospital systems and state perinatal collaboratives to improve care for opioid-exposed infants.

抽象的 阿片类药物的使用，孕妇中阿片类药物使用障碍的诊断以及新生儿阿片类药物的诊断 在过去的20年中，戒断综合征（现在）急剧增加。 2017年，估计有100,000 婴儿接触阿片类药物，其中25,000名婴儿被诊断出患有现在。阿片类药物暴露 婴儿，无论是否被诊断出现在被诊断出，都更有可能患有不良结果 与类似的非暴露婴儿相比，包括：更长，更复杂的初始医院住院 参与儿童福利系统的可能性，更高的医院再入院率和紧急情况 部门访问和较低使用推荐的预防服务。此外，将医疗服务提供给 暴露于阿片类药物的婴儿仍然可变，导致美国医院和社区的不平衡结果。 针对阿片类药物暴露婴儿的有效且可靠的措施的制定对于改善结果至关重要 这个脆弱的人口。为了填补这一现有空白，我们将：1）为阿片类药物制定候选质量措施 通过参与包括地方，州和国家的主要利益相关者，暴露婴儿并完善这些措施 公共政策制定者；私人和公共保险公司；医疗保健提供者；和使用修改的家庭 RAND/UCLA适当方法； 2）确定措施的可靠性，可重复性和有效性 候选质量措施同时使用两个评估措施的可用性，有效性和可靠性 独特的数据集，从2007 - 2014年的医疗补助分析提取物中链接的孕产妇数据和 临床收集的数据来自两个大型临床系统，并将确定经过风险调整的医院变化 大型基于人群的样本中阿片类药物暴露婴儿的措施。 R34将产生质量 接触阿片类药物的婴儿和初步数据的措施，随后将为R01务实提供信息 临床试验将评估临床医生在质量测量方面的绩效如何导致提供者的变化 婴儿结果的行为和随后的改变。此外，这些措施也可以作为 随机临床试验的结果，检查各种治疗对健康的影响 阿片类药物暴露的婴儿的健康以及出生后是否经历戒断症状。最终 R34和随后的R01的目标是为临床医生，研究人员， 决策者，付款人，医院系统和州围产期合作，以改善对阿片类药物暴露的护理 婴儿。