Health Systems Node of the NIDA Clinical Trials Network

NIDA 临床试验网络的卫生系统节点

• 批准号: 10656818
• 负责人: KATHARINE ANTHONY BRADLEY
• 金额: $ 146.4万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10656818
• 关键词: Academy; Address; COVID-19 pandemic; Caring; Cause of Death; Cessation of life; Clinical; Clinical Trials Network; Cohort Studies; Colorado; Criminal Justice; Data; Data Analyses; Databases; Economics; Electronic Health Record; Eligibility Determination; Employment; Ensure; Ethnic Origin; Event; Frequencies; Gender; Geography; Health; Health Insurance; Health Services Accessibility; Health system; Imprisonment; Incidence; Individual; Insurance; Insurance Coverage; Knowledge; Lead; Length; Link; Methodology; Methods; National Institute of Drug Abuse; Outcome; Overdose; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Public Health; Race; Recording of previous events; Registries; Reporting; Research; Risk; Site; Vital Statistics; Work; active method; addiction; adverse outcome; barrier to care; base; buprenorphine treatment; care systems; central database; cohort; ethnic minority; experience; follow-up; health plan; high risk; improved; indexing; mortality; mortality risk; opioid epidemic; opioid overdose; opioid use disorder; prescription opioid; prevent; psychiatric comorbidity; public health insurance; racial and ethnic; relapse risk; research study; treatment duration

PROJECT ABSTRACT In the ongoing public health crisis of opioid overdoses, the incidence of opioid use disorder (OUD) has increased and medication-based treatment for OUD remain underutilized. While longer OUD treatment duration is generally associated with improved patient outcomes, maintaining continuous health insurance coverage represents a significant challenge to sustaining access to treatment. Patients with OUD may be vulnerable to experiencing health insurance instability that results in barriers to OUD treatment access. High- risk care transitions or disruptions to treatment may increase risk of relapse, overdose, and mortality. Despite the potential for insurance instability to create significant barriers to OUD treatment continuity, current knowledge regarding its health and mortality impacts is limited due to the challenge of capturing and evaluating patient outcomes after disenrollment from health systems. To address this knowledge gap, the proposed Clinical Trials Network (CTN) research concept seeks to examine the association of health insurance instability and mortality risk among patients receiving buprenorphine treatment for OUD in a multi-site cohort study, leveraging data from the Prescription Opioid Registry (POR) that include four diverse health systems participating in the CTN Health Systems Node. The aims of the study are: (1) Ascertain fact and cause of death from the National Death Index; (2) Examine insurance instability during buprenorphine treatment for OUD and associated patient and health plan factors; (3) Assess the association of insurance instability and risk of all-cause, opioid overdose, and other substance-related overdose mortality; and (4) Link data from one study site to all-payer claims data and criminal justice data to explore events associated with disenrollment from health plans. The proposed research concept will contribute to understanding the mortality consequences associated with insurance instability for patients in treatment for OUD. It will also inform strategies in health systems to ensure continuity of treatment access and to prevent poor outcomes in patients at risk of experiencing insurance coverage disruptions.

项目摘要 在正在进行的阿片类药物过量的公共卫生危机中，阿片类药物使用障碍的发生率（OUD）具有 增加和基于药物的OUD治疗仍未得到充分利用。而越来越多的口 持续时间通常与改善患者预后有关，维持持续的健康保险 覆盖范围是维持治疗机会的重大挑战。 OUD患者可能是 容易受到健康保险不稳定性的影响，这会导致OUD治疗通道的障碍。高的- 风险护理过渡或治疗中断可能会增加复发，过量和死亡的风险。尽管 保险不稳定的潜力会为Oud治疗连续性创造重大障碍，当前 由于捕获和评估的挑战，有关其健康和死亡率影响的知识受到限制 对卫生系统的剥夺后的患者预后。为了解决这个知识差距，提议 临床试验网络（CTN）研究概念旨在检查健康保险不稳定性协会 在一项多站点队列研究中接受丁丙诺啡治疗的患者的死亡风险， 利用处方阿片类药物注册中心（POR）的数据，其中包括四个不同的卫生系统 参加CTN卫生系统节点。该研究的目的是：（1）确定事实和原因 全国死亡指数的死亡； （2）检查丁丙诺啡治疗期间的保险不稳定的 OUD以及相关的患者和健康计划因素； （3）评估保险不稳定和风险的关联 全因，阿片类药物过量和其他与物质相关的过量死亡率； （4）一个来自一个的链接数据 全付款人索赔数据和刑事司法数据的研究站点，以探索与贬低有关的事件 来自健康计划。拟议的研究概念将有助于理解死亡率后果 与患者在OUD治疗中的保险不稳定性相关。它还将为健康策略提供信息 确保治疗访问连续性并防止患者的不良预后的系统 经历保险范围中断。