Improving MOUD Access, Opioid-Related Outcomes and Equity Among Medicare Beneficiaries with Disability

改善残疾医疗保险受益人的 MOUD 获取、阿片类药物相关成果和公平

基本信息

批准号：
10693295
负责人：
Stephen Crystal
金额：
$ 71.35万
依托单位：
RUTGERS BIOMEDICAL AND HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10693295
关键词：
Accounting Address Adult Affect American Black race Caring Cessation of life Characteristics Clinical Communities Complement Complex Data Data Sources Diagnosis Disabled Persons Disparity Distant Drug Prescriptions Enrollment Environment Equity Ethnic Origin Event Excision Failure Fentanyl Formularies Gender Harm Reduction Healthcare Systems Hispanic Hospitalization Individual Intervention Link Low income Measures Medicaid Medical Medicare Mental Health Minority Modality Opioid Outcome Overdose Overdose reduction Pain Patients Pattern Peer Review Penetration Persons Policies Policy Developments Population Prevalence Provider Publications Race Resources Risk Risk Reduction Role Shapes Subgroup Suicide Survivors System Time Translations Treatment outcome Uninsured Update Urine Variant access disparities beneficiary cohort comorbidity disability disparity reduction dissemination strategy dosage drug testing experience experimental study high risk improved indexing innovation insight longitudinal analysis male medication for opioid use disorder minority patient mortality multiple chronic conditions opioid epidemic opioid mortality opioid overdose opioid use disorder overdose death overdose risk patient subsets policy implication poor communities prescription opioid prior authorization provider networks psychosocial racial minority residence social vulnerability success telehealth tool treatment and outcome treatment disparity treatment duration treatment pattern trend uptake

项目摘要

PROJECT ABSTRACT Medications for opioid use disorder (MOUD) are a key tool in reducing harms of the opioid epidemic. Yet only a minority of those with OUD initiate treatment, early discontinuation is typical, and disparities are endemic. People with disabilities are at especially high risk and epitomize the challenges of OUD with multimorbidity. Preliminary analyses identified 45,035 fatal opioid overdoses among Medicare disability beneficiaries (MDBs) from 2008-2016, and continuing under-utilization and disparities in MOUD, including among overdose survivors. With its wide influence in the health care system, Medicare's role is vital; it is essential to examine the Medicare system's successes and failures in engaging and retaining MDBs in treatment. Several recent policy changes are promising, with important implications for other payers, but their impact across beneficiary subgroups, time and communities needs to be better understood to inform action to improve uptake and reduce disparities. This study, responding to RFA-DA-22-037, will use national Medicare data linked with the National Death Index, Medicaid claims, community resources, prescription drug plan (PDP) formulary policies, and other data sources to assess how policy, community, provider and patient factors interact to shape MOUD initiation and retention, and in turn overdose and other clinical outcomes. With annual updates through 2025, the project will provide a powerful framework for assessing evolving treatment patterns and outcomes in a rapidly evolving environment, as well as potential changes in policy impacts over time. We will assess the drivers of racial/ethnic and other disparities in access; MOUD changes following policy and formulary changes by Medicare and its PDPs; and how these policies interact with the evolving MOUD provider system, community resources and patient characteristics. We will analyze trends and disparities in MOUD treatment and overdoses among MDBs. In cohorts of beneficiaries with new OUD diagnoses or non-fatal overdoses, we will assess factors associated with treatment initiation and retention, and association of treatment with clinical outcomes including non-fatal and fatal overdose. We will assess MOUD uptake across community, provider, and patient subgroups; changes in MOUD treatment patterns associated with the shift to tele-health; and associated changes in the MOUD treatment network serving MDBs. We will examine the sequelae of changes in formulary policies across Medicare's more than 6000 PDPs, including prior authorization requirements for MOUD, across beneficiary subgroups. Expanded reimbursement for tele-MOUD and elimination of prior authorization have the potential to save many lives, but it is critical to better understand their impact on access and disparities. An active dissemination strategy supported by a Stakeholder Advisory Board, complementing peer-reviewed publication, will support translation into evidence-informed policy. Results of this innovative and comprehensive assessment of the multi-level factors shaping MOUD uptake and outcomes among MDBs will have important implications for policy and practice across patient subgroups, payers and health care systems.

项目摘要阿片类药物使用障碍（MOUD）的药物是减少阿片类药物流行危害的关键工具。只有少数接受OUD开始治疗的人，早期停用是典型的，并且差异是地方性的。残疾人特别高风险，体现了多个多发病的OUD挑战。在医疗保险残疾受益人（MDB）中，初步分析确定了45,035次致命阿片类药物过量药物从2008 - 2016年开始，以及穆德的持续不足和差异，包括过量幸存者。 Medicare的角色在医疗保健系统中的广泛影响至关重要。检查至关重要 Medicare系统在参与和保留MDB的治疗方面的成功和失败。最近的几个政策变化是有希望的，对其他付款人产生了重要影响，但它们对受益人的影响亚组，时间和社区需要更好地理解以提高行动以改善吸收和减少差异。这项响应RFA-DA-22-037的研究将使用与该数据有关的国家医疗保险数据国家死亡指数，医疗补助索赔，社区资源，处方药计划（PDP）配方政策，以及其他数据源，以评估政策，社区，提供者和患者因素如何相互作用以塑造MOUD 启动和保留率，进而过量服用和其他临床结果。到2025年的年度更新，该项目将为评估不断发展的治疗模式和结果提供一个强大的框架迅速发展的环境以及政策随着时间的影响的潜在变化。我们将评估种族/种族和其他差异的驱动因素； MOUD在政策和配方更改后更改 Medicare及其PDP；以及这些政策如何与不断发展的MOUD提供商系统相互作用，社区资源和患者特征。我们将分析MOUD治疗中的趋势和差异 MDB中的过量服用。在具有新的OUD诊断或非致命性过量的受益人中，我们将评估与治疗开始和保留率相关的因素，以及治疗与临床的关联包括非致命和致命过量的结果。我们将评估整个社区，提供商，和患者亚组； MOUD治疗模式的变化与转向远程健康有关；和 MOUD治疗网络的相关变化服务于MDB。我们将检查变化的后遗症在Medicare的6000多个PDP中的配方政策中，包括先前的授权要求穆德，跨受益人子组。扩大的报销以征收telet-od和消除先验授权有潜力挽救许多生命，但是要更好地了解其对访问的影响至关重要和差异。利益相关者顾问委员会支持的积极传播策略，补充经过同行评审的出版物，将支持翻译成证据的政策。这种创新的结果全面评估塑造MOUD吸收和MDB的结果的多层次因素将对患者子组，付款人和医疗保健系统的政策和实践具有重要意义。