Identifying Disparities in the Cascade of Care for Medicaid-Enrolled Youth with Opioid Use Disorder

确定对参加医疗补助的患有阿片类药物使用障碍的青少年的一系列护理中的差异

基本信息

批准号：
10584158
负责人：
Scott Evan Hadland
金额：
$ 59.8万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
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：
2022-09-15 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10584158
关键词：
Accident and Emergency department Adolescence Adolescent and Young Adult Adopted Adult Age Black race Buprenorphine Caring Chronic Disease Climate Clinical Continuity of Patient Care County Data Databases Diagnosis Drug abuse Early Intervention Enrollment Ensure Ethnic Origin Evaluation Family Foundations Future Generations Geographic Locations Geographic state Goals HIV Health Health Services Research Healthcare Systems Hospitalization Hospitals Imprisonment Individual Information Systems Inpatients Insurance Carriers Intervention Lead Legal Life Cycle Stages Link Longitudinal Studies Measures Medicaid Methadone Modeling Morbidity - disease rate Naltrexone Not Hispanic or Latino Outcome Outpatients Overdose Pharmaceutical Preparations Pharmacy facility Policies Population Quality of Care Race Research Research Personnel Role Series Services Time Unemployment Work World Health Youth addiction adverse outcome age group aged children of color clinical care community engagement ethnic minority experience falls health disparity health equity interest minority children mortality novel operation opioid misuse opioid use opioid use disorder prevent primary outcome programs protocol development racial and ethnic disparities racial minority secondary outcome social substance use treatment disparity young adult

项目摘要

PROJECT SUMMARY/ABSTRACT: Two-thirds of individuals with opioid use disorder (OUD) first misuse opioids before age 25. Intervention early in the life course is critical, and requires that adolescents and young adults (hereafter, “youth”) receive high- quality care in a continuum of care. Optimizing clinical care at every stage in this continuum is critical, and cannot be achieved alongside persistent racial and ethnic disparities. To lay the groundwork for quality improvement nationwide in Medicaid programs—the primary insurers for youth of color in the US—this project will apply the Cascade of Care framework to OUD identification and treatment in youth. The Cascade describes a series of 5 stages, i.e., how many youth with OUD (i) are identified (“diagnosis”), (ii) begin treatment (“initiation”), (iii) start medications for opioid use disorder (“MOUD”), (iv) stay in treatment in the short-term (“engagement”), and (v) stay in treatment in the long term (“retention”). Analyses will use newly released Medicaid data from across US states linked to numerous national databases to provide key county- and state-level information. The central objective is to provide a comprehensive picture of the Cascade for youth aged 13-25 with OUD, throughout focusing on disparities. Specific Aims are to: (1) Apply the Cascade of Care framework to youth with OUD and estimate racial and ethnic disparities at each stage, using a systematic approach to uncover underlying, potentially intervenable mechanisms contributing to disparities; (2) Determine whether MOUD receipt is associated with subsequent treatment engagement and retention, and with smaller racial and ethnic disparities, thus informing whether MOUD might be a strategy to reduce inequities in OUD treatment; and (3) Determine whether the Cascade is associated with emergency department use and hospitalizations, thus identifying whether real-world clinical outcomes worsen when youth leave the Cascade, and whether such outcomes are disproportionately experienced by youth of color. Throughout, race is conceptualized as a social (not biological) construct, and the project seeks to identify ways that the operation of healthcare systems and legal and regulatory climates contribute to health disparities, in order to ultimately guide policy change. The research team brings together expertise in youth, OUD treatment, health disparities, community engagement, health services research, and relevant statistical approaches. The project will be guided by a diverse Youth and Family Advisory Board to inform protocol development, analysis, interpretation, and dissemination of findings, with a goal of maximizing relevance and delivery of results to youth and families, as well as key stakeholders nationally.

项目摘要/摘要：三分之二的阿片类药物使用障碍 (OUD) 患者在 25 岁之前首次滥用阿片类药物。及早干预在生命历程中至关重要，并要求青少年和年轻人（以下简称“青年”）接受高水平的教育。在连续护理过程中优化每个阶段的临床护理至关重要，并且长期存在的种族和民族差异是无法实现的。为质量奠定基础。改善全国范围内的医疗补助计划（美国有色人种青少年的主要保险公司）该项目将应用级联护理框架来识别和治疗青少年的 OUD。描述了一系列 5 个阶段，即有多少患有 OUD 的青少年 (i) 被识别（“诊断”），(ii) 开始治疗（“开始”），(iii) 开始治疗阿片类药物使用障碍（“MOUD”），(iv) 在医院继续治疗短期（“参与”），以及（v）长期继续治疗（“保留”）。发布了美国各州的医疗补助数据，这些数据与众多国家数据库相链接，以提供关键的县级数据和国家级信息的中心目标是提供级联的全面信息。 13-25 岁青年与 OUD，始终关注差异，具体目标是： (1) 应用级联。使用 OUD 为青少年提供护理框架，并使用系统的方法估计每个阶段的种族和民族差异揭示造成差异的潜在的、可干预的机制的方法 (2) 确定； MOUD 收据是否与后续治疗参与度和保留率以及较小的治疗相关性相关种族和民族差异，从而了解 MOUD 是否可能是减少 OUD 不平等的战略 (3) 确定 Cascade 是否与急诊室的使用相关；以及住院治疗，从而确定当年轻人离开喀斯喀特时，现实世界的临床结果是否会恶化，以及有色人种年轻人是否在整个过程中经历了这种结果。该项目被概念化为一种社会（而非生物）构造，旨在确定操作的方式医疗保健系统以及法律和监管环境的不同会导致健康差异，以便最终研究团队汇集了青年、OUD 治疗、健康差异等方面的专业知识。该项目将包括社区参与、卫生服务研究和相关统计方法。由多元化的青少年和家庭咨询委员会指导，为协议的制定、分析、解释、和传播调查结果，以最大限度地提高与青年和家庭的相关性并交付成果，以及全国主要利益相关者。