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

• 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
• 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

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： 三分之二的人患有OOID使用障碍（OUD）25岁之前的小姐OIDS。 在生活中，重要的是至关重要，要求青少年和年轻人（以下简称“青年”）获得高度 质量护理在连续的护理中。在此连续体的每个阶段优化临床护理至关重要，并且 无法与持续的种族和种族差异一起实现。为质量奠定基础 全国范围内的医疗补助计划（美国青年的主要确保有色人种）的改进，该项目 将把级联护理框架应用于青年人的识别和治疗。级联 描述了一系列5个阶段，即确定了有多少个OUD（i）的年轻人（“诊断”），（ii）开始 治疗（“启动”），（iii）开始治疗阿片类药物使用障碍（“ moud”），（iv）在治疗中保持治疗 短期（v）长期保持治疗（“保留”）。分析将使用新的 从美国各州发布了与众多国家数据库相关的美国各州的医疗补助数据，以提供关键计数 - 和州级信息。核心目的是为级联的全面了解 在整个关注差异的过程中，年龄在13-25岁之间，以OUD为单位。具体目的是：（1）应用 使用系统的 发现潜在的，潜在的干预机制导致差异的方法； （2）确定 MOUD收据是否与随后的治疗参与和保留有关，并且与较小 种族和种族分布，从而告知Moud是否可能是减少OUD不平等现象的策略 治疗; （3）确定级联是否与急诊部使用和 住院治疗，从而确定现实世界中的临床结果是否引起青年离开级联时的关注， 以及这种结果是否受到有色青年的不成比例。整个种族是 被概念化为一种社会（不是生物学）结构，该项目试图确定该运作的方式 医疗保健系统以及法律和法规气候的促进健康分配的贡献，以最终 指导政策更改。研究小组汇集了青年，OUD治疗，健康分配， 社区参与，卫生服务研究和相关统计方法。该项目将是 在潜水员青年和家庭顾问委员会的指导下，为协议开发，分析，解释， 并传播发现，以最大程度地提高与青年和家庭的相关性和结果的目的 以及全国的关键利益相关者。