Improving value-based healthcare delivery for opioid use disorder

改善阿片类药物使用障碍的基于价值的医疗保健服务

• 批准号: 10626896
• 负责人: Heather Hsu
• 金额: $ 17.59万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10626896
• 关键词: Address; Adopted; Advisory Committees; American; Applied Research; Benchmarking; Boston; Caring; Cause of Death; Clinical; Community Surveys; Complex; Data; Diabetes Mellitus; Educational workshop; Effectiveness; Electronic Health Record; Enrollment; Ensure; Evidence based intervention; Evidence based treatment; Foundations; Funding; Goals; Group Practice; Health; Health Care Reform; Health Services Research; Health system; Healthcare; Healthcare Systems; Home; Homelessness; Hospitals; Hypertension; Incentives; Infectious Disease Epidemiology; Interruption; Intervention; K-Series Research Career Programs; Knowledge; Link; Managed Care Programs; Massachusetts; Measures; Medicaid; Medical; Medical center; Medicine; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; National Institute of Drug Abuse; Natural experiment; Neighborhood Health Center; Neighborhoods; Organizational Models; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Performance; Persons; Pharmacotherapy; Physicians; Positioning Attribute; Prevention strategy; Principal Investigator; Process; Proliferating; Provider; Public Health; Quality of Care; Quasi-experiment; Research; Research Design; Research Personnel; Retrospective cohort study; Risk; Risk Adjustment; Risk Factors; Service delivery model; Strategic Planning; Substance Use Disorder; System; Time Series Analysis; Training; Treatment Efficacy; United States; Universities; accountable care organization; addiction; base; behavioral health; beneficiary; care costs; care delivery; care providers; career; comparison group; cost; disability; econometrics; effectiveness evaluation; efficacious treatment; evidence base; experience; health care delivery; health care model; health care quality; health economics; health management; housing instability; improved; innovation; medical schools; member; novel; opioid use disorder; payment; population health; predictive modeling; primary outcome; programs; safety net; skill acquisition; skills; social; social health determinants; substance use; treatment strategy; uptake; Address; Adopted; Advisory Committees; American; Applied Research; Benchmarking; Boston; Caring; Cause of Death; Clinical; Community Surveys; Complex; Data; Diabetes Mellitus; Educational workshop; Effectiveness; Electronic Health Record; Enrollment; Ensure; Evidence based intervention; Evidence based treatment; Foundations; Funding; Goals; Group Practice; Health; Health Care Reform; Health Services Research; Health system; Healthcare; Healthcare Systems; Home; Homelessness; Hospitals; Hypertension; Incentives; Infectious Disease Epidemiology; Interruption; Intervention; K-Series Research Career Programs; Knowledge; Link; Managed Care Programs; Massachusetts; Measures; Medicaid; Medical; Medical center; Medicine; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; National Institute of Drug Abuse; Natural experiment; Neighborhood Health Center; Neighborhoods; Organizational Models; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Performance; Persons; Pharmacotherapy; Physicians; Positioning Attribute; Prevention strategy; Principal Investigator; Process; Proliferating; Provider; Public Health; Quality of Care; Quasi-experiment; Research; Research Design; Research Personnel; Retrospective cohort study; Risk; Risk Adjustment; Risk Factors; Service delivery model; Strategic Planning; Substance Use Disorder; System; Time Series Analysis; Training; Treatment Efficacy; United States; Universities; accountable care organization; addiction; base; behavioral health; beneficiary; care costs; care delivery; care providers; career; comparison group; cost; disability; econometrics; effectiveness evaluation; efficacious treatment; evidence base; experience; health care delivery; health care model; health care quality; health economics; health management; housing instability; improved; innovation; medical schools; member; novel; opioid use disorder; payment; population health; predictive modeling; primary outcome; programs; safety net; skill acquisition; skills; social; social health determinants; substance use; treatment strategy; uptake

Project Summary Opioid use disorder (OUD) is an increasingly common cause of death, disability, and cost to the healthcare system. Though evidence-based OUD treatment exists, uptake is often poor; and those with OUD frequently have profound health-related social needs that complicate their care. Improving OUD outcomes depends not only on treatment efficacy, but also on optimizing the healthcare delivery and payment systems in which efficacious treatments are deployed. Value-based care – a healthcare delivery and payment model that aims to incentivize value rather than volume of care – represents a widespread approach to healthcare reform touted for its potential to improve OUD care processes and outcomes. Despite this promise, however, large knowledge gaps remain in our understanding of whether – and how – value-based care may promote quality care for people with OUD. This K01 proposal therefore leverages an opportunity to assess the effectiveness of value-based care delivery for OUD in the context of Massachusetts’ implementation of an innovative new Medicaid accountable care organization (ACO) model of care. The Massachusetts Medicaid ACO program is the first of its kind to base ACO payments not only on beneficiaries’ medical complexity, but also on behavioral health and social complexity. The research aims are to use implementation of this novel ACO program as a natural experiment to 1) assess the impact of value-based care reform on OUD care quality, 2) understand whether current risk adjustment methods for setting ACO payments adequately cover costs of care for socially complex patients with OUD and housing instability, and 3) develop a pilot risk adjustment model for OUD care quality measures. The Principal Investigator, Dr. Heather Hsu, is an early career clinician-investigator with prior research experience at the intersection of infectious disease epidemiology, health services research, and value-based care. With this K01, she seeks to transition the clinical focus of her research to substance use, focusing on developing content expertise in addiction healthcare delivery and advanced methodologic skills in quasi-experimental study design and risk adjustment for quality and payment. Dr. Hsu will acquire these skills and conduct the proposed research at Boston Medical Center and Boston University School of Medicine, national leaders in addiction medicine and research and home to the largest group of Medicaid ACOs in Massachusetts. The proposal is supported by an interdisciplinary mentorship and advisory team with expertise in addiction medicine, substance use research, social determinants of health, advanced methods for causal inference, health economics, econometrics, and risk adjustment. Training will be accomplished through an intensive combination of formal coursework, workshops, field experience, applied research experience, guided tutorials, and focused mentorship. At the end of the K01 award period, Dr. Hsu will be well-positioned to accomplish her long-term goal to become an independent investigator and expert on improving value-based healthcare delivery to persons with substance use disorders.

项目摘要 阿片类药物使用障碍（OUD）是越来越普遍的死亡，残疾和医疗费用 系统。尽管存在基于证据的OUD治疗，但吸收通常很差。和那些经常有oud的人 拥有与健康相关的深刻社会需求，使他们的护理变得复杂。改进的结果不取决于 仅在治疗效率上，而且还要优化医疗保健交付和支付系统 部署有效的治疗方法。基于价值的护理 - 一种医疗保健交付和付款模式，旨在 激励价值而不是护理数量 - 代表一种吹捧医疗改革的宽大方法 尽管承诺，但很大 知识差距仍然在我们对是否以及如何基于价值的护理可能促进质量的理解中 照顾有Oud的人。因此，该K01提案利用了一个机会来评估 在马萨诸塞州实施创新的新的背景下，OUD基于价值的护理交付 医疗补助责任护理组织（ACO）护理模型。马萨诸塞州医疗补助ACO计划是 同类不仅是受益人的医学复杂性，而且是行为上的第一个基础ACO支付的基础 健康和社会复杂性。研究目的是将这种新颖ACO计划的实施作为一个 自然实验1）评估基于价值的护理改革对Oud护理质量的影响，2）了解 当前的风险调整方法是否适当涵盖社会上的护理费用 复杂的OUD和住房不稳定性的患者，以及3）为OUD CARE开发飞行员风险调整模型 质量措施。首席调查员希瑟·胡（Heather Hsu）博士是早期职业临床评估者 在传染病流行病学，卫生服务研究和 基于价值的护理。有了这个K01，她试图将研究的临床重点转变为吸毒的临床重点， 专注于发展成瘾医疗保健提供的内容专业知识和高级方法论技巧 准实验研究设计和质量和付款的风险调整。 HSU博士将获得这些技能 并在波士顿医学中心和波士顿大学医学院进行拟议的研究， 成瘾医学和研究领域的国家领导者，以及最大的医疗补助ACO群体的住所 马萨诸塞州。该提案得到了具有专业知识的跨学科心态和咨询团队的支持 在成瘾医学中，药物使用研究，健康的社会决定者，催化的高级方法 推论，健康经济学，经济学和风险调整。培训将通过 正式课程，研讨会，现场经验，应用研究经验的密集组合，指导 教程和集中的心态。在K01颁发期结束时，HSU博士将有充分的位置 实现她的长期目标，成为一名独立研究者和改善基于价值的专家 医疗保健向患有药物使用障碍的人提供。