Policy Dissemination Strategies to Improve the Use of Research Evidence in Medicaid Benefits for Opioid Use Disorder Treatment

政策传播策略，以改善阿片类药物使用障碍治疗的医疗补助福利中研究证据的使用

• 批准号: 10625532
• 负责人: Erika Lynn Crable
• 金额: $ 18.02万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10625532
• 关键词: 18 year old; Academy; Address; Adult; Advocacy; American; Authorization documentation; Behavior; Buprenorphine; Caring; Child; Child Health; Communication; Communities; Contracts; Data; Decision Making; Development; Dissemination and Implementation; Enrollment; FDA approved; Goals; Health; Health Insurance; Implant; Improve Access; Individual; Injectable; K-Series Research Career Programs; Laws; Level of Evidence; Life; Link; Managed Care; Mediator; Medicaid; Mentors; Mentorship; Methadone; Methods; Modeling; Naltrexone; National Institute of Drug Abuse; Opioid; Oral; Organizational Policy; Outcome; Patients; Pediatrics; Pharmaceutical Preparations; Policies; Policy Maker; Population; Positioning Attribute; Process; Public Health; Recovery; Relapse; Reporting; Research; Services; Source; Statistical Data Interpretation; Subgroup; Substance Use Disorder; Surveys; System; Testing; Training; United States Centers for Medicare and Medicaid Services; United States Food and Drug Administration; Youth; access restrictions; authority; behavioral health; beneficiary; career; design; disorder prevention; dissemination science; dissemination strategy; effectiveness testing; evidence base; federal policy; flexibility; health inequalities; implementation strategy; improved; medication for opioid use disorder; methadone clinic/center; mortality; opioid epidemic; opioid overdose; opioid use disorder; pilot test; preference; prevent; programs; safety net; skills; standard care; substance use treatment

PROJECT SUMMARY/ABSTRACT The purpose of this proposed K01 Mentored Research Career Development Award is to support the applicant in advancing and maximizing her research skills in order to launch an independent research career in the dissemination and implementation of evidence-based substance use treatment for safety net populations. Safety net populations, especially individuals who are publicly insured by Medicaid and the Children’s Health Insurance Program (CHIP), have been disproportionately impacted by the U.S. opioid epidemic. Despite a significant need for treatment, lifesaving medications for opioid use disorder (MOUD) are underused by this population. Low MOUD use is driven by a myriad of misaligned federal, state, Medicaid/CHIP agency and managed care organization benefit and utilization management policies informed by varying levels of evidence. Federal policy requires all three MOUD (i.e., buprenorphine, methadone, naltrexone) be included as mandatory Medicaid state plan benefits, but not all states have complied, and the Centers for Medicare and Medicaid Services acknowledges that enforcing coverage is not feasible. Even when Medicaid/CHIP agencies cover all three MOUD, they can restrict access via preferred drug lists, fail-first, prior and re-authorization requirements – thus imposing potentially life-threatening care delays on beneficiaries. Managed care organizations (MCOs) that many state agencies contract to administer benefits can enact additional utilization management policies that limit MOUD access. Research is needed to promote Medicaid/CHIP and MCO policymakers’ use of scientific evidence when designing MOUD benefits. Under the mentorship of Dr. Gregory Aarons (sponsor and mentor) and an expert mentoring team, the applicant will pursue training in: (1) survey design, (2) multivariate statistical analysis, including latent class analysis and finite mixture modeling, (3) policy dissemination strategy development, including packaging and communicating evidence for policymakers, and (4) developing research partnerships with policy-relevant decision-makers. These training goals will facilitate accomplishing research aims to: (1) develop and administer a national survey to Medicaid/CHIP agency and MCO policymakers to identify determinants, mechanisms, and intermediaries that influence their evidence use behaviors; (2) empirically identify and describe distinct subgroups of Medicaid/CHIP agencies and MCOs based on their evidence use behaviors when designing MOUD benefits; (3) design and pilot test the acceptability, appropriateness and feasibility of dissemination strategies, tailored to each latent class, for promoting policymakers’ evidence-based decision-making regarding MOUD benefits. This proposal is aligned with NIDA’s strategic objectives to assess the impact of substance use disorder-related federal, state and systems policies on public health, and to identify strategic intermediaries and policy implementation strategies aimed at improving evidence use in policy. The planned K01 activities will effectively position the applicant to achieve an independent research career focused on improving access to evidence-based substance use treatment.

项目摘要/摘要 该拟议的K01指导研究职业发展奖的目的是支持申请人 在提高和最大化她的研究技能方面，以启动独立研究职业 用于安全净人种群的基于证据的物质使用治疗的传播和实施。安全 人口净人，特别是由医疗补助和儿童健康保险公开保险的个人 计划（芯片）受美国阿片类药物流行的影响不成比例。尽管有很大的需求 为了进行治疗，该人群不足以挽救阿片类药物使用障碍（MOUD）的救生药物。低的 MOUD使用是由无数未对准的联邦，州，医疗补助/芯片机构和托管护理驱动的 组织福利和利用管理政策以不同水平的证据告知。联邦政策 要求将所有三个moud（即丁丙诺啡，方法加多酮，纳曲酮）作为强制性医疗补助状态包括在内 计划福利，但并非所有州都遵守，以及医疗保险和医疗补助服务的中心 承认执行覆盖范围是不可行的。即使医疗补助/芯片机构涵盖这三个 moud，他们可以通过首选药物清单，失败优先，先验和重新授权要求限制访问权限 - 因此 对受益人施加潜在威胁生命的护理延迟。托管护理组织（MCO） 许多州机构合同管理福利，可以制定其他利用管理政策 限制MOUD访问。需要进行研究来促进医疗补助/芯片和MCO决策者对科学的使用 设计MOUD好处时的证据。在Gregory Aarons博士（赞助商和精神）的指导下 和专业的心理团队，申请人将在：（1）调查设计，（2）多变量统计中进行培训 分析，包括潜在类别分析和有限混合建模，（3）政策传播策略 开发，包括包装和传达决策者的证据，以及（4）开发研究 与政策相关的决策者的合作伙伴关系。这些培训目标将有助于完成研究 目的是：（1）开发和管理医疗补助/芯片机构和MCO决策者的国家调查 确定影响其证据使用行为的确定性，机制和中间体； （2） 根据经验，并根据他们 设计穆德福利时，证据使用行为； （3）设计和飞行员测试可接受性， 针对每个潜在阶级量身定制的传播策略的适当性和可行性，用于促进 决策者对MOUD益处的基于证据的决策。该建议与NIDA的一致 评估与药物使用障碍有关的联邦，州和系统政策的影响的战略目标 关于公共卫生，并确定旨在改善的战略中间体和政策实施策略 政策中使用证据。计划的K01活动将有效地定位申请人，以实现独立 研究职业的重点是改善获得基于证据的药物使用治疗的机会。

项目成果

Impact of U.S. Federal Loan Repayment Programs on the Behavioral Health Workforce: Scoping Review.

美国联邦贷款偿还计划对行为健康劳动力的影响：范围界定审查。

• DOI: 10.1176/appi.ps.20230258
• 发表时间: 2024
• 期刊: Psychiatric services (Washington, D.C.)
• 作者: Last,BrianaS;Crable,ErikaL;Khazanov,GabrielaKattan;Scheinfeld,LaurelP;McGinty,EmmaE;Purtle,Jonathan
• 通讯作者: Purtle,Jonathan

Elucidating the Perspectives of Autistic Youth About Their Health Care Experiences: A Qualitative Study.

阐明自闭症青少年对其医疗保健经历的看法：一项定性研究。

• DOI: 10.1097/dbp.0000000000001228
• 发表时间: 2024
• 期刊: Journal of developmental and behavioral pediatrics : JDBP
• 作者: O'Hagan,Belinda;Foster,Sarah;Ursitti,Amy;Crable,ErikaL;Friedman,AlexanderJ;Bartolotti,Lauren;Krauss,Shari
• 通讯作者: Krauss,Shari

Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans.

• DOI: 10.1177/26334895221096289
• 发表时间: 2022-01
• 期刊: Implementation research and practice
• 作者: Economou, Melina A.;Kaiser, Bonnie N.;Yoeun, Sara W.;Crable, Erika L.;McMenamin, Sara B.
• 通讯作者: McMenamin, Sara B.