Improving racial equity in opioid use disorder treatment in Medicaid

改善医疗补助中阿片类药物使用障碍治疗的种族平等

基本信息

批准号：
10683980
负责人：
JULIE Marie DONOHUE
金额：
$ 142.53万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
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 2026-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10683980
关键词：
Accounting Address Adopted Affect Automobile Driving Benchmarking Black Populations Black race Buprenorphine COVID-19 pandemic Characteristics Contracts Criminal Justice Data Death Rate Disparity Drug Prescriptions Equity Ethnic Origin Ethnic Population Ethnic equity Evidence based treatment Formulation Funding Gender Geographic Locations Geography Goals Healthcare Hispanic Populations Housing Improve Access Incentives Individual Inequity Infrastructure Investments Knowledge Learning Licensing Linguistics Managed Care Managed Care Programs Marketing Measurement Measures Medicaid Methadone Minority Naltrexone National Institute of Drug Abuse Outcome Outcome Study Ownership Patients Performance Persons Policies Policy Developments Policy Maker Positioning Attribute Provider Quality of Care Race Racial Equity Research Research Personnel Role Services Single-Payer System Social Work Source Structural Racism System Time Travel Universities Variant barrier to care behavioral health development policy differences in access ethnic difference ethnic disparity ethnic minority population financial incentive improved medical specialties medication for opioid use disorder mortality multilevel analysis opioid epidemic opioid overdose opioid treatment program opioid use disorder overdose death overdose prevention payment prevention service programs provider networks racial difference racial disparity racial minority population racial population residential segregation

项目摘要

Abstract Access to medications for opioid use disorder (MOUD) is not equitable. Black and Hispanic individuals are substantially less likely to receive MOUD and other overdose prevention services. The overdose death rate has risen nearly twice as fast for Black individuals as for White individuals in recent years, a disparity that appears to have widened during the COVID-19 pandemic. Racial/ethnic inequities in receipt of MOUD are rooted in the structural racism ingrained in policies governing healthcare, housing, social services, criminal justice and other systems. As the largest single payer for MOUD and a key source of coverage for racial/ethnic minority groups, Medicaid is well-positioned to address inequities in MOUD. Although they have not done so to date, Medicaid agencies can adopt policies to alter (a) financial incentives for MOUD providers, and (b) contracts with managed care plans to improve equity in MOUD. Medicaid programs could institute requirements for provider networks; invest in building capacity for minority-serving Medicaid providers to deliver MOUD; include equity measures in provider performance measurement; and alter managed care contracts to incentivize plans to address inequities in MOUD. There is, however, little evidence on which of these levers is most likely to be effective. To inform Medicaid policy development, we harness the Medicaid Outcomes Distributed Research Network (MODRN), which is made up of university partnerships with Medicaid agencies in 11 states representing 22% of all US Medicaid enrollees. MODRN is currently funded by NIDA to study the quality of opioid use disorder treatment in Medicaid and has developed analytic infrastructure to conduct multi-state analyses of treatment with MOUD in Medicaid. We propose analyses that examine the role of place, providers, plans and policies in driving racial/ethnic inequities in MOUD. First, we examine racial/ethnic inequities in geographic access to MOUD providers among Medicaid enrollees. Second, we examine the contribution of provider- and plan-level factors to racial/ethnic equity in MOUD. Third, we estimate the association between state policies aimed at (a) changing delivery system reforms, and (b) managed care contracts, and equity in MOUD. Study outcomes are any use of MOUD and continuity of MOUD, both of which are associated with reduced mortality. We will use geospatial analyses, multi-level modeling, and difference-in difference analyses to accomplish our specific aims. Long-standing relationships with state Medicaid officials allow us to share findings directly with policymakers who can act on them. MODRN facilitates rapid knowledge transfer from researchers to policymakers, allows state Medicaid agencies to benchmark their performance on racial/ethnic equity in MOUD against other states, and supports state agencies learning from one another about the most effective policy levers for improving equity in MOUD.

抽象的阿片类药物使用障碍 (MOUD) 药物的获取并不公平。黑人和西班牙裔人士是接受 MOUD 和其他药物过量预防服务的可能性大大降低。服药过量死亡率近年来，黑人的增长速度几乎是白人的两倍，这一差距在 COVID-19 大流行期间，这种情况似乎有所扩大。 MOUD 中的种族/民族不平等是植根于医疗保健、住房、社会服务、刑事政策中根深蒂固的结构性种族主义司法和其他系统。作为 MOUD 最大的单一支付者以及种族/民族报道的主要来源针对少数群体，医疗补助计划能够很好地解决 MOUD 中的不平等问题。虽然他们还没有这样做届时，医疗补助机构可以采取政策来改变 (a) MOUD 提供者的经济激励措施，以及 (b) 与管理式医疗计划签订合同，以提高 MOUD 的股权。医疗补助计划可以启动对提供商网络的要求；投资于少数族裔医疗补助提供者的能力建设交付 MOUD；将公平衡量纳入提供商绩效衡量；并改变管理式医疗合同来激励解决 MOUD 不平等问题的计划。然而，几乎没有证据表明这些杠杆很可能是有效的。为了为医疗补助政策的制定提供信息，我们利用医疗补助结果分布式研究网络 (MODRN)，由大学与医疗补助计划的合作伙伴组成 11 个州的机构，占美国医疗补助计划参保人数的 22%。 MODRN 目前由 NIDA 资助研究医疗补助中阿片类药物使用障碍治疗的质量，并开发了分析基础设施对医疗补助中的 MOUD 治疗进行多状态分析。我们提出分析来检验角色 MOUD 中推动种族/族裔不平等的地点、提供者、计划和政策。首先，我们检查医疗补助计划参与者在接触 MOUD 提供者方面存在种族/族裔不平等。第二，我们检查提供者和计划层面的因素对 MOUD 中种族/族裔公平的贡献。第三，我们估计旨在 (a) 改变服务提供系统改革和 (b) 管理式医疗的国家政策之间的关联 MOUD 的合同和股权。研究结果是 MOUD 的任何使用和 MOUD 的连续性，两者与死亡率降低有关。我们将使用地理空间分析、多层次建模和差异化差异分析以实现我们的特定目标。与州医疗补助官员的长期关系让我们能够直接与能够据此采取行动的政策制定者分享调查结果。 MODRN 促进快速知识从研究人员到政策制定者的转移，允许州医疗补助机构衡量其绩效 MOUD 中针对其他州的种族/族裔平等，并支持各州机构相互学习关于改善 MOUD 公平性的最有效的政策杠杆。