Improving MOUD Access, Opioid-Related Outcomes and Equity Among Medicare Beneficiaries with Disability

改善残疾医疗保险受益人的 MOUD 获取、阿片类药物相关成果和公平

基本信息

批准号：
10583892
负责人：
Stephen Crystal
金额：
$ 71.46万
依托单位：
RUTGERS BIOMEDICAL AND HEALTH SCIENCES
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 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10583892
关键词：
Accounting Address Adult Affect American Black race Caring Cessation of life Characteristics Clinical Communities Complement Complex Data Data Sources Diagnosis Disabled Persons Distant Drug Prescriptions Enrollment Environment Ethnic Origin Event Excision Failure Fentanyl Formularies Gender Healthcare Systems Hispanic Hospitalization Individual Intervention Link Low income Measures Medicaid Medical Medicare Mental Health Minority Modality Opioid Outcome Overdose Overdose reduction Pain Patients Pattern Peer Review Penetration Persons Pharmaceutical Preparations Policies Policy Developments Population Prevalence Provider Publications Race Resources Risk Risk Reduction Role Shapes Subgroup Suicide Survivors System Time Translations Treatment outcome Uninsured Update Urine Variant beneficiary cohort comorbidity disability disparity reduction dissemination strategy dosage drug testing experience experimental study high risk improved indexing innovation insight longitudinal analysis male minority patient mortality multiple chronic conditions opioid epidemic opioid mortality opioid overdose opioid use disorder overdose death overdose risk patient subsets policy implication poor communities prescription opioid prior authorization provider factors provider networks psychosocial racial and ethnic residence social vulnerability success telehealth tool treatment disparity treatment duration trend uptake

项目摘要

PROJECT ABSTRACT Medications for opioid use disorder (MOUD) are a key tool in reducing harms of the opioid epidemic. Yet only a minority of those with OUD initiate treatment, early discontinuation is typical, and disparities are endemic. People with disabilities are at especially high risk and epitomize the challenges of OUD with multimorbidity. Preliminary analyses identified 45,035 fatal opioid overdoses among Medicare disability beneficiaries (MDBs) from 2008-2016, and continuing under-utilization and disparities in MOUD, including among overdose survivors. With its wide influence in the health care system, Medicare's role is vital; it is essential to examine the Medicare system's successes and failures in engaging and retaining MDBs in treatment. Several recent policy changes are promising, with important implications for other payers, but their impact across beneficiary subgroups, time and communities needs to be better understood to inform action to improve uptake and reduce disparities. This study, responding to RFA-DA-22-037, will use national Medicare data linked with the National Death Index, Medicaid claims, community resources, prescription drug plan (PDP) formulary policies, and other data sources to assess how policy, community, provider and patient factors interact to shape MOUD initiation and retention, and in turn overdose and other clinical outcomes. With annual updates through 2025, the project will provide a powerful framework for assessing evolving treatment patterns and outcomes in a rapidly evolving environment, as well as potential changes in policy impacts over time. We will assess the drivers of racial/ethnic and other disparities in access; MOUD changes following policy and formulary changes by Medicare and its PDPs; and how these policies interact with the evolving MOUD provider system, community resources and patient characteristics. We will analyze trends and disparities in MOUD treatment and overdoses among MDBs. In cohorts of beneficiaries with new OUD diagnoses or non-fatal overdoses, we will assess factors associated with treatment initiation and retention, and association of treatment with clinical outcomes including non-fatal and fatal overdose. We will assess MOUD uptake across community, provider, and patient subgroups; changes in MOUD treatment patterns associated with the shift to tele-health; and associated changes in the MOUD treatment network serving MDBs. We will examine the sequelae of changes in formulary policies across Medicare's more than 6000 PDPs, including prior authorization requirements for MOUD, across beneficiary subgroups. Expanded reimbursement for tele-MOUD and elimination of prior authorization have the potential to save many lives, but it is critical to better understand their impact on access and disparities. An active dissemination strategy supported by a Stakeholder Advisory Board, complementing peer-reviewed publication, will support translation into evidence-informed policy. Results of this innovative and comprehensive assessment of the multi-level factors shaping MOUD uptake and outcomes among MDBs will have important implications for policy and practice across patient subgroups, payers and health care systems.

项目摘要治疗阿片类药物使用障碍 (MOUD) 的药物是减少阿片类药物流行危害的关键工具。然而仅少数 OUD 患者开始治疗，通常会提前停药，而且差异也很普遍。残疾人面临的风险尤其高，是多病态 OUD 挑战的缩影。初步分析发现 Medicare 残疾受益人 (MDB) 中有 45,035 名阿片类药物过量致死从 2008 年到 2016 年，MOUD 的利用持续不足和差异，包括用药过量之间的差异幸存者。医疗保险在医疗保健系统中具有广泛的影响力，其作用至关重要；有必要进行检查医疗保险系统在吸引和保留 MDB 参与治疗方面的成功和失败。最近的几个政策变化是有希望的，对其他付款人有重要影响，但它们对受益人产生影响需要更好地理解亚群体、时间和社区，以便为提高吸收和利用的行动提供信息减少差距。这项研究响应 RFA-DA-22-037，将使用与国家死亡指数、医疗补助索赔、社区资源、处方药计划 (PDP) 处方政策、和其他数据源，以评估政策、社区、提供者和患者因素如何相互作用来塑造 MOUD 启动和保留，以及过量和其他临床结果。到 2025 年为止每年都会更新，该项目将为评估不断变化的治疗模式和结果提供一个强大的框架快速变化的环境，以及政策影响随时间的潜在变化。我们将评估种族/族裔和其他获取机会方面差异的驱动因素； MOUD 随着政策和处方的变化而变化通过 Medicare 及其 PDP；以及这些政策如何与不断发展的 MOUD 提供商系统互动，社区资源和患者特征。我们将分析 MOUD 治疗的趋势和差异以及 MDB 中的药物过量。在新诊断出 OUD 或非致命药物过量的受益人群体中，我们将评估与治疗开始和保留相关的因素，以及治疗与临床的关联结果包括非致命和致命的药物过量。我们将评估社区、提供商、和患者亚组；与远程医疗转变相关的 MOUD 治疗模式的变化；和服务 MDB 的 MOUD 处理网络的相关变化。我们将检查变化的后遗症医疗保险 6000 多个 PDP 的制定政策中，包括事先授权要求 MOUD，跨受益人亚组。扩大远程 MOUD 的报销范围并消除先前的授权有可能挽救许多生命，但更好地了解其对访问的影响至关重要和差异。由利益相关者咨询委员会支持的积极传播策略，补充同行评审出版物，将支持转化为循证政策。这一创新和成果对多边开发银行采用 MOUD 和结果的多层次因素进行全面评估将对患者亚群、付款人和医疗保健系统的政策和实践具有重要影响。