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首页> 外文期刊>Journal of substance abuse treatment >Facility-level changes in receipt of pharmacotherapy for opioid use disorder: Implications for implementation science
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Facility-level changes in receipt of pharmacotherapy for opioid use disorder: Implications for implementation science

机译：用于阿片类药物治疗药物治疗的设施水平变化：对实施科学的影响

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BackgroundThe U.S. is facing an opioid epidemic, but despite mandates for pharmacotherapy for opioid use disorder to be available at Veterans Health Administration (VHA) facilities, the majority of veterans with opioid use disorder do not receive these medications. In implementation research, facilities are often targeted for qualitative inquiry or quality improvement efforts based on quality measure performance during a one-year period. However, sites that experience quality performance changes from one year to the next may be highly informative because mechanisms that impact facility change may be more discoverable. The current study examined changes in receipt of pharmacotherapy for opioid use disorder in a national healthcare system to determine the extent to which sites fluctuated in performance over a two-year period and illustrate how changes in quality measures over time may be useful for implementation research and healthcare surveillance of quality measures. MethodsUsing national VHA data from Fiscal Years (FY) 2016 and 2017, we calculated quality measure performance as the number of patients who received pharmacotherapy for opioid use disorder (i.e., methadone, buprenorphine, and naltrexone) divided by the number of patients with a current non-remitted opioid use disorder diagnosis for each FY at each facility (n?=?129) and examined change from FY16 to FY17. ResultsThe mean rate of receipt of pharmacotherapy for opioid use disorder was 38% (facility range?=?3% to 74%) in FY16 and 41% (facility range?=?2% to 76%) in FY17. The average facility-level change in performance was 3% and ranged from ?19% to 26%. There were 32 facilities that decreased in provision of pharmacotherapy, 12 facilities with no change, and 85 facilities that increased. ConclusionsFor facilities with average or high performance, it was difficult to maintain their performance over time. Identifying and learning from facilities with recent fluctuations may be more informative to guide the design of future quality improvement efforts than studying facilities with stable high or low performance.
机译：背景技术面临阿片类疫情，尽管在退伍军人卫生管理局（VHA）设施中可获得药物治疗的药物治疗的药物治疗，但具有阿片类药物的大多数退伍军人不会收到这些药物。在实施研究中，设施往往是根据在一年期间的质量措施表现的定性查询或质量改进努力。然而，在接下来的一年内经历质量性能变化的网站可能是高度信息的，因为影响设施变化的机制可能会更加可发现。目前的研究检测了在国家医疗系统中接收药物治疗的药物治疗的变化，以确定在为期两年期间在表现中波动的程度，并说明了如何随时间的质量措施变化可能对实施研究有用医疗保健监测质量措施。 Methationsing Figural VHA数据来自财政年度（FY）2016和2017，我们计算了质量措施表现，作为接受阿片类药物使用障碍（即美沙酮，丁丙诺啡和纳曲酮）的药物治疗的患者数量除以当前患者的数量非汇率的阿片类药物使用每个设施的每个FY的疾病诊断（n？=？129），并从2016财年检查到FY17。结果，适用于阿片类药物治疗的药物治疗的平均率为38％（设施范围？=？=？3％至74％）在FY17中的41％（设施范围？=？2％至76％）。性能平均的设施水平变化为3％，范围为19％至26％。提供药物治疗的32种设施减少了12个设施，没有变化，85个设施增加。结论有限于平均或高性能的设施，很难随着时间的推移保持其性能。从近期波动的设施中识别和学习可能更有信息，可以更有信息，指导未来的质量改善努力的设计，而不是学习具有稳定的高或低性能的设施。

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