背景:政策是系统改变医疗服务和质量的强大工具,但是对政策差距的研究阻碍了将循证实践转化为公共政策,并限制了服务和人口健康结果的广泛改善。美国阿片类药物的流行不成比例地影响了医疗补助成员,他们依靠公共资助的福利来获得循证治疗,包括阿片类药物使用障碍(MOUD)。联邦机构的政策制定者无数错位的政策和证据使用行为,州医疗补助机构,和管理式护理组织限制了医疗补助成员对MOUD的覆盖和访问。提高政策制定者使用现有证据的传播策略对于提高MOUD益处和减少健康差异至关重要。然而,没有研究描述医疗补助政策制定者的关键决定因素,“证据使用行为或偏好,很少有研究审查数据驱动的方法来制定传播战略,以加强循证决策。本研究旨在确定影响决策者证据使用行为的决定因素和中介,然后开发和测试数据驱动的量身定制的传播策略,以促进MOUD在福利阵列中的覆盖。
方法:在探索的指导下,准备工作,实施,和可持续性(EPIS)框架,我们将对国家医疗补助机构和管理式医疗组织政策制定者进行全国调查,以确定影响他们寻求方式的决定因素和中介机构,接收,并在他们的决策过程中使用研究。我们将使用潜在的类方法来经验地识别具有不同证据使用行为的机构子组。将使用10个步骤的传播策略开发和规范过程来调整策略,以适应为每个潜在类别确定的重要预测因素。将向每一类决策者部署量身定制的传播战略,并评估其可接受性,适当性,以及提供有关MOUD效益设计的证据的可行性。
结论:这项研究将阐明影响政策制定者的关键决定因素和中介在为MOUD设计利益时的证据使用行为。这项研究将产生一组急需的数据驱动,量身定制的政策传播战略。研究结果将为随后的多站点试验提供信息,以衡量针对MOUD利益设计和实施的量身定制的传播策略的有效性。传播策略制定的经验教训将为未来有关决策者的证据使用偏好的研究提供信息,并为定制传播策略提供可复制的过程。
BACKGROUND: Policy is a powerful tool for systematically altering healthcare access and quality, but the research to policy gap impedes translating evidence-based practices into public policy and limits widespread improvements in service and population health outcomes. The US opioid epidemic disproportionately impacts Medicaid members who rely on publicly funded benefits to access evidence-based treatment including medications for opioid use disorder (MOUD). A myriad of misaligned policies and evidence-use behaviors by policymakers across federal agencies, state Medicaid agencies, and managed care organizations limit coverage of and access to MOUD for Medicaid members. Dissemination strategies that improve policymakers\' use of current evidence are critical to improving MOUD benefits and reducing health disparities. However, no research describes key determinants of Medicaid policymakers\' evidence use behaviors or preferences, and few studies have examined data-driven approaches to developing dissemination strategies to enhance evidence-informed policymaking. This
study aims to identify determinants and intermediaries that influence policymakers\' evidence use behaviors, then develop and test data-driven tailored dissemination strategies that promote MOUD coverage in benefit arrays.
METHODS: Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we will conduct a national survey of state Medicaid agency and managed care organization policymakers to identify determinants and intermediaries that influence how they seek, receive, and use research in their decision-making processes. We will use latent class methods to empirically identify subgroups of agencies with distinct evidence use behaviors. A 10-step dissemination strategy development and specification process will be used to tailor strategies to significant predictors identified for each latent class. Tailored dissemination strategies will be deployed to each class of policymakers and assessed for their acceptability, appropriateness, and feasibility for delivering evidence about MOUD benefit design.
CONCLUSIONS: This
study will illuminate key determinants and intermediaries that influence policymakers\' evidence use behaviors when designing benefits for MOUD. This
study will produce a critically needed set of data-driven, tailored policy dissemination strategies.
Study results will inform a subsequent multi-site
trial measuring the effectiveness of tailored dissemination strategies on MOUD benefit design and implementation. Lessons from dissemination strategy development will inform future research about policymakers\' evidence use preferences and offer a replicable process for tailoring dissemination strategies.