Enhanced Assessment of Overdose Mortality, Other OUD-Related Outcomes, Treatment Access and Equity Among Medicare Beneficiaries with Disability, Across Racial/Ethnic Subgroups and Communities
Grant
Overview
Affiliation
View All
Overview
description
PROJECT ABSTRACT Analyses of MOUD access and medically treated overdoses in samples of Medicare disability beneficiaries (MDBs) have provided important insights, but it is vital to extend these to incorporate linkage with the National Death Index (NDI) to better understand predictors of fatal overdoses involving opioids and health system strategies to reduce them. Particularly critical is the need for firmer understanding of treatment history, clinical, demographic, community, and other factors associated with increasing fatal-overdose risk among minoritized communities, using 100% Medicare data with the statistical power to support accurate assessment across racial/ethnic subgroups and communities, providing insights with broad significance for overdose prevention across populations and payers. Under new CMS policies, NDI-claims linkage is available only in CMS’s Virtual Data Research Warehouse (VRDC) through purchase of a VRDC seat. At the same time, newly-available data from a 100% NDI-claims match now in the VRDC offer an opportunity to expand statistical power and outcomes assessment to accurately measure MOUD uptake and fatal-overdose risk. Linkage of NDI data with diagnostic and treatment histories from Medicare claims for the full MDB population offers a unique, timely opportunity to improve statistically significant estimation across subgroups and communities from the original sample of fee-for-service beneficiaries to the broader population of Medicare disability beneficiaries (MDBs), adding NDI linkage. This will enhance power for variations and outcomes across minoritized populations and communities, and provide access to mortality outcomes that is no longer possible through investigator- managed physical-data linkage as originally planned, due to new CMS policy changes. Under this supplement, we will utilize 100% linked NDI-Medicare claims data in the VRDC to identify evolving patterns of diagnostic and treatment history for fatal drug overdoses across racial-ethnic subgroups; construct 100% cohorts of opioid overdose survivors; and analyze MOUD treatment trajectories and fatal overdose risk in these expanded high-risk cohorts. This will greatly enhance resolving power for variations across racial/ethnic subgroups, improve generalizability by including the managed care population; incorporate more-recent years of data; and incorporate methadone treatment, added to Medicare in 2020. We will utilize the linked data to assess evolving patterns of fatal drug overdoses across racial/ethnic subgroups and communities; create 100% cohorts of MDBs treated for non-fatal overdose, anchored on overdose date as index date; implement event history analyses of MOUD treatment and overdose fatality risk in these cohorts; assess the role of components of treatment disparities on outcome disparities including risk of fatal overdose; and identify the most promising targets in the treatment cascade for intervention to reduce outcome disparities.
