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Principal Investigator: Paul J Joudrey
Organization: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
Fiscal Year: 2024
Award: $823,809
Funding agency: National Institute on Drug Abuse
PROJECT SUMMARY
Medications for opioid use disorder (MOUD) improve the health of individuals with opioid use disorder (OUD).
However, there are significant gaps in obtaining services at each step of the opioid treatment cascade.
Individual’s access to MOUD vary by community characteristics, most often characterized simply by physical
availability (e.g., drive time to treatment location), and are different based on an individual’s age, gender, and
race/ethnicity. Using geographic availability metrics alone fails to account for other barriers and facilitators of
MOUD access (e.g., insurance, stigma, access to vehicles) and thus leads to erred assessments of
community’s responsiveness to OUD treatment needs. The patient-centered access to healthcare framework
organizes individual and structural level factors impacting access into five stages including the opportunity to (i)
identify healthcare needs, and then (ii) seek, (iii) reach, (iv) obtain, and (v) use the appropriate health care
services. The overarching goal of our study is to improve receipt of opioid treatment cascade services via data-
driven tailoring and monitoring of services. The primary objective is to develop and validate a replicable and
scalable Small Area Multidimensional MOUD Access (SAMMA) suite of measures along with computing
dashboards to enable dissemination. The rationale for this proposal is that embedding a multidimensional,
patient-centered framework of MOUD access within a socio-ecological view of health should facilitate improved
understanding of community variation in the opioid treatment cascade and enable a more sophisticated
tailoring and monitoring of interventions. The primary objective will involve three specific aims: 1) create a suite
of SAMMA measures within 50 US states and the District of Columbia; 2) validate and refine the SAMMA
measures on the community level; and 3) validate and refine the SAMMA measures by exploring access within
small areas where individual level access diverges from the SAMMA measures. For Aim 1, we will engage with
governmental health agencies and key community partners to create the SAMMA measures using publicly-
available, community level data including the American Community Survey. For Aim 2, we will validate and
refine the SAMMA measures with community level Medicaid claims data, MOUD availability data, and the
Centers for Disease Control and Prevention Social Vulnerability Index. For Aim 3, we will employ a mixed-
method convergent parallel approach using multi-location surveys of people who use drugs (PWUD) to
measure bivariate and multilevel model associations of individual level access and the SAMMA measures and
conduct semi-structured interviews among PWUD who’s individual level access diverged from the SAMMA
measures. Our innovative study will be the first to integrate multiple stages of healthcare access into a
community MOUD access measure by engaging key partners during development. It has potential for high
impact actionable insights, as we will leverage data science to better localize and monitor responses for OUD
treatment by developing a replicable and scalable suite of SAMMA measures.
Terms: <Adanon><Affect><Age><Althose><American><Area><Buprenorphine><Censuses><Centers for Disease Control><Centers for Disease Control and Prevention><Centers for Disease Control and Prevention (U.S.)><Characteristics><Clinic><Collaborations><Communities><Community Surveys><County><D.C. Washington><DC Washington><Data><Data Science><Data Set><Decision Analysis><Development><Dimensions><District of Columbia><Dolophine><Drug user><Drugs><Environment><Equity><Ethnic Origin><Ethnicity><Funding><Gender><Generations><Geography><Goals><HRSA><Harm Minimization><Harm Reduction><Health><Health Resources and Services Administration><Healthcare><Individual><Insurance><Intervention><Intervention Strategies><Interview><Link><Location><Measures><Medicaid><Medication><Methadone><Methadose><Methods><Modeling><Monitor><NIDA><Nalorex><Naltrexone><National Institute of Drug Abuse><National Institute on Drug Abuse><Nemexin><Opiates><Opioid><Outcome><Overdose reduction><PWUD><Pharmaceutical Preparations><Public Health><Race><Races><ReVia><Research><Research Resources><Resources><Risk><Rural Community><Services><Structure><Survey Instrument><Surveys><System><Techniques><Time><US State><United States Centers for Disease Control><United States Centers for Disease Control and Prevention><United States Health Resources and Services Administration><Urban Community><Variant><Variation><Vivitrol><access disparities><access to health care><access to healthcare><accessibility disparities><accessibility of health care><accessibility to health care><accessibility to healthcare><age associated><age correlated><age dependent><age linked><age related><age specific><ages><beneficiary><community partners><community-based partners><dashboard><developmental><dimension reduction><dimensionality reduction><disparities in access><disparities in race><disparity due to race><drug/agent><geographic disadvantage><geographic disparity><geographic inequality><geographic inequity><geographic location disparity><health care><health care access><health care availability><health care service><health care service access><health care service availability><healthcare access><healthcare accessibility><healthcare availability><healthcare service><healthcare service access><healthcare service availability><improved><indexing><inequality due to race><inequality in access><inequity due to race><inequity in access><inequity in accessibility><innovate><innovation><innovative><insight><interventional strategy><medication for opioid use disorder><methods to study multiple-level influences><multi-level analysis><multi-level model><multilevel analysis><multilevel model><multilevel modeling><opiate deaths><opiate mortality><opiate use disorder><opioid deaths><opioid mortality><opioid overdose death><opioid related death><opioid use disorder><overdose death><overdose fatalities><patient centered><patient oriented><people who use drugs><people who use illicit drugs><persons who use drugs><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial disparity><racial inequality><racial inequity><racial origin><racially unequal><reduce data dimension><reduce dimensionality><reduce overdose><reduction in overdose><response><service organization><social stigma><social vulnerability><stigma><structural health determinants>