CHSE Research Collaborations

In addition to our own projects, CHSE provides analytic and methodological support for other investigators' delivery-system research.  Current work includes the following:


Effectiveness of Prescription Monitoring Program Use in Emergency Departments
PI: Benjamin Sun

Since July 2012, Washington state has mandated that emergency-department providers have access to a prescription monitoring program (PMP) database showing patient histories of prescriptions for controlled substances such as opioids. EDs are the source of 39% of prescriptions for these substances, and many states now offer monitoring databases. ED providers, however, have been slow to adopt them. Taking advantage of Washington state's new mandate, Dr. Sun is conducting a variety of studies on opioid-use in Washington state. This work includes an assessment of the adoption of PMP use and its impact on ED opioid prescribing and patient outcomes, an examination of opioid-related overdoses and deaths among "opioid shoppers" who obtain prescriptions from multiple doctors or pharmacies, as well as an analysis of Washington's integration of PMP information into Washington's Emergency Department Information Exchange (EDIE) system.

CHSE contributors:  John McConnell, Nicoleta Lupulescu-Mann, Christina Charlesworth, Hyunjee Kim


Integrating Addiction Treatment and Medical Care in a Commercial Health Plan
PI:  Dennis McCarty

Twelve addiction-treatment centers, matched with 12 controls, will implement the Advancing Recovery systems-change model for treatment of patients dependent on opioids or alcohol.  CHSE will assist Dr. McCarty with analyzing claims data for the two groups, comparing their patterns of utilization and expenditures  for inpatient, emergency, and residential addiction treatment.

CHSE contributors:  John McConnell, Nicoleta Lupulescu-Mann


Oregon's Coordinated Care Organizations Integrate Care for Drug Use Disorders
PI: Dennis McCarty

Central to Oregon's CCO transformation is the integration of behavioral and physical health care as a single point of accountability to streamline access to care, reduce overall costs, and improve health outcomes. This study examines CCO integration strategies and assesses the change in services for the treatment of alcohol and drug use disorders.

CHSE contributors: John McConnell, Stephanie Renfro

 

Integrating Addiction Treatment and Medical Care in a Commercial Health Plan
PI: Dennis McCarty

Health insurance agencies collaborate with a number of addiction treatment centers to facilitate the usage of medications as part of treatment plans for opioid and alcohol use disorders. However, adoption of this practice has not been widespread. The Medication Research Partnership is a collaboration between researchers, the commercial health plan and providers to test approaches to facilitate medication-assisted treatment and improve the integration of medical care and addiction treatment. Through utilization of the Advancing Recovery model, this study uses evidence-based practices to implement medication-assisted treatment at ten addiction treatment centers. Following implementation, researchers document the impacts of the model on utilization and expenditures as well as the barriers faced by addiction centers in the implementation of this practice.

CHSE contributors: John McConnell, Nicoleta Lupulescu-Mann


ESCALATES
PI: Deborah Cohen

ESCALATES (E_valuating S_ystem C_hange to A_dvance L_earning A_nd T_ake E_vidence to S_cale) is a nation-wide collaboration of researchers and practitioners led by OHSU researcher Deborah Cohen. The ESCALATES team works with seven regional cooperatives that help primary care practices use the latest evidence in preventive treatment of cardiovascular disease. The primary goal of ESCALATES is to understand which practice supports and quality improvement strategies are most effective across the regional cooperatives. Through the utilization of the evidence-based practice change model, ESCALATES also provides general insight for strategies of change in healthcare.

CHSE Contributors: John McConnell, Stephan Lindner

 

Refinement in Study Design and Analysis for Health Reform to Address Multiple Chronic Conditions
PI:  David Dorr

With the increasing prevalence of complex patients in the population, health researchers need methods for adjusting study models to incorporate information on risks due to multiple chronic conditions (MCCs).  Dr. Dorr's project will use records from the Integrated Care Coordination Information System and the Oregon All Payer All Claims database to assess effects of MCC factors on study design and will use advanced processing to improve patient selection and MCC summarization for risk adjustment in delivery-systems research.

CHSE contributors:  John McConnell, Peter Graven, Nicoleta Lupulescu-Mann


School-Based Health Centers: Impacts of Alternative Payment Structures
PI: Allison Leof, Center for Evidence-based Policy

Oregon’s School Based Health Centers (SBHCs) provide critically needed health services to adults and children, including many without insurance. This project examines several potential payment designs to understand their impacts on SBHC finances.  Under the direction of the Center for Evidence-based Policy, CHSE will use service data from the Oregon School-Based Health Alliance to model the impacts of specific clinic payment structures.

CHSE contributors:  Peter Graven, Thomas Meath, John McConnell

 

From Evidence to Action:  Developing a Family Planning Research Agenda with the State of Oregon 
PI:  Maria Rodriguez, Obstetrics and Gynecology

Traditionally progressive at providing contraceptive services, Oregon has seen the Affordable Care Act and its own Medicaid reforms reconfigure parts of the state’s family-planning delivery systems.  For example, women in Oregon’s coordinated care organizations may now be more likely to receive contraceptive services through their primary care providers than through specialized family-planning clinics. This project joins researchers from OHSU with the Oregon Reproductive Health Program to develop a research agenda on impacts of these changes.   

CHSE contributors:  Stephanie Renfro, John McConnell

 

Regional Variation in Colorectal Cancer Screening and Access to Primary Care within Oregon's Medicaid and Commercially Insured Populations
PI: Melinda Davis, Oregon Rural Practice Based Research Network

The Centers for Disease Control and Prevention (CDC) supports two nationwide cancer screening programs: the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the Colorectal Cancer Control Program (CRCCP). Both provide free or low-cost screening services to low-income and un/under-insured clients who meet program eligibility requirements. Both programs also increasingly emphasize the use of evidence-based interventions (EBIs) to increase cancer screening rates. This study (1) explores changes in colorectal cancer screening rates in Oregon following Medicaid expansion, and (2) models the effects of public programs intended to increase colorectal cancer screenings to inform Oregon’s coordinated care organizations and state-level interventions. The work is funded by the CDC’s Cancer Prevention and Control Research Network (CPCRN) and through an AHRQ Patient-Centered Outcomes Research K12 awarded to Dr. Davis. 

CHSE contributors: Stephanie Renfro, John McConnell

 

Opioid analgesic policies and prescription drug abuse in state Medicaid programs
PI: Daniel Hartung, College of Pharmacy

From 1997 to 2007, the volume of opioid analgesics dispensed through pharmacies increased more than six-fold, roughly paralleling the number of people dying from opioid overdoses. The flood of opioid analgesics reflects both calls for more aggressive treatment of pain as well as the proliferation of many different forms of opioid pain-killers. Opioid prescribing among Medicaid patients is especially of interest, since Medicaid recipients are more likely to have substance-abuse disorders and are disproportionately represented among overdose deaths. This project uses Medicaid data to quantify how pharmacy benefit designs in three state Medicaid programs (Oregon, Oklahoma, Colorado) impact opioid analgesic utilization, inappropriate use, and adverse health outcomes.

CHSE contributors: Hyunjee Kim, John McConnell