BACKGROUND In light of the accelerating and rapidly evolving overdose crisis in the United States (US), new strategies are needed to address the epidemic and to efficiently engage and retain individuals in care for opioid use disorder (OUD). Moreover, there is an increasing need for novel approaches to using health data to identify gaps in the cascade of care for persons with OUD. METHODS AND FINDINGS Between June 2018 and May 2019, we engaged a diverse stakeholder group (including directors of statewide health and social service agencies) to develop a statewide, patient-centered cascade of care for OUD for Rhode Island, a small state in New England, a region highly impacted by the opioid crisis. Through an iterative process, we modified the cascade of care defined by Williams et al. for use in Rhode Island using key national survey data and statewide health claims datasets to create a cross-sectional summary of 5 stages in the cascade. Approximately 47,000 Rhode Islanders (5.2%) were estimated to be at risk for OUD (stage 0) in 2016. At the same time, 26,000 Rhode Islanders had a medical claim related to an OUD diagnosis, accounting for 55% of the population at risk (stage 1); 27% of the stage 0 population, 12,700 people, showed evidence of initiation of medication for OUD (MOUD, stage 2), and 18%, or 8,300 people, had evidence of retention on MOUD (stage 3). Imputation from a national survey estimated that 4,200 Rhode Islanders were in recovery from OUD as of 2016, representing 9% of the total population at risk. Limitations included use of self-report data to arrive at estimates of the number of individuals at risk for OUD and using a national estimate to identify the number of individuals in recovery due to a lack of available state data sources. CONCLUSIONS Our findings indicate that cross-sectional summaries of the cascade of care for OUD can be used as a health policy tool to identify gaps in care, inform data-driven policy decisions, set benchmarks for quality, and improve health outcomes for persons with OUD. There exists a significant opportunity to increase engagement prior to the initiation of OUD treatment (i.e., identification of OUD symptoms via routine screening or acute presentation) and improve retention and remission from OUD symptoms through improved community-supported processes of recovery. To do this more precisely, states should work to systematically collect data to populate their own cascade of care as a health policy tool to enhance system-level interventions and maximize engagement in care.

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定义针对阿片类药物使用障碍的恢复导向的护理服务：社区驱动的全州性横断面评估。

背景技术鉴于美国（US）的加速和迅速发展的药物过量危机，需要新的策略来解决该流行病并有效地参与并保持个体对阿片类药物使用障碍（OUD）的护理。此外，对使用健康数据来识别对OUD的人的医疗服务级联中的差距的新颖方法的需求日益增长。方法和调查结果在2018年6月至2019年5月期间，我们与一个不同的利益相关者团体（包括州范围内的卫生和社会服务机构的负责人）进行了合作，为新英格兰的一个小州罗德岛州（Rhode Island）开发了一个以患者为中心的，以患者为中心的OUD护理服务受到阿片类药物危机严重影响的地区。通过迭代过程，我们修改了Williams等人定义的护理级联。使用主要的国家调查数据和州范围内的健康声明数据集在罗得岛州使用，以创建级联中5个阶段的横截面摘要。据估计，2016年约有47,000名罗德岛民（5.2％）有OUD风险（0级）。同时，有26,000名罗德岛民有与OUD诊断有关的医疗索赔，占高危人群的55％ （阶段1）; 0期人群中有27％的人（12,700人）有开始使用OUD药物的证据（MOUD，第2期），18％或8,300人的患者有MOUD保留的证据（第3期）。一项全国调查得出的结论估计，截至2016年，有4,200名罗德岛民正在从OUD中康复，占受威胁总人口的9％。局限性包括使用自我报告数据来估算面临OUD风险的人数，以及使用国家估算值来确定由于缺乏可用的州数据源而正在恢复的人数。结论我们的研究结果表明，针对OUD的护理的级联横断面总结可以用作健康政策工具，以发现护理方面的差距，为以数据为依据的政策决策提供依据，设定质量基准并改善OUD者的健康结果。存在大量机会来增加开始OUD治疗之前的参与度（即通过常规筛查或急性表现识别OUD症状），并通过改善社区支持的康复过程来改善OUD症状的保留和缓解。为了更精确地做到这一点，