Appendix E : Continuity of Care , “ Cascade of Care ” Example
A “ cascade of care ” is a structure often used to identify gaps continuity of care gaps . A recent Florida study published by the Recovery Research Institute of the Opioid Use Disorder ( OUD ) “ cascade of care ” shows that the people identified with an OUD often do not receive care . The biggest challenge identified in the research was that continuity of care and “ hand-offs ” failed to successfully link 72 % of people identified with OUD to a provider of an FDA approved medication . Note , too , that the study found that individuals who stayed in treatment for 180 days were five time less likely to die from a OUD-related cause . The study also found that people over age 50 were significantly less likely to receive medication to address OUD issues . 46
The research concludes saying that “ all those that qualify should be offered medication to treat their OUD and have a system that permits at least a 180-day course of medication .” Embedded in the research is the observation that the process of care , continuity of care , is a critical piece to effective outcomes . 47
30,000 28,370
Florida Medicaid Recipients with OUD
25,000
20,000
20,500
15,000
10,000
5,000
5,740
2,181
- Florida Medicaid recipients with an OUD ( NSDUH 2017 )
Medicaid Recipients with and OUD included in the Study
Recipients with OUD who went on to be treated with an FDA approved medication
Retained in treatment for 180 days
Cascade of Care Stage |
Number of Individuals Percent Loss from Previous Stage |
Florida Medicaid recipients with an OUD ( NSDUH 2017 ) |
28,370 |
NA |
Medicaid Recipients with and OUD included in the Study |
20,500 |
28 % |
Recipients with OUD who went on to be treated with an FDA approved medication |
5,740 |
72 % |
Retained in treatment for 180 days |
2,181 |
62 % |
ten‐year period from 1987 to 1997 , the percentage of patients who received psychiatric medication from PCPs increased from 37.3 % to 74.5 %.
6 These trends demonstrate that the role of the primary care physician has expanded such that PCPs are also becoming the primary psychiatric care physician ( PPCP ) for a considerable number of their patients .” Abed Faghri , N . M ., Boisvert , C . M ., & Faghri , S . ( 2010 ). Understanding the expanding role of primary care physicians ( PCPs ) to primary psychiatric care physicians ( PPCPs ): enhancing the assessment and treatment of psychiatric conditions . Mental health in family medicine , 7 ( 1 ), 17 – 25 . Available at
https :// www . ncbi . nlm . nih . gov / pmc / articles / PMC2925161 /
46
Johnson , K ., Hills , H ., Ma , J ., Brown , C . H ., & McGovern , M . ( 2020 ).
Treatment for opioid use disorder in the Florida Medicaid population : Using a cascade of care model to evaluate quality . The American Journal of Drug and Alcohol Abuse , [ Epub ahead of print ]. doi : 10.1080 / 00952990.2020.1824236
47
Ibid .
76