Measuring Improvement in the Quality of ED-initiated Treatment for OUD using Observation

使用观察来衡量 ED 发起的 OUD 治疗质量的改善

基本信息

批准号：
10186872
负责人：
Ryan P McCormack
金额：
$ 83.44万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10186872
关键词：
Accident and Emergency department Accountability Adopted Adult Ambulatory Care Buprenorphine Caring Case Manager Characteristics Client satisfaction Clinical Protocols Clinical Trials Clinical Trials Network Collection Data Development Dose Drug usage Economics Effectiveness Emergency Department patient Emergency department visit Ensure Environment Evidence based treatment Health Health Care Costs Health Personnel Health Services Accessibility Hospitals Hour Housing Incentives Individual Infrastructure Insurance Intervention Kentucky Life Link Measures Methods Multicenter Studies National Institute of Drug Abuse Opioid Opioid agonist Outcome Outcome Measure Outpatients Overdose Paper Patient Care Patient Outcomes Assessments Patient Self-Report Patients Pharmaceutical Preparations Pharmacotherapy Phase Policies Population Process Process Measure Protocols documentation Provider Quality of Care Quality of life Randomized Randomized Clinical Trials Randomized Controlled Trials Recovery Resources Risk Adjustment Running Rural Community Safety Savings Services Site Structure Testing Third-Party Payer Time Transportation Universities Visit Work acute care cost disparity reduction economic evaluation effectiveness measure experience functional status health care service improved interest mortality risk multidisciplinary opioid epidemic opioid use disorder overdose death patient oriented personalized approach primary outcome public health priorities relative effectiveness safety outcomes secondary outcome success treatment services trial comparing working group

项目摘要

Treatment of opioid use disorder (OUD) with buprenorphine (BUP) has significant individual and societal benefits, and decreases the risk of death from overdose. Yet, few individuals have access to these treatments. Narrowing the treatment gap by expanding access to treatment in Emergency Department (ED) settings is widely viewed to be a public health priority. It has been 3 years since D’Onofrio et al.’s landmark paper demonstrated the feasibility, safety, and efficacy of ED-initiated BUP, and, despite a highly visible opioid epidemic, few EDs have adopted this life-saving intervention. Coincident with the intensifying opioid epidemic, there have been increasing calls for development and use of quality measures to track and improve the quality of care for OUD and implement policy strategies to identify and incentivize use of best practices. Through our work, including leading two ongoing NIDA Clinical Trials Network multicenter studies of the implementation and effectiveness of ED-initiated BUP and referral, our team has identified unique challenges to implementation and collection of information about care quality. By providing an environment within and managed by the ED that allows sufficient time for enhanced care, beyond a 4-6 hour ED visit, protocol-driven ED Observation Units (EDOUs) would mitigate many identified challenges and promote better utilization of existing infrastructure. Further, it would enable patients presenting for overdose to remain in the ED long enough to receive their first dose of BUP prior to discharge. In the R61 phase, we will build on our existing clinical protocols as well as linked process and outcome measures of quality related to ED-initiated BUP and referral to be delivered during (1) a standard ED visit and (2) an enhanced ED visit in EDOU. Then, for the R33 phase, we propose a multicenter, randomized controlled trial in which patients with untreated OUD presenting to the University of Kentucky, NYU-Brooklyn (NYC), and Bellevue Hospital (NYC) EDs are randomized (1:1) to treatment though one of the two clinical protocols with outcomes assessed at the ED visit, 1, 3, and 6 months. We will evaluate processes and outcomes granularly to inform the development of reliable, valid measures using data that could be captured without undue burden. We will compare the relative effectiveness of the two approaches on the proportion of patients who receive ED- initiated BUP and referral, are linked to formal OUD treatment within 7 days and engaged in treatment at 30 days. We will assess changes in patient reported outcomes and drug use, and conduct an economic evaluation from a third-party payer perspective. Linking structural and process measures to population-level outcomes will allow us to guide and define quality improvement to inform accountability and policy. Evaluating the associations between patient-level characteristics, measure completion, and outcomes will help identify population needs and apply strategies to improve quality and reduce disparities.

用丁丙诺啡（BUP）治疗阿片类药物使用障碍（OUD）具有重要的个人和社会收益，并降低过量死亡的风险。然而，很少有人可以使用这些治疗方法。通过扩大急诊科（ED）设置的治疗范围来缩小治疗差距是被广泛认为是公共卫生优先事项。自D'Onofrio等人的地标纸已经3年了证明了发射的BUP的可行性，安全性和效率，尽管阿片类药物高度可见流行病，很少有ED采用这种挽救生命的干预措施。与加强阿片类药物的流行相吻合，越来越多的呼吁开发和使用质量措施以跟踪和提高质量护理OUD和实施政策策略，以确定和激励使用最佳实践。通过我们的工作，包括领导两项正在进行的NIDA临床试验网络对实施和我们的团队确定了实施的独特挑战以及有关护理质量的信息的收集。通过在内部提供环境并由ED管理这为增强护理的时间提供了足够的时间，超过4-6小时的ED访问，由协议驱动的ED观察单元（Erdous）将减轻许多确定的挑战，并促进对现有基础设施的更好利用。此外，这将使出现过量的患者能够留在ED中足够长的时间出院前的BUP剂量。在R61阶段，我们将建立在现有的临床方案以及链接过程和结果的基础上（1）在（1）访问和（2）Edou的ED访问增强。然后，对于R33阶段，我们提出了一个多中心，随机控制的未经治疗的OUD患者向肯塔基大学，纽约 - 布鲁克林（NYC）和 Bellevue医院（NYC）EDS是随机分别（1：1）进行治疗，这是两种临床方案之一在ED访问，1、3和6个月进行评估的结果。我们将详细评估过程和结果通知使用可以捕获的数据而无需负担的数据来开发可靠的有效措施。我们将比较两种方法与接受ED-的患者比例的相对有效性启动BUP和推荐与7天内的正式OUD治疗有关，并在30时进行治疗天。我们将评估患者报告的结果和吸毒的变化，并进行经济从第三方付款人的角度进行评估。将结构和过程指标与人群级别联系起来成果将使我们能够指导和定义质量改进，以指导问责制和政策。评估患者级特征，测量完成和结果之间的关联将有助于确定人口需求并采用策略来提高质量并减少分布。