Integrated Care for Chronic Pain and Opioid Use Disorder: The IMPOWR Research Center at Montefiore/Einstein (IMPOWR-ME)

慢性疼痛和阿片类药物使用障碍的综合护理：蒙蒂菲奥里/爱因斯坦 IMPOWR 研究中心 (IMPOWR-ME)

• 批准号: 10391075
• 负责人: JULIA H. ARNSTEN
• 金额: $ 513.28万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10391075
• 关键词: Address; Adoption; Advocate; Area; Buprenorphine; Caring; Chronic Care; Clinic; Clinical; Collaborations; Combined Modality Therapy; Communities; County; Data Analyses; Data Analytics; Death Rate; Dissemination and Implementation; Effectiveness; Ensure; Evidence based practice; Future; Goals; Grant; Health; Health Services Accessibility; Health system; Helping to End Addiction Long-term; Hispanics; Hospitals; Hybrids; Improve Access; Individual; Interdisciplinary Study; Intervention; Knowledge; Leadership; Maintenance; Mental Health; Mentors; Methadone; Morbidity - disease rate; Neighborhoods; New York City; Opiate Addiction; Outcome; Overdose; Pain Research; Pain management; Participant; Patient-Focused Outcomes; Patients; Physical Function; Physical therapy; Physiological; Pilot Projects; Policies; Population; Positioning Attribute; Poverty; Primary Health Care; Psychiatry; Public Health; Qualitative Methods; Quality of life; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recording of previous events; Recovery; Research; Research Infrastructure; Research Personnel; Research Project Grants; Research Training; Resources; Site; Testing; Time; United States; Vulnerable Populations; Yoga; acute care; base; biopsychosocial factor; black patient; buprenorphine treatment; care seeking; chronic pain; chronic pain management; chronic pain patient; clinical care; comorbidity; cost effective; cost effectiveness; data management; design; effective intervention; effectiveness implementation trial; effectiveness outcome; effectiveness testing; experience; flexibility; health care settings; implementation cost; implementation trial; innovation; methadone treatment; mindfulness; mortality; multi-component intervention; multidisciplinary; multimodality; novel; opioid epidemic; opioid misuse; opioid mortality; opioid treatment program; opioid use disorder; opioid withdrawal; overdose death; programs; psychologic; racial diversity; racism; response; smartphone Application; social factors; social health determinants; social stigma; three-arm trial; treatment adherence; treatment program; two-arm trial

ABSTRACT Chronic pain (CP) and opioid use disorder (OUD) are leading causes of morbidity and mortality in the United States. Despite being commonly comorbid, there is a striking lack of integrated treatments accessible to people in need. This is particularly true for Black and Hispanic individuals living and seeking care in under-resourced settings like The Bronx, NY, one of the poorest and most racially diverse counties in the U.S. Submitted in response to the HEAL Initiative: Integrative Management of Chronic Pain and OUD for Whole Recovery (IMPOWR) RFA-DA-21-030, the overall goal of this proposal is to create the IMPOWR Research Center at Montefiore/Einstein (“IMPOWR-ME”), in the high-impact county of The Bronx NY. IMPOWR-ME is a synergistic multidisciplinary research center that leverages exceptional research infrastructure in CP and OUD and existing relationships with people living with CP and OUD, advocates, policymakers and payers, and health system stakeholders. The aims of IMPOWR-ME are to: 1) create a robust and sustainable research infrastructure to rigorously test and disseminate integrated and cost-effective evidence-based practices for people with CP and OUD; 2) partner with people with lived experience with CP, OUD, or both, and diverse stakeholders in all stages of the research; and 3) provide opportunities for multidisciplinary early stage investigators to become independent researchers focusing on CP and OUD. Three innovative hybrid type 1 effectiveness-implementation trials are proposed to rigorously examine multi-modal evidence-based practices in diverse health care settings and populations of people with comorbid CP and OUD. Specifically, we propose: 1) a three-arm trial of yoga and physical therapy onsite at methadone opioid treatment programs, 2) a 2x2 factorial trial to test Acceptance and Commitment Therapy and a care management smartphone app for individuals in primary-care based buprenorphine treatment, and 3) a two-arm trial to test microdosing vs. standard induction of buprenorphine for hospitalized patients. Participants in all projects have both CP and OUD or opioid misuse, and specific aims for each project will examine CP, OUD, implementation, and cost-effectiveness outcomes; additional patient-centered outcomes will be driven by people with lived experience. All three projects improve access to care for Black and Hispanic individuals in under-resourced settings by bringing integrated treatment of CP and OUD to them, and the interventions have high potential for dissemination and sustainability. An innovative program for pilot studies achieves a dual aim of catalyzing stakeholder-driven research and training early stage and new investigators. An exceptional team of investigators and clinical experts focused on CP and OUD, a longstanding history of collaboration with stakeholders and people with lived experience, and a high-impact population make Montefiore-Einstein an ideal site for an IMPOWR research center.

抽象的 慢性疼痛（CP）和阿片类药物使用障碍（OUD）是统一发病率和死亡率的主要原因 国家。尽管通常是合并的，但人们缺乏综合治疗方法。 需要。对于黑人和西班牙裔人来说，这尤其如此 像布朗克斯，纽约这样的设置，美国最贫穷，最多样化的县之一 对治疗计划的反应：慢性疼痛和OUD的综合管理，以进行整个康复 （Impowr）RFA-DA-21-030，该提案的总体目标是在建立Impowr研究中心 在布朗克斯纽约州的高影响力计数中，蒙特菲奥尔/爱因斯坦（“ Impowr-me”）。 Impowr-me是一种协同作用 多学科研究中心利用CP和OUD和OUD和 与CP和OUD，倡导者，政策制定者和付款人以及健康的现有关系 系统利益相关者。 Impowr-Me的目的是：1）创建一项强大而可持续的研究 基础架构严格测试并传播基于循证的综合和成本效益 CP和OUD的人的实践； 2）与拥有CP，OUD或现场经验的人合作 在研究的各个阶段，都有潜在的利益相关者； 3）为 多学科的早期研究人员成为专注于CP和的独立研究人员 Oud。提出了三项创新的杂种1型有效性试验试验以严格检查 在潜水员医疗保健环境中的多模式循证实践和合并症患者的人群 CP和Oud。具体而言，我们提出：1）美沙酮现场的瑜伽和物理治疗的三臂试验 阿片类药物治疗计划，2）2x2阶乘试验，以测试接受和承诺疗法和护理 用于基于初级护理的丁丙诺啡治疗的个人的管理智能手机应用程序，3）两臂 试验，用于测试住院患者的丁丙诺啡的微末期与标准诱导。参与者 项目同时具有CP和OUD或OOPIEID MISSUSE，每个项目的具体目标将检查CP，Oud， 实施和成本效益结果；其他以患者为中心的结果将由 有现场经验的人。这三个项目都改善了对黑人和西班牙裔个人的关怀的机会 通过将CP和OUD的综合处理方式带到它们，干预措施的设置不足 传播和可持续性的高潜力。试点研究的创新计划实现了双重目标 催化利益相关者驱动的研究和培训的早期阶段和新研究人员。一个杰出的团队 研究人员和临床专家专注于CP和OUD，这是与 利益相关者和具有现场经验的人，高影响力的人口使蒙特菲奥雷 - 因斯坦成为 Impowr研究中心的理想场所。