DAT- Implementing routine screening for cannabis and other drug use disorders in primary care: impact on diagnosis and treatment in a randomized pragmatic trial in 22 clinics

DAT-在初级保健中实施大麻和其他药物使用障碍的常规筛查：22 个诊所的随机实用试验对诊断和治疗的影响

• 批准号: 10454855
• 负责人: Julie Elissa Richards
• 金额: $ 32.3万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10454855
• 关键词: Address; Adult; Alcohols; Cannabis; Caring; Cessation of life; Clinic; Clinical; Code; DSM-V; Diagnosis; Diagnostic; Disease; Documentation; Drug Screening; Drug Use Disorder; Drug usage; Effectiveness; Electronic Health Record; Feedback; Funding; Health system; Healthcare Systems; Individual; Institute of Medicine (U.S.); International Classification of Disease Codes; Knowledge; Legal; Medical; Medical Marijuana; Methods; Monitor; Natural Language Processing; Newly Diagnosed; Observational Study; Opioid; Outcome; Outpatients; Patient Care; Patients; Performance; Persons; Pharmaceutical Preparations; Preventive screening; Primary Health Care; Provider; Public Health; Quality of Care; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Risk; Shame; Site; Specialist; Substance Use Disorder; Symptoms; Testing; Text; Time; Training; Treatment Effectiveness; Treatment outcome; United States; Visit; Washington; addiction; alcohol misuse; alcohol use disorder; base; brief intervention; care providers; design; disability; health data; high risk; implementation strategy; implementation trial; improved; improved outcome; innovation; insurance claims; marijuana use; neglect; opioid epidemic; opioid use; patient oriented; pragmatic trial; primary outcome; programs; routine screening; screening; screening guidelines; screening program; social; social stigma; substance use treatment; therapy design

PROJECT SUMMARY DAT18-06 The personal, social, and public health burdens of substance use disorders (SUDs) in the United States have been compounded by the opioid epidemic and legalization of recreational and medical cannabis use. Traditionally, healthcare systems have referred patients with SUDs to specialists. Although SUD treatment is associated with improved outcomes, most people with SUDs remain unidentified and untreated. The magnitude of unmet need has led experts to recommend incorporating screening and assessment for SUDs into routine primary care (PC), to increase rates of diagnosis and treatment of SUDs. Despite extensive observational research, to our knowledge no randomized controlled trial has evaluated the impact of PC-based programs of screening and assessment on new SUD treatment. The proposed study takes advantage of a unique and fortuitous opportunity to evaluate the impact of a PC program of screening and assessment for SUDs on new diagnosis and treatment of SUDs. The Sustained Patient-centered Alcohol Related Care (SPARC) trial, completed in July 2018, was a rigorously-designed randomized implementation trial testing a multifaceted approach to improving care for unhealthy alcohol use. However, at the request of clinical leaders at Kaiser Permanente Washington (KPWA) where the SPARC program was implemented, routine screening and assessment for opioid, cannabis, and other drug use disorders (CUD, OUD, and DUD, respectively) were added before the trial was launched in 22 KPWA PC clinics. As a result, the SPARC trial's implementation program—consisting of practice coaching, electronic health record (EHR) support, performance monitoring and feedback, and provider training—also targeted SUDs. Data from health system monitoring reports indicate the trial achieved high, sustained rates of screening for SUDs, exceeding the target of 80% of patients with PC visits. However, the SPARC trial was only funded to evaluate alcohol-related outcomes. The proposed study will rigorously evaluate the SPARC program's impact on the clinically meaningful primary outcome of new SUD treatment within 90 days of a primary care visit (Aim 1). To illuminate potential continued gaps in the quality of SUD care (Aim 2), we will use natural language processing (NLP) to extract and quantify reasons why: 1) patients reporting ≥4 DSM-5 symptoms of SUDs do not receive formal coded diagnoses of OUD, CUD, or DUD, and 2) why patients with newly diagnosed OUDs, CUDs, and DUDs do not received treatment. Most people with OUDs, CUDs, and other DUDs are never treated. An estimated 2.5-3.9% of US adults have past-year SUDs, and nearly 90% report no SUD treatment. Yet >84% of US adults have outpatient visits annually, and over half of these visits are in PC. If the proposed innovative study demonstrates that screening and assessment in PC increase SUD treatment, it would provide support for a widely endorsed yet previously untested approach to addressing a critically important gap in the quality of care for SUDs.

项目摘要 DAT18-06联合的物质使用障碍（SUD）的个人，社会和公共卫生伯恩斯 娱乐和医用大麻的阿片类流行和合法化使国家更加复杂 使用。传统上，医疗保健系统将有SUD的患者转交给专家。虽然SUD治疗 与改善的结果有关，大多数泡沫状况仍然不明显且未经治疗。这 未满足的需求的大小使专家建议纳入筛查和评估SUDS 进入常规初级保健（PC），以提高诊断率和SUD治疗。尽管很广泛 据我们所知，观察性研究没有随机对照试验评估了 基于PC的新SUD治疗程序筛查和评估程序。拟议的研究需要 一个独特而偶然的机会的优势，可以评估PC筛选计划的影响和 关于新诊断和SUD治疗的SUD评估。持续以患者为中心的酒精 相关护理（SPARC）试验于2018年7月完成，是一个严格设计的随机实施 试验测试一种多方面的方法，用于改善对不健康饮酒的护理。但是，应 Kaiser Permanente Washington（KPWA）的临床领导者实施了SPARC计划， 阿片类药物，大麻和其他药物使用障碍的常规筛查和评估（CUD，OUD和DUD， 在22 kPWA PC诊所发起试验之前，分别添加）。结果，SPARC试验的 实施计划 - 执业教练，电子健康记录（EHR）的支持， 绩效监控和反馈，以及提供者培训 - 也针对的泡沫。来自卫生系统的数据 监测报告表明，该试验获得了较高的，持续的SUD筛查率，超出了目标 有80％的PC访问患者。但是，SPARC试验仅用于评估与酒精有关的 结果。拟议的研究将严格评估SPARC计划对诊所的影响 在初级保健访问后的90天内，新的SUD治疗的有意义的主要结果（AIM 1）。到 阐明潜在的潜在的肥皂护理质量差距（AIM 2），我们将使用自然语言处理 （NLP）提取和量化原因：1）报告≥4dsm-5 sud符号的患者未接受 OUD，CUD或DUD的正式编码诊断，以及2）为什么有新诊断的OUD，CUD和 傻瓜没有接受治疗。大多数拥有Oud，Cuds和其他Duds的人从未受到治疗。一个 估计有2.5-3.9％的美国成年人过去一年的SUDS，几乎90％的人没有报告SUD治疗。 > 84％ 美国成年人中，每年都有门诊就诊，其中一半以上的访问在PC中。如果拟议的创新 研究表明，PC中的筛查和评估增加了SUD治疗，它将提供支持 广泛认可但以前未经测试的方法来解决质量至关重要的差距 照顾泡沫。