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.

项目概要 DAT18-06 美国物质使用障碍 (SUD) 的个人、社会和公共卫生负担 阿片类药物的流行以及娱乐和医用大麻的合法化使各州雪上加霜。 传统上，医疗保健系统会将 SUD 患者转介给专家治疗。 虽然与改善结果相关，但大多数患有 SUD 的人仍未被识别和治疗。 由于未满足的需求的严重程度，专家建议对 SUD 进行筛选和评估 纳入常规初级保健 (PC)，以提高 SUD 的诊断和治疗率，尽管范围广泛。 观察性研究，据我们所知，没有随机对照试验评估过 拟议的研究采用基于 PC 的新 SUD 治疗筛选和评估程序。 利用一个独特而偶然的机会来评估 PC 计划的影响 对 SUD 的新诊断和治疗的评估 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，是一项严格设计的随机实施 然而，应要求，试验了一种多方面的方法来改善对不健康饮酒的护理。 实施 SPARC 计划的 Kaiser Permanente Washington (KPWA) 的临床领导者， 对阿片类药物、大麻和其他药物使用障碍（CUD、OUD 和 DUD、 在 22 个 KPWA PC 诊所启动试验之前添加了这些信息。 实施计划——包括实践指导、电子健康记录（EHR）支持、 绩效监控和反馈以及提供者培训——也针对来自卫生系统的 SUD 数据。 监测报告表明该试验实现了高、持续的 SUD 筛查率，超过了目标 80% 的 PC 就诊患者然而，SPARC 试验的资助仅用于评估酒精相关性。 拟议的研究将严格评估 SPARC 计划对临床的影响。 在初级保健就诊后 90 天内，新 SUD 治疗的有意义的主要结果（目标 1）。 阐明 SUD 护理质量方面潜在的持续差距（目标 2），我们将使用自然语言处理 (NLP) 提取并量化以下原因：1) 报告 ≥ 4 种 SUD 的 DSM-5 症状的患者未接受治疗 OUD、CUD 或 DUD 的正式编码诊断，以及 2) 为什么患者新诊断出 OUD、CUD 和 大多数患有 OUD、CUD 和其他 DUD 的人从未接受治疗。 据估计，2.5-3.9% 的美国成年人过去一年患有 SUD，近 90% 的人表示没有接受过 SUD 治疗，但超过 84%。 的美国成年人每年都会就诊，其中一半以上是在 PC 上就诊。 研究表明，PC 筛查和评估可增加 SUD 治疗，将为 一种得到广泛认可但之前未经测试的方法，用于解决质量方面至关重要的差距 关心 SUD。