C-DIAS RP 2: Implementing contingency management for stimulant use in specialty addiction treatment organizations

C-DIAS RP 2：在专业成瘾治疗组织中实施兴奋剂使用应急管理

• 批准号: 10493960
• 负责人: Sara J. Becker
• 金额: $ 57.05万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10493960
• 关键词: Abstinence; Address; Adoption; Advisory Committees; Cessation of life; Climate; Cocaine; Collaborations; Computerized Medical Record; Data; Data Collection; Dissemination and Implementation; Drops; Effectiveness; Ensure; Evaluation; Evidence based intervention; Evidence based treatment; Excision; Family; Feedback; Goals; HIV Infections; Human Resources; Incentives; Individual; Interview; Laboratories; Leadership; Legal; Maintenance; Measures; Mediator of activation protein; Medical; Mentors; Methamphetamine; Methods; Modeling; New England; Opioid; Outcome; Overdose; Patient-Focused Outcomes; Patients; Perception; Performance; Persons; Pharmaceutical Preparations; Phase; Population; Provider; Public Health; Public Sector; Quality of Care; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Reporting; Research; Research Project Grants; Risk; Role; Science; Service provision; Services; Source; Specific qualifier value; Stimulant; Technology Transfer; Testing; Time; Training; United States Substance Abuse and Mental Health Services Administration; addiction; cohort; contextual factors; contingency management; data harmonization; design; effective intervention; effectiveness implementation study; effectiveness implementation trial; effectiveness testing; evidence base; experience; experimental study; follow up assessment; follow-up; high risk; implementation context; implementation determinants; implementation outcomes; implementation science; implementation strategy; improved; medical specialties; opioid epidemic; opioid overdose; opioid treatment program; opioid use; opioid use disorder; overdose death; psychostimulant; recruit; research to practice; standardize measure; stimulant dependence; stimulant use; treatment duration; treatment organization; treatment response; treatment services; uptake

C-DIAS RESEARCH PROJECT 2: PROJECT SUMMARY/ABSTRACT This rigorous experiment addresses a critical public health problem--the rising stimulant/opioid epidemic. It advances implementation science through the evaluation of a multi-level implementation strategy and specifies of contextual determinants of outcomes. Stimulants constitute a new and deadly fourth wave of the opioid epidemic. Among persons with opioid use disorder, stimulant use has been associated with more persistent opioid use; higher risk of HIV infection; higher levels of family, medical, legal, and vocational problems; and higher risk of lethal overdose. Contingency management (CM) is the most effective intervention for stimulant use and is an evidence-based adjunct to medication for opioid use disorder (MOUD). Yet, uptake of CM in opioid treatment programs (OTPs) that provide MOUD remains low: in fact, access to CM is arguably one of the greatest research-to-practice gaps in the addiction treatment services field. The goal of C-DIAS Research Project 2 is to conduct a type III hybrid effectiveness-implementation trial to evaluate a multi-level implementation strategy, the Science to Service Laboratory (SSL), to install CM for stimulant use in OTPs. The SSL has three core components: didactic training; performance feedback; and external facilitation. The project employs common C-DIAS frameworks, measures, and methods to guide SSL evaluation. Utilizing a stepped wedge design, a regional cohort of 10 public sector OTPs will be randomized to receive SSL at five distinct time points. At six intervals, each of the 10 OTPs will provide data from all available patient charts on CM delivery and patient outcomes. Each OTP will also recruit 10 patients per wedge (n = 500 patients) to complete a baseline interview and 3-month follow-up. In addition, staff from each OTP will report on contextual determinants of implementation outcomes at three timepoints. This study will rigorously evaluate whether a multi-level implementation strategy developed by one of the longest-standing national intermediary purveyor organizations--the SAMHSA Technology Transfer Centers, will improve both implementation and patient outcomes. Implementation outcomes are guided by RE-AIM and include CM Reach, Adoption, Implementation and Sustainment, while patient outcomes include measures of CM Effectiveness such as stimulant abstinence and treatment retention. The study will advance the C-DIAS scientific aims by unpacking the black box of implementation strategies and exploring the mediational and moderating influence of context on implementation outcomes. Focused on the active IMPLEMENT phase, this Research Project leverages a bi- directional synergistic relationship with C-DIAS. Some but not all examples of this include: 1) standardized measures of implementation context, outcomes and procedural details of strategies; 2) PI (Becker)’s role on the C-DIAS Research Core; 3) a close network of collaboration and mentoring among the key project personnel and C-DIAS PI; and 4) harmonization of data that can be used for modeling by C-DIAS Research Core experts.

C-DIAS研究项目2：项目摘要/摘要 这项严格的实验解决了一个关键的公共卫生问题 - 兴奋剂/阿片类药物流行不断上升。它 通过评估多级实施策略和规格来推进实施科学 结果的确定剂。兴奋剂构成了Ooid的新的致命的第四波 流行性。在患有阿片类药物使用障碍的患者中，兴奋剂的使用与更持久有关 Opioid使用；艾滋病毒感染的风险更高；更高水平的家庭，医疗，法律和职业问题；和 致命过量的较高风险。应急管理（CM）是兴奋剂最有效的干预措施 使用，是阿片类药物使用障碍药物（MOUD）药物的循证辅助手段。然而，cm的吸收 提供MOUD的阿片类药物治疗计划（OTP）仍然很低：实际上，可以说获得CM是一种 成瘾治疗服务领域中最大的研究对实践差距。 C-DIAS研究的目标 项目2是要进行III型混合有效性 - 实现试验，以评估多层次 实施策略，服务实验室的科学（SSL），以在OTP中安装CM以刺激性使用。 SSL有三个核心组成部分：教学培训；性能反馈；和外部设施。项目 员工常见的C-DIA框架，措施和指导SSL评估的方法。利用阶梯 楔形设计，一个由10个公共部门OTP组成的区域队列将随机分配以接收五个不同的SSL 时间点。在六个间隔中，10个OTP中的每一个都将提供来自CM上所有可用患者图表的数据 分娩和患者结果。每个OTP还将招募10名患者（n = 500名患者）完成 基线采访和3个月的随访。此外，每个OTP的工作人员都会报告上下文 在三个时间点上实现结果的决定因素。这项研究将严格评估是否 由最长的国家中级供应商之一制定的多级实施策略 组织 - SAMHSA技术转移中心，将改善实施和患者 结果。实施结果以RE-AIM为指导，包括CM覆盖范围，采用，实施 和维持阶段，而患者的结果包括CM有效性的措施，例如刺激性禁欲 和治疗保留。该研究将通过解开黑匣子的包装来推动C-DIAS科学的目标 实施策略并探索上下文对 实施结果。该研究项目专注于主动实施阶段，利用 方向与C-DIA的协同关系。其中一些但并非所有例子包括：1）标准化 实施背景，结果和策略的程序细节的度量； 2）PI（Becker）在 C-DIAS研究核心； 3）关键项目之间的协作和心理网络紧密 人员和C-Dias Pi； 4）可以通过C-DIAS Research进行建模的数据协调 核心专家。