C-DIAS RP3: Scaling-out app-based treatments: a multi-level strategy to promote equity across primary care patients with substance use

C-DIAS RP3：扩展基于应用程序的治疗：促进初级保健药物使用患者公平的多层次策略

• 批准号: 10493961
• 负责人: Joseph Edwin Glass
• 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/10493961
• 关键词: Address; Adherence; Advisory Committees; African American; Asian Americans; Black American; Buprenorphine; Caring; Cellular Phone; Clinic; Collaborations; Communication; Community Health Systems; Data; Devices; Dissemination and Implementation; Engineering; Ensure; Ethics; Ethnic Origin; Evidence based practice; Evidence based treatment; Failure; Feedback; Glass; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Hispanic; Home; Human Resources; Individual; Intervention; Laboratories; Language; Latino; Leadership; Learning; Medicine; Mental Health Services; Mentors; Methodology; Modeling; Outcome; Ownership; Patient Care; Patient-Focused Outcomes; Patients; Perception; Performance; Persons; Phase; Population Heterogeneity; Primary Health Care; Privacy; Privatization; Problem Solving; Public Health; Race; Randomized; Research; Research Design; Research Personnel; Research Project Grants; Role; Service provision; Statistical Methods; Substance Use Disorder; System; Testing; Time; United States National Academy of Sciences; United States National Institutes of Health; Visit; Washington; addiction; base; brief intervention; comorbidity; cost; data harmonization; design; digital; digital health; digital healthcare; digital treatment; disadvantaged population; disparity reduction; effectiveness implementation study; health disparity populations; health equity; high risk; implementation context; implementation cost; implementation evaluation; implementation outcomes; implementation science; implementation strategy; implementation study; improved; innovation; member; patient subsets; pragmatic trial; social determinants; social stigma; standardize measure; stem; substance use; substance use treatment; success; web-based intervention

C-DIAS RESEARCH PROJECT 3: PROJECT SUMMARY/ABSTRACT At the SUSTAIN phase, C-DIAS Research Project 3 addresses a critical scientific and public health gap: How can we improve equity when offering digital treatments to patients with substance use disorders (SUDs) in primary care? A wide range of effective digital treatments —app or web-based interventions—for SUDs and comorbid conditions are available for use in primary care, and many have been evaluated in diverse populations. Digital treatments for SUDs could potentially reduce inequities, as they: 1) have the potential to reach more people by reducing access barriers; 2) can circumvent SUD stigma; and 3) allow patients to initiate interventions from the comfort and privacy of home. At the same time, digital treatments may also magnify inequities due to factors stemming from the “digital divide.” We will rigorously evaluate an implementation strategy to “scale-out” digital treatments to disadvantaged populations as an approach to potentially improve equity in digital care for people with SUDs, and as a model for how to ethically sustain digital treatments in real-world healthcare. Prior pragmatic trials found that evidence-based practices and other initiatives are hard to sustain without leadership and clinic buy-in, so our multi-level study design and analytic plan focuses on these issues. Our delivery system partners in Kaiser Permanente Washington are committed to collaborating with us to study multi-level strategies for scaling-out existing digital treatments in 32 primary care clinics in Washington State to address expected equity challenges. All clinics will receive a 3-part system-level set of implementation strategies that are suitable for primary care: 1) system-wide audit and feedback; 2) patient stories from members of disadvantaged populations; and, 3) engaging key stakeholders in problem solving to reduce barriers to the use of digital treatments among disadvantaged populations. To test a clinic-level implementation strategy, a subset of 12 clinics will be randomized to receive external facilitation or to a control condition (no facilitation) in a 1:1 parallel-groups design. Equity outcomes will be assessed by comparing reach across subgroups of patients defined by key social determinants (e.g., race/ethnicity). Specific Aims are to: 1) estimate the impact of a multi-level implementation strategy (system- and clinic-level) in increasing equity in the reach of digital treatments among patients with SUD in primary care clinics; and 2) describe the costs of and adherence to the implementation strategies, and examine how contextual determinants can impact equity in implementation and patient outcomes. Research Project 3 leverages a bi-directional relationship with C- DIAS, demonstrated in part by: 1) standardized measures of implementation context, outcomes and procedural details of strategies; 2) PI (Glass)’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; 4) harmonization of data that can be used for modeling by C-DIAS Research Core experts; 5) data on digital treatment implementation costs for decision- makers; and 6) expanded options for dissemination and impact of study findings through C-DIAS.

C-DIAS研究项目3：项目摘要/摘要 在维持阶段，C-DIAS研究项目3解决了一个关键的科学和公共卫生差距：如何 在为患有药物使用障碍（SUD）的患者提供数字治疗时，我们可以提高股本 初级保健？ SUD和 合并条件可用于初级保健，并且在潜水员中进行了评估。 人群。 SUD的数字处理可能会减少不平等，因为它们：1）有可能 通过减少访问障碍来吸引更多人； 2）可以绕过SUD污名； 3）允许患者启动 家庭的舒适和私密性干预措施。同时，数字处理也可能放大 由于“数字鸿沟”引起的因素引起的不平等。我们将严格评估实施 “扩展”对灾难人群“扩展”数字处理的策略作为一种潜在改善的方法 对于泡沫者的数字护理中的公平护理，以及如何在道德上维持数字处理的模型 现实世界中的医疗保健。先前的务实试验发现，循证实践和其他举措很难 为了维持没有领导和诊所的买入，我们的多层次研究设计和分析计划着重于 这些问题。我们在Kaiser Permanente Washington的交付系统合作伙伴致力于合作 与我们一起研究在32个初级保健诊所中扩展现有数字处理的多层次策略 华盛顿州应解决预期的股权挑战。所有诊所都将获得一组三部分的系统级集合 适合初级保健的实施策略：1）全系统审计和反馈； 2）病人 弱势群体成员的故事； 3）让关键利益相关者参与解决问题 减少在灾难人群中使用数字处理的障碍。测试诊所级别 实施策略，将随机分配12个诊所的子集以接收外部设施或控制 1：1平行组设计中的条件（无设施）。公平成果将通过比较覆盖范围来评估 跨关键社会决定者（例如种族/种族）定义的患者的子组。具体目的是：1） 估计多层实施策略（系统和诊所级别）对增加股权的影响 初级保健诊所中SUD患者中数字治疗的范围； 2）描述成本 并遵守实施策略，并研究上下文决定者如何影响权益 在实施和患者预后。研究项目3利用与c-的双向关系 DIA，部分通过：1）实施环境，结果和程序的标准化度量 策略的详细信息； 2）PI（玻璃）在C-DIAS研究核心上的作用； 3）一个紧密的协作网络和 在关键项目人员和C-DIAS PI中进行指导； 4）可以用于用于用于用于的数据的数据 由C-DIAS研究核心专家建模； 5）关于决策数字处理实施成本的数据 - 制造商； 6）扩大了通过C-DIA的研究结果的传播和影响的选择。