Stagewise Implementation-To-Target- Medications for Addiction Treatment (SITT-MAT)

分阶段实施成瘾治疗目标药物 (SITT-MAT​​)

• 批准号: 10462739
• 负责人: James H Ford
• 金额: $ 65.07万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10462739
• 关键词: Academy; Accident and Emergency department; Address; Adherence; Adoption; Biometry; Budgets; Buprenorphine; COVID-19 pandemic; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Communities; Community Healthcare; Decision Making; Diagnosis; Discipline; Educational workshop; Effectiveness; Engineering; Ensure; Epidemic; Evidence based intervention; Evidence based practice; Evidence based treatment; FDA approved; Feedback; Funding; Goals; Growth; Health; Health Benefit; Health Services Research; Health system; Healthcare; Hospitals; Hour; Improve Access; Intervention; Investments; Lead; Maintenance; Measurement; Measures; Mediator of activation protein; Medical; Medication Management; Methods; Modeling; Modification; Monitor; Naltrexone; National Institute of Drug Abuse; Nature; Neighborhood Health Center; Normalcy; Outcome; Overdose reduction; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmacology; Pharmacotherapy; Policies; Prevention; Primary Health Care; Procedures; Process; Protocols documentation; Provider; Public Health; Quarantine; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Recommendation; Reporting; Research; Research Personnel; Strategic Planning; Substance Use Disorder; System; Translations; United States National Institutes of Health; United States Substance Abuse and Mental Health Services Administration; Washington; Work; addiction; arm; authority; base; care systems; combat; contextual factors; coping; cost; design; dissemination research; economic evaluation; evidence base; global health; health care service organization; implementation research; implementation science; implementation strategy; implementation trial; improved; innovation; medical specialties; novel therapeutics; opioid epidemic; opioid use disorder; overdose death; pandemic disease; patient engagement; prescription opioid; programs; recruit; research study; response; scale up; standardize measure; substance use treatment; treatment organization; treatment program; treatment services; trial design

PROJECT SUMMARY/ABSTRACT To combat the US opioid epidemic, massive efforts have been focused on expanding access to medications for opioid use disorder (MOUD). While there are indications of improved reach and adoption, an ironic gap persists—only about one-third of specialty addiction treatment organizations offer MOUD. This proposal, Stagewise Implementation-To-Target – Medications for Addiction Treatment (SITT-MAT), not only advances the science of implementation, but advances our empirical understanding of how to best respond to a substance-related epidemic. This is a revised application in response to PAR-19-274: Dissemination and Implementation Research in Health” and aligned with the National Institute on Drug Abuse Strategic Plan “ensuring the effective translation and implementation of scientific research findings to improve the prevention and treatment of substance use disorders.” Within an adaptive implementation strategy trial design, using an innovative stagewise implementation-to-target approach, 72 community addiction treatment programs will participate. The stagewise implementation-to-target, stepped “care” type approach, deploys increasingly intensive strategies only if needed. The sequence of implementation strategies are: 1) Enhanced Monitoring and Feedback; 2) “NIATx/MAT Academy,” a 2-day workshop on MOUD and NIATx (Network for Improvement of Addiction Treatment)—an evidence-based process improvement strategy; 3) Randomization to either NIATx Internal Facilitation or NIATx External Facilitation; and, 4) If outcome targets are not achieved in the NIATx Internal Facilitation arm, assignment to NIATx External Facilitation. We evaluate the relative impact of 5 possible paths of implementation strategies on RE-AIM target outcomes: reach, effectiveness, adoption, and implementation quality. Maintenance of outcomes is evaluated for sustainment. Measures of multi-level contextual determinants are rigorous and systematic. In opening the “black box” of implementation strategies, we detail procedures, fidelity, participation and costs using standardized measures. The collective expertise of the research team, the established partnership with a state system of care and addiction treatment organizations, forecasts successful project execution. As we submit this application, the US is still coping with the COVID19 pandemic. The global health situation may rebound to relative normalcy in the months from December 2020. Meanwhile, the CDC, SAMHSA, CMS, and the State of Washington Health Care Authority have all made accommodations to continue the initiation and management of MOUD for patients receiving addiction treatment services. Therefore, even if the current quarantine restrictions persist, we do not anticipate major modifications to the study protocol, except in-person implementation support activities would be transitioned to videoconference formats. During this pandemic, it is even more critical for patients with opioid use disorders to access pharmacological interventions that require minimal physical contact with providers. This study has the potential to shift the paradigm in public health and implementation research.

项目概要/摘要 为了对抗美国阿片类药物的流行，我们大力努力扩大药物的获取范围 尽管有迹象表明阿片类药物使用障碍（MOUD）的覆盖范围和采用率有所提高，但存在着讽刺性的差距。 仍然存在——只有大约三分之一的专业成瘾治疗组织提供 MOUD 这一建议， 分阶段实施目标——药物成瘾治疗 (SITT-MAT​​)，不仅如此 推进了实施科学，但也增进了我们对如何最好地应对的经验理解 这是针对 PAR-19-274 的修订申请：传播和 健康实施研究”并与国家药物滥用研究所战略计划保持一致 “确保科研成果的有效转化和实施，提高预防水平 和物质使用障碍的治疗。”在适应性实施策略试验设计中，使用 创新的分阶段实施目标方法，将实施 72 个社区成瘾治疗项目 分阶段实施、分阶段“关怀”式部署日益增多。 仅在需要时才采取强化战略。 实施战略的顺序是： 1) 加强监测。 2) “NIATx/MAT 学院”，为期 2 天的 MOUD 和 NIATx（改进网络）研讨会 成瘾治疗）——基于证据的过程改进策略 3) 随机分配至 NIATx； 内部促进或 NIATx 外部促进；以及，4) 如果 NIATx 未实现结果目标 内部促进部门，分配给 NIATx 外部促进 我们评估 5 的相对影响。 RE-AIM 目标成果战略的可能实施路径：范围、有效性、采用和 实施质量的维持评估是多层次的。 背景决定因素是严格且系统的。在打开实施策略的“黑匣子”时， 我们使用标准化措施来详细说明程序、忠诚度、参与和成本。 研究团队与国家护理和成瘾治疗系统建立了合作伙伴关系 当我们提交此申请时，美国仍在应对。 全球卫生状况可能会在未来几个月内恢复到相对正常状态。 2020 年 12 月。同时，CDC、SAMHSA、CMS 和华盛顿州医疗保健管理局 已全部做出安排以继续启动和管理接收患者的 MOUD 因此，即使目前的隔离限制持续存在，我们预计也不会提供成瘾治疗服务。 除亲自实施支持活动外，对研究方案的重大修改将是 在这次大流行期间，过渡到视频会议形式对于阿片类药物患者来说更为重要。 利用疾病来获得需要与提供者进行最少身体接触的药物干预措施。 这项研究有可能改变公共卫生和实施研究的范式。