Strategies to improve Utilization of Post-overdose Evidence-based Risk mitigation among Non-fatal Overdoses in VA (SUPER NOVA)

提高药物过量后利用率的策略 基于证据的 VA 非致命药物过量风险缓解策略 (SUPER NOVA)

• 批准号: 10425936
• 负责人: Elizabeth M. Oliva
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10425936
• 关键词: Accidents; Accounting; Address; Adoption; Age; Caring; Cause of Death; Cessation of life; Clinical; Cocaine; Community Healthcare; Data; Data Reporting; Dimensions; Disease Management; Disparity; Emergency Medicine; Ensure; Ethnic Origin; Event; Evidence based treatment; Feedback; Future; Gender; Harm Reduction; Health; Health Personnel; Healthcare; Heroin; Homelessness; Individual; Intervention; Interview; Justice; Massachusetts; Medical Records; Medicare; Mental Health; Methamphetamine; Methodology; Modeling; Naloxone; Opioid; Outcome; Overdose; Patient Monitoring; Patients; Pharmaceutical Preparations; Policies; Process; Provider; Race; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reporting; Research; Risk Factors; Role; Services; Standardization; Stimulant; Stimulant overdose; Substance Use Disorder; Suicide; Suicide prevention; Translating; Treatment outcome; United States; Veterans; Veterans Health Administration; care providers; clinical care; contingency management; data repository; data warehouse; design; evidence base; experience; follow-up; high risk; implementation facilitators; improved; innovation; medication for opioid use disorder; mortality; operation; opioid mortality; opioid overdose; overdose death; overdose education; overdose prevention; prevent; programs; psychostimulant; response; risk mitigation; rurality; social health determinants; social stigma; stimulant use disorder; suicidal behavior; synthetic opioid; treatment disparity; trend; uptake

Background: Drug overdose is a leading cause of death, accounting for 70,630 deaths in the United States (US) in 20193. The majority of drug overdoses involve opioids, and opioid-involved stimulant deaths are rising with 3 out of every 4 cocaine-related deaths involving opioids and 53% of psychostimulant-related deaths involving opioids7. Drug overdose mortality among Veterans mirror these trends5,6. In Massachusetts, among individuals who died of an opioid overdose, 1 in 6 had a non-fatal overdose in the preceding 12 months17. These non-fatal overdoses serve as a promising target for opioid overdose prevention efforts, especially for evidence-based treatments such as medications for opioid use disorder (MOUD). The increase in stimulant- involved opioid overdoses also highlights the need to investigate strategies to improve uptake of evidence- based treatments for stimulant use disorders. Significance: In March 2019, the VHA Office of Mental Health and Suicide Prevention released a national clinical note template, the Suicide Behavior and Overdose Report (SBOR). The SBOR standardizes the reporting process, enhances the visibility of suicide and overdose events in the medical record, and is intended to improve clinical care after these events (e.g., by incorporating risk factors for overdose and strategies to mitigate risk, including referrals for care). However, the SBOR is currently mandated for intentional overdose and only recommended for unintentional overdose. Moreover, it is unclear the extent to which it is being used and whether its use improves post-overdose care as intended. Innovation and Impact: The proposed study will characterize non-fatal opioid-, stimulant-, and combined opioid and stimulant overdoses among VHA patients and the extent to which they receive recommended post- overdose care. Given that the SBOR will soon be mandated for all overdoses, and to ensure that VHA is doing everything it can to prevent overdose mortality among Veterans, it is critical to understand whether the SBOR is improving post-overdose care as intended and if additional strategies may be needed. Specific Aims: The proposed study will pursue the following specific aims: Aim 1: Characterize non-fatal opioid and/or stimulant overdoses within VHA and patient-, prescriber-, and setting-related factors associated with post-overdose treatment utilization. Aim 2: Describe utilization of the SBOR among providers of patients with non-fatal opioid and/or stimulant overdoses and associations between SBOR use, post-overdose treatment utilization, and treatment outcomes. Aim 3: Identify barriers and facilitators of post-overdose care and ways to improve it via interviews with VHA patients, patients’ concerned others, and treatment providers. Methodology: The Reach, Effectiveness, Adoption, Implementation, and Maintenance—RE-AIM—framework will guide our study. Aim 1: VHA patients with non-fatal overdoses will be identified using Corporate Data Warehouse (CDW), Community Care, and Medicare data from Fiscal Years 2014 to 2021 (FY2014-2021). Regression models will describe patient, prescriber, and setting factors associated with post-overdose care. Aim 2: Using CDW, Community Care, and Medicare data combined with VA Mortality Data Repository data, primary analyses will examine whether providers’ SBOR use is associated with patients’ post-overdose treatment utilization and reduced mortality using marginal structural Cox mediational models. Aim 3: Up to 60 total interviews will be conducted with VHA patients who experienced a non-fatal overdose, their concerned others, and VHA providers who documented a non-fatal overdose. Rapid and in-depth qualitative analytic approaches will be used; the former allows for rapid provision of actionable feedback to operations partners. Next Steps/Implementation: Our research team has strong operational partnerships and helped develop and implement the SBOR. Our team will ensure that findings are quickly translated to improve post-overdose care.

背景：药物过量是导致死亡的主要原因，导致美国 70,630 人死亡 （美国）20193 年。大多数药物过量涉及阿片类药物，且与阿片类药物相关的兴奋剂死亡人数正在上升 每 4 例可卡因相关死亡中就有 3 例与阿片类药物相关死亡，53% 与精神兴奋剂相关死亡 在马萨诸塞州，退伍军人中的阿片类药物过量死亡率反映了这些趋势5,6。 死于阿片类药物过量的人中，六分之一的人在过去 12 个月内曾服用过非致命性阿片类药物17。 这些非致命性过量用药是阿片类药物过量预防工作的一个有希望的目标，特别是对于 循证治疗，例如治疗阿片类药物使用障碍 (MOUD) 的药物。 涉及的阿片类药物过量也凸显了研究策略以提高证据吸收的必要性。 基于兴奋剂使用障碍的治疗。 意义：2019 年 3 月，VHA 心理健康和自杀预防办公室发布了全国 临床记录模板，自杀行为和用药过量报告 (SBOR) SBOR 标准化了自杀行为和用药过量报告。 报告流程，提高了医疗记录中自杀和服药过量事件的可见性，旨在 改善这些事件后的临床护理（例如，通过纳入用药过量的危险因素和策略 缓解风险，包括转诊治疗）但是，SBOR 目前针对故意过量用药。 并且仅推荐用于无意过量服用。此外，尚不清楚其使用程度。 以及其使用是否能按预期改善用药过量后的护理。 创新和影响：拟议的研究将描述非致命阿片类药物、兴奋剂和联合药物的特征 VHA 患者中阿片类药物和兴奋剂过量服用以及他们接受治疗后建议的程度 鉴于 SBOR 很快将被强制用于所有过量用药，并确保 VHA 正在开展工作。 为了防止退伍军人中服药过量死亡，了解 SBOR 是否能够采取一切措施至关重要 正在按预期改善服药过量后的护理以及是否需要其他策略。 具体目标：拟议的研究将追求以下具体目标： 目标 1：描述 VHA 内以及患者、处方者和患者的非致命阿片类药物和/或兴奋剂过量用药的特征 与服药过量后治疗利用相关的环境相关因素。 目标 2：描述非致命阿片类药物和/或兴奋剂患者的提供者对 SBOR 的利用情况 药物过量以及 SBOR 使用、药物过量后治疗利用和治疗结果之间的关联。 目标 3：通过与 VHA 访谈确定服药过量后护理的障碍和促进因素以及改进方法 患者、患者相关的其他人以及治疗提供者。 方法论：范围、有效性、采用、实施和维护——RE-AIM——框架 将指导我们的研究目标 1：将使用公司数据来识别非致命性过量服用 VHA 的患者。 2014 至 2021 财年 (FY2014-2021) 的仓库 (CDW)、社区护理和医疗保险数据。 回归模型将描述与用药过量后护理相关的患者、处方者和设置因素。 目标 2：使用 CDW、社区护理和医疗保险数据与 VA 死亡率数据存储库数据相结合， 主要分析将检查提供者的 SBOR 使用是否与患者服药过量后相关 使用边际结构 Cox 中介模型提高治疗利用率并降低死亡率 目标 3：最多 60。 将对经历过非致命性药物过量的 VHA 患者进行全面访谈，他们关心的问题 其他人以及记录非致命过量的 VHA 提供者 快速和深入的定性分析。 将使用方法；前者可以向运营合作伙伴快速提供可行的反馈。 后续步骤/实施：我们的研究团队拥有强大的运营合作伙伴关系，并帮助开发和 实施 SBOR。我们的团队将确保快速转化研究结果以改善用药过量后的护理。