Hub and Spoke Opioid Treatment Networks: 2nd Generation Approaches to Improve Medication Treatment for Opioid Use Disorders

中心辐射型阿片类药物治疗网络：改善阿片类药物使用障碍药物治疗的第二代方法

基本信息

批准号：
9894581
负责人：
SHARON REIF
金额：
$ 278.51万
依托单位：
BRANDEIS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-30 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9894581
关键词：
Accident and Emergency department Address Adult Alcohol or Other Drugs use American Indians Buprenorphine Care given by nurses Caring Case Manager Cessation of life Characteristics Client Communities Criminal Justice Data Effectiveness Employment Enrollment Ensure Evaluation Evidence based practice Evolution Experimental Designs Funding Generations Goals Grant Guidelines Health Personnel Health Services Accessibility Health Services Research Homelessness Hybrids Individual Infrastructure Jail Knowledge Link Maintenance Medicaid Methadone Methods Modeling Naltrexone National Institute of Drug Abuse Needle-Exchange Programs Opioid Overdose Pathway Analysis Pathway interactions Patients Pattern Pharmaceutical Preparations Population Primary Health Care Provider Ramp Recommendation Recovery Research Research Activity Rural Rural Community Shelter facility Site Social Network Statistical Methods Study models Testing Thinking Treatment outcome United States Substance Abuse and Mental Health Services Administration Veterans Washington addiction base comparison group evidence base flexibility improved improved outcome network models opioid epidemic opioid use disorder programs response success treatment program

项目摘要

Medication treatment for opioid use disorder (OUD) remains an underutilized evidence-based practice. Washington State used federal Opioid-STR funding to develop and implement the Washington State Hub and Spoke Model (H&S), an integrated care model to expand access to OUD medications (buprenorphine, methadone, naltrexone). Their model is a flexible approach incorporating primary care and substance use treatment programs, referral organizations, nurse care managers and care navigators. Based on the initial success in an original 6 H&S networks and aiming to increase access in underserved and marginalized populations, Washington funded 5 more H&S networks and developed a second-generation, low-barrier H&S model, to place medication initiation sites in 17 non-traditional settings such as emergency departments, syringe exchanges, jails, and homeless shelters, with connections to community partners who will offer OUD medication maintenance. The proposed study expands the research team’s activities funded under RFA DA- 18-005 by studying implementation and effectiveness of the new H&S model. We maintain a hybrid effectiveness-implementation approach, and utilize social network analysis to understand how and how well H&S networks develop to serve the OUD population. Thus, the specific aims for the proposed study are: 1) Examine the implementation and effectiveness of the expanded first- and second-generation H&S models in addressing OUD (e.g., initiation of and retention in OUD medication treatment, overdose, employment, criminal justice involvement), extending our original NIDA study. 2) Conduct a social network analysis among all H&S networks that will describe patterns of connection, coordination, and integration among organizations; how the two types of H&S networks build upon each other and how they differ; and what pathways of OUD medication treatment clients use within and across networks. 3) Test the relationships between network features identified in Aim 2 (e.g. network characteristics and treatment pathways) and effectiveness of the first- and second- generation H&S models. The study will focus on adults (18+) with OUDs in Washington who are enrolled in Medicaid, about 90% of people with OUDs in treatment in Washington. Statistical methods will be used to ensure a rigorous quasi-experimental design. The findings will enable us to understand what makes the H&S model effective for increasing OUD medication treatment and improving outcomes for people with OUD, for whom, and how to expand the reach to individuals who may not seek treatment. Wide dissemination efforts in the form of issue briefs and guidelines will support states and providers to implement flexible H&S models that incorporate nurse care managers, care navigators, and low-barrier OUD medication initiation. Thus, we will be able to help ensure “no wrong door” to enter treatment and access to the treatment models with the best success for promoting recovery.

阿片类药物使用障碍（OUD）的药物治疗仍然是一种基于证据的实践。华盛顿州利用联邦阿片类 - STR资金来开发和实施华盛顿州枢纽和 Skok Model（H＆S），一种综合护理模型，可扩展对OUD药物的访问（丁丙诺啡， Metagadone，Naltrexone）。他们的模型是一种灵活的方法，结合了初级保健和物质使用治疗计划，推荐组织，护理管理人员和护理导航员。基于初始在原始的6 H＆S网络中的成功，旨在增加服务不足和边缘化的访问人口，华盛顿为另外5个H＆S网络提供了资金，并开发了第二代低级式H＆S 模型，将药物倡议站点放置在17个非传统环境中，例如急诊室，注射器交流，监狱和无家可归的庇护所，与社区合作伙伴的联系，他们将提供Oud 药物维护。拟议的研究扩大了根据RFA DA-资助的研究团队的活动 18-005通过研究新型H＆S模型的实施和有效性。我们保持混合动力有效性实施方法，并利用社交网络分析来了解如何以及如何良好 H＆S网络发展为为Oud人群提供服务。这是拟议研究的具体目的：1）检查扩展的第一代和第二代H＆S模型的实施和有效性解决OUD（例如，OUD用药治疗，用药过量，就业，刑事的主动性和保留措施司法参与），扩展了我们最初的NIDA研究。 2）在所有H＆S之间进行社交网络分析将描述组织之间连接，协调和集成模式的网络；如何两种类型的H＆S网络相互依靠，以及它们的不同之处。以及哪种OUD药物的途径治疗客户在网络内部和跨网络中使用。 3）测试已确定网络功能之间的关系在AIM 2（例如网络特征和治疗途径）以及第一和第二 H＆S一代模型。这项研究将重点放在成年人（18岁以上医疗补助约90％在华盛顿接受治疗的人。统计方法将用于确保严格的准实验设计。这些发现将使我们能够了解是什么使H＆S 有效增加OUD药物治疗和改善OUD的结果的模型谁，以及如何将覆盖范围扩展到可能不寻求治疗的个人。广泛的传播努力发行简介和准则的形式将支持各州和提供商实施灵活的H＆S模型合并护士护理经理，护理导航员和低级式OUD药物计划。那我们将能够帮助确保“没有错误的门”进入治疗和使用最好的治疗模型促进恢复的成功。