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未充分利用的循证实践。华盛顿州利用联邦阿片类药物-STR 资金来开发和实施华盛顿州中心和 Spoke Model (H&S)，一种综合护理模式，旨在扩大 OUD 药物（丁丙诺啡、他们的模型是一种结合初级保健和药物使用的灵活方法。治疗计划、转诊组织、护士护理经理和护理导航员。最初的 6 个 H&S 网络取得了成功，旨在增加服务不足和边缘化群体的接入机会人口，华盛顿又资助了 5 个 H&S 网络，并开发了第二代、低门槛的 H&S 模型，在 17 个非传统场所（例如急诊室）设置药物启动点，注射器交换、监狱和无家可归者收容所，与提供 OUD 的社区合作伙伴建立联系拟议的研究扩大了 RFA DA- 资助的研究小组的活动。 18-005 通过研究新的 H&S 模型的实施和有效性我们维持混合型。有效性实施方法，并利用社交网络分析来了解如何实施以及效果如何 H&S 网络的发展是为了服务 OUD 人群，因此，拟议研究的具体目标是：1) 检查扩展的第一代和第二代 H&S 模型在解决 OUD（例如，开始和保留 OUD 药物治疗、用药过量、就业、刑事犯罪 2) 对所有 H&S 进行社交网络分析网络将描述组织之间的联系、协调和整合模式；两种类型的 H&S 网络相互构建，它们有何不同，以及 OUD 药物治疗的途径；客户在网络内部和跨网络使用的治疗方法 3) 测试所识别的网络特征之间的关系。目标 2（例如网络特征和治疗途径）以及第一个和第二个的有效性该研究将重点关注华盛顿州 OUD 注册的成年人（18 岁以上）。华盛顿州约有 90% 接受 OUD 治疗的人将采用医疗补助计划。确保严格的准实验设计。研究结果将使我们能够了解 H&S 的构成因素。增加 OUD 药物治疗和改善 OUD 患者预后的模型有效性，谁以及如何将影响范围扩大到可能不寻求治疗的个人。问题简报和指南的形式将支持各州和提供商实施灵活的 H&S 模型，包括护士护理经理、护理导航员和低门槛 OUD 药物启动。能够帮助确保“无错门”进入治疗并获得最好的治疗模型成功促进康复。