MassHEAL - Reducing overdose deaths by 40% (2019-2023)

MassHEAL%20-%20减少%20过量%20死亡%20by%2040%%20(2019-2023)

• 批准号: 9917749
• 负责人: JEFFREY H. SAMET
• 金额: $ 2553.08万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-17 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9917749
• 关键词: Affect; Age; Automobile Driving; Cessation of life; Clinical; Collaborations; Communication; Communities; Communities That Care; Complement; Data; Data Coordinating Center; Death Rate; Development; Drug Metabolic Detoxication; Ensure; Evidence based program; Feedback; Fentanyl; Health; Health Care Sector; Health Professional; Health Services; Heroin; Hospitalization; Imprisonment; Individual; Infrastructure; Intervention; Link; Massachusetts; Measures; Medical; Modeling; Morbidity - disease rate; Naloxone; National Institute of Drug Abuse; Opioid; Outcome; Ownership; Pharmaceutical Preparations; Phase; Policies; Population; Prevention; Process; Program Evaluation; Public Health; Randomized; Request for Applications; Research Personnel; Resources; Risk Reduction; Scientist; Services; Site; Specialist; Time; United States Substance Abuse and Mental Health Services Administration; Work; addiction; arm; base; clinical care; community based participatory research; community intervention; cost; data warehouse; design; disorder prevention; economic evaluation; economic impact; effective intervention; experience; healing; high risk; implementation science; innovation; models and simulation; mortality; multidisciplinary; opioid mortality; opioid overdose; opioid use; opioid use disorder; opioid withdrawal; overdose death; overdose risk; prescription opioid; prevent; primary outcome; programs; randomized trial; secondary analysis; secondary outcome; service gap; shared decision making; standard of care; success; synthetic opioid; treatment arm; treatment as usual

PROJECT SUMMARY/ABSTRACT Rates of opioid overdose (OD) deaths have risen drastically in the US over the last decade; Massachusetts (MA) is one of the hardest hit states, ranking 7th in age-adjusted OD death rate. Clinical care innovations have led to effective interventions; unfortunately, these innovations have not become standard in many MA communities. Using the Communities That Care (CTC) model, MassHEAL experts and community stakeholders will utilize a data-driven approach to identify and narrow service gaps to tailor and implement a suite of programs to reduce OD deaths in MA by 40% in 3 years. Key components will include identifying people with opioid use disorder (OUD); providing OD risk reduction; and accelerating access to low-threshold initiation of medications for OUD (MOUD) for high-risk individuals during hospitalization, incarceration, and opioid detoxification. Sixteen highly impacted communities have been identified across MA. MassHEAL will use a cluster-randomized parallel group design with communities randomized 1:1 to the intervention arm (office-based addiction treatment [OBAT] PLUS external facilitation for communities to select from a menu of programs and strategies, n=8) vs. a control arm (OBAT only, n=8). The MA Public Health Data (PHD) Warehouse, which links individual-level data from more than a dozen state agencies, is a unique resource available only in MA permitting pragmatic assessment of community- and individual-level outcomes. The MassHEAL team exemplifies the multi-disciplinary expertise and collaborative experience necessary to execute this study successfully. It includes clinicians who specialize in safer opioid prescribing and treatment of OUD and have developed many of the programs proposed. This clinical team is complemented with health services researchers, public health professionals, biostatisticians, community engagement specialists, implementation scientists, and health economists in order to evaluate the intervention comprehensively. Using principles of community-based participatory research (CBPR), MassHEAL has established a Community Advisory Board that will support effective community–academic partnerships. The Specific Aims are: 1) employ community engagement principles to develop and implement tailored clinical, prevention, and communication strategies in MassHEAL intervention communities; 2) determine the impact of the MassHEAL intervention on opioid OD deaths and other outcomes; 3) measure the impact of external facilitation on communities' success implementing an OUD prevention and treatment intervention; and 4) estimate the value of the MassHEAL community intervention relative to standard of care. MassHEAL will implement and assess a menu of evidence-based programs to reduce opioid OD deaths in highly impacted communities across MA. Results of this study will inform the broad dissemination and implementation of innovative medical and public health strategies to achieve the aims of the HEALing Communities initiative across the US.

项目概要/摘要 过去十年，美国马萨诸塞州阿片类药物过量 (OD) 死亡率急剧上升； 马萨诸塞州是受灾最严重的州之一，其临床护理创新的按年龄调整的 OD 死亡率排名第七。 导致有效的干预措施；不幸的是，这些创新尚未成为许多MA的标准 使用关怀社区 (CTC) 模型、MassHEAL 专家和社区。 利益相关者将利用数据驱动的方法来确定和缩小服务差距，以定制和实施 三年内将马萨诸塞州 OD 死亡人数减少 40% 的一系列计划的关键组成部分将包括确定。 患有阿片类药物使用障碍 (OUD) 的人；降低 OD 风险并加速获得低阈值药物； 在住院、监禁和康复期间对高危人群开始使用 OUD (MOUD) 药物 MassHEAL 已确定了 16 个受影响严重的社区。 使用整群随机平行组设计，将社区按 1:1 随机分配到干预组 （基于办公室的成瘾治疗 [OBAT] 加上供社区从菜单中选择的外部便利 计划和策略，n=8）与对照组（仅限 OBAT，n=8）。 仓库链接了来自十多个国家机构的个人级数据，是一种独特的资源 仅在 MA 中可用，允许对社区和个人层面的结果进行务实评估。 MassHEAL 团队体现了必要的多学科专业知识和协作经验 它包括谁专门从事更安全的阿片类药物处方和治疗。 OUD 并制定了许多建议的计划，该临床团队得到了健康的补充。 服务研究人员、公共卫生专业人员、生物统计学家、社区参与专家、 实施科学家和健康经济学家，以全面评估干预措施的使用。 根据基于社区的参与性研究 (CBPR) 的原则，MassHEAL 建立了一个社区 顾问委员会将支持有效的社区与学术伙伴关系，其具体目标是：1）雇用。 制定和实施量身定制的临床、预防和沟通的社区参与原则 MassHEAL 干预社区的策略；2) 确定 MassHEAL 干预对 阿片类药物消耗死亡和其他结果；3) 衡量外部促进对社区成功的影响； 实施 OUD 预防和治疗干预措施；以及 4) 评估 MassHEAL 的价值 MassHEAL 将实施并评估一系列与护理标准相关的社区干预措施。 减少马萨诸塞州受影响严重社区的阿片类药物消耗死亡的基于证据的计划。 这项研究将为创新医疗和公共卫生的广泛传播和实施提供信息 实现全美 HEALing 社区倡议目标的策略。