A systems science approach for improving continuity of service in substance use disorder treatment

提高药物滥用障碍治疗服务连续性的系统科学方法

• 批准号: 9982290
• 负责人: Suzanne Evelyn Spear
• 金额: $ 14.5万
• 依托单位: CALIFORNIA STATE UNIVERSITY NORTHRIDGE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9982290
• 关键词: Address; Administrator; Admission activity; Aftercare; Alcohol consumption; California; Caring; Characteristics; Computer Simulation; County; Data; Development; Drug Metabolic Detoxication; Ecology; Effectiveness; Ego; Evidence based treatment; Failure; Funding; Future; Goals; Grant; Health Services Accessibility; Heroin Dependence; Improve Access; Individual; Intervention; Interview; Link; Los Angeles; Measures; Methodology; Methods; Modality; Modeling; Morbidity - disease rate; Opiate Addiction; Overdose; Participant; Pathway Analysis; Patient Transfer; Patient risk; Patient-Focused Outcomes; Patients; Pattern; Pharmaceutical Preparations; Pilot Projects; Prevalence; Protocols documentation; Rehabilitation therapy; Reporting; Research; Research Project Grants; Resources; Science; Services; Social Network; Source; Structure; Substance Addiction; Substance Use Disorder; Substance abuse problem; Surveys; System; Testing; TimeLine; Training; United States; United States National Institutes of Health; Visualization; base; density; design; experience; high risk; improved; innovation; medication-assisted treatment; member; models and simulation; mortality; mortality risk; network models; opioid use; opioid use disorder; patient engagement; programs; public health priorities; referral services; relapse risk; service gap; service programs; skills; social networking website; sound; substance abuse prevention; theories; treatment program

Project Summary/Abstract Increasing access to substance use disorder (SUD) treatment is an important public health priority because substance abuse and dependence is associated with significant morbidity and mortality. While evidence-based treatments are available to care for people with SUDs, only 11% of individuals who need professional treatment receive it. One major service gap in the treatment of SUDs, particularly alcohol and opioid use disorders, is the engagement of patients in treatment or rehabilitation after an initial detoxification (detox). At the point of discharge from detox, patients are at high risk of relapse and therefore vulnerable to system failures. Detox alone increases patients' risk of mortality from overdose if they do not transition to rehabilitation after discharge. To date, research on the problem of continuity of service after detox has focused on patient characteristics and attributes of organizations with no consideration to the dynamic contexts within which SUD treatment occurs. What has not been explored to date is the impact of referral networks between service programs on entry into SUD treatment after detox. The goal of this pilot study is to determine the impact of systems-level predictors such as network structures on continuity of service in the SUD treatment system in Los Angeles County. The central hypothesis will be tested by pursuing three specific aims: 1) Describe the ecology of the publicly-funded SUD treatment system in Los Angeles County using social network analysis, 2) Determine the impact of network structure on continuity of service from detox to SUD treatment using computer simulation models, and 3) Design a protocol for a service implementation network intervention to increase continuity of service after detox. The unique strengths of the study are the experienced research team, theory-driven approach, and application of systems science methodologies such as social network analysis and agent-based modeling. Achieving the study aims will create greater understanding of the interdependency of programs within the treatment systems and demonstrate how partnerships and referral patterns at a system level can impact patient outcomes. The results of the study will be used to plan an R34 study to test the implementation and effectiveness of a service implementation network model for SUD treatment.

项目摘要/摘要 增加获得药物使用障碍（SUD）治疗是重要的公共卫生 优先级，因为滥用药物和依赖性与大量发病率有关 死亡。虽然有循证治疗可用于照顾泡沫的人，但只有11％ 需要专业治疗的人接受。治疗中的一个主要服务差距 SUD，尤其是酒精和阿片类药物使用障碍，是患者参与治疗 或初始排毒后的康复（排毒）。在排毒排出点， 患者有复发的高风险，因此容易受到系统失败的影响。独自排毒 如果患者不过渡到康复后，会增加患者死亡的风险 释放。迄今为止，对排毒后的连续服务问题进行研究 组织特征和组织的属性，不考虑动态 发生SUD治疗的环境。迄今尚未探索的是 在排毒后进入SUD治疗的服务计划之间的推荐网络。目标 这项试点研究是为了确定系统级预测因子（例如网络）的影响 洛杉矶县SUD治疗系统中服务连续性的结构。这 中心假设将通过追求三个具体目标来检验：1）描述 通过社交网络分析，洛杉矶县的公共资助的SUD治疗系统，2） 确定网络结构对从排毒到SUD治疗连续连续性的影响 使用计算机仿真模型，3）设计用于服务实现的协议 网络干预以增加排毒后服务连续性。独特的优势 研究是经验丰富的研究团队，理论驱动的方法和系统的应用 科学方法，例如社交网络分析和基于代理的建模。实现 研究目的将使对计划内计划的相互依赖性有更深入的了解 处理系统并说明系统级别的伙伴关系和转诊模式如何 影响患者的结果。该研究的结果将用于计划R34研究，以测试 SUD治疗服务实施网络模型的实施和有效性。