Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment

传播和了解阿片类药物使用障碍治疗实施的联盟

• 批准号: 10181067
• 负责人: WILLIAM C BECKER
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10181067
• 关键词: Academic Detailing; Accident and Emergency department; Address; Adopted; Adoption; Alternative Therapies; Area; Budgets; Buprenorphine; Caring; Clinic; Clinical; Collaborations; Communication; Complex; Consolidated Framework for Implementation Research; Continuity of Patient Care; Critical Care; Data; Economics; Education; Educational Materials; Evaluation; Evidence based practice; Evidence based treatment; Face; Feedback; Future; Goals; Health; Improve Access; Inpatients; Investments; Lead; Leadership; Life; Manuals; Measurable; Measurement; Measures; Mental Health; Methods; Modeling; Morbidity - disease rate; Opioid; Outcome; Pain management; Patients; Pharmaceutical Preparations; Phase; Pilot Projects; Primary Health Care; Procedures; Process; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Regimen; Research; Rural; Safety; Savings; Science; Site; Structure; Substance Use Disorder; Suicide prevention; System; Techniques; Training; Veterans; Veterans Health Administration; Work; acute care; base; chronic pain; chronic pain management; cost; cost estimate; design; effective therapy; effectiveness evaluation; evidence base; formative assessment; implementation cost; implementation efforts; implementation facilitation; implementation science; implementation strategy; improved; innovation; medical specialties; meetings; mortality; multidisciplinary; operation; opioid use; opioid use disorder; prescription opioid; primary outcome; product development; programs; scale up; secondary outcome; standardize measure; synergism; telehealth; tool; uptake; Academic Detailing; Accident and Emergency department; Address; Adopted; Adoption; Alternative Therapies; Area; Budgets; Buprenorphine; Caring; Clinic; Clinical; Collaborations; Communication; Complex; Consolidated Framework for Implementation Research; Continuity of Patient Care; Critical Care; Data; Economics; Education; Educational Materials; Evaluation; Evidence based practice; Evidence based treatment; Face; Feedback; Future; Goals; Health; Improve Access; Inpatients; Investments; Lead; Leadership; Life; Manuals; Measurable; Measurement; Measures; Mental Health; Methods; Modeling; Morbidity - disease rate; Opioid; Outcome; Pain management; Patients; Pharmaceutical Preparations; Phase; Pilot Projects; Primary Health Care; Procedures; Process; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Regimen; Research; Rural; Safety; Savings; Science; Site; Structure; Substance Use Disorder; Suicide prevention; System; Techniques; Training; Veterans; Veterans Health Administration; Work; acute care; base; chronic pain; chronic pain management; cost; cost estimate; design; effective therapy; effectiveness evaluation; evidence base; formative assessment; implementation cost; implementation efforts; implementation facilitation; implementation science; implementation strategy; improved; innovation; medical specialties; meetings; mortality; multidisciplinary; operation; opioid use; opioid use disorder; prescription opioid; primary outcome; product development; programs; scale up; secondary outcome; standardize measure; synergism; telehealth; tool; uptake

Opioid use disorder (OUD) is a major cause of morbidity and mortality among Veterans and a high-priority target for quality improvement in the Veterans Health Administration (VHA). Effective medications for OUD (MOUD) are available but uptake of them has been highly variable across VHA. Additionally, VHA has been at the forefront in the U.S. in promoting alternative therapies for pain, but these are not consistently available to Veterans in great need of them: those with chronic pain and harmful opioid use. VHA, through its Office of Mental Health and Suicide Prevention, has made access to MOUD for all Veterans who need it a system-wide priority. However, successful implementation of complex care processes that face myriad barriers requires intentional, structured, evidence-based implementation efforts carried out by expert teams in close partnership with local leadership. As such, the overarching goal of this project – the Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment (CONDUIT) -- is to unite five inter-related VISN/QUERI pilot Partnered Implementation Initiative projects in a concerted effort to improve access to MOUD among Veterans with OUD and access to alternative therapies for pain in 57 VHA sites spanning six VISNs. CONDUIT will span four critical care settings in the OUD continuum of care: Primary Care; Specialty Care; Acute Care (inpatient and Emergency Department); and Telehealth. These efforts will be connected by Veteran Engagement, Implementation, and Quantitative/Economic Cores that will help CONDUIT teams harmonize on metrics, processes and outcomes. There will also be a Strategic Advisory Group composed of Operations leaders and Veterans that will help CONDUIT remain maximally aligned with VHA and Veteran priorities. CONDUIT will also offer sites the opportunity to implement new evidence-based practices (i.e. ones that were not part of initial launch) in the latter half of the project period. The methods deployed by each of the CONDUIT teams will be similar: expert “external facilitation” teams will lead partnered “internal facilitation” teams at local sites in a process called “Implementation Facilitation (IF)” – a multi-component suite of tools aimed to help the sites effectively adopt evidence-based practices. The five projects piloted and systematically modified IF strategies in Phase 1 and now propose to disseminate those sharpened strategies on a national scale over the next three years, including two new VISNs and dozens of additional sites. In terms of evaluation, CONDUIT will use well-established formative evaluation methods to assess the effectiveness of and to drive refinements to the IF strategies. Additionally, CONDUIT will use cutting edge quantitative methods to assess the impact the work on important clinical targets and to assess the value of the work in terms of costs vs. benefits. Throughout the project period, teams will develop and refine products such as patient and provider educational materials, prescribing and communication guides, and clinic operations manuals. These evaluation and product development efforts will prime successful scale-up and dissemination efforts throughout VHA.

阿片类药物使用障碍（OUD）是退伍军人发病率和死亡率的主要原因和高优先级 退伍军人卫生管理局（VHA）的质量改进目标。有效的OUD药物 （MOUD）可用，但是在VHA中，它们的吸收量很大。此外，VHA一直在 美国在促进痛苦替代疗法方面的最前沿，但这些疗法并不一致地可用于 退伍军人非常需要他们：那些患有慢性疼痛和有害阿片类药物的人。 VHA，通过其办公室 心理健康和预防自杀，已经为所有需要系统的退伍军人提供了穆德 优先事项。但是，成功实施面临无数障碍的复杂护理过程需要 专家团队与密切合作伙伴关系进行的故意，结构化，基于证据的实施工作 与当地领导。 因此，该项目的总体目标 - 传播和理解的财团 实施阿片类药物使用障碍治疗（导管） - 是五单元相关的VISN/QUERI飞行员 合作实施计划项目，共同努力，以改善退伍军人的穆德访问权限 在57个VHA站点中，使用OUD并获得替代疗法，涉及六个VISN。导管将跨越 OUD继续护理中的四个重症监护设置：初级保健；专业护理；急性护理（住院） 和急诊室）；和远程医疗。这些努力将通过退伍军人参与来联系， 实施和定量/经济核心将有助于渠道团队协调指标， 过程和结果。还将有一个战略咨询小组，由运营负责人组成， 将有助于导管的退伍军人与VHA和退伍军人的优先事项保持最大一致。导管会 还为网站提供了实施新的基于证据的实践的机会（即不属于的循证实践 最初的发布）在项目期的后半段。 每个导管团队部署的方法将相似：专家“外部设施”团队 将在当地站点领导合作的“内​​部设施”团队，以“实施促进（如果）” - 一套多组分的工具套件，旨在帮助网站有效地调整基于证据的实践。五 如果在第1阶段的策略和现在提议传播这些策略的策略，则试行并系统地修改项目 在未来三年中，在全国范围内采取了更加锐化的策略，其中包括两个新的Visn和数十个 其他站点。在评估方面，导管将使用良好的形成性评估方法 评估并推动对IF策略进行改进的有效性。此外，导管将使用 最先进的定量方法来评估对重要临床目标的工作的影响并评估 工作价值与成本与福利的价值。在整个项目期间，团队将开发和完善 诸如患者和提供者教育材料，开处方和通讯指南以及诊所等产品 操作手册。这些评估和产品开发工作将成功扩大规模，并 整个VHA的传播工作。