Improving the treatment cascade of MAT initiation and retention for opioid use disorder

改善阿片类药物使用障碍的 MAT 启动和保留治疗级联

基本信息

批准号：
10213680
负责人：
Arthur R Williams
金额：
$ 19.67万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-15 至 2023-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10213680
关键词：
AIDS/HIV problem Accident and Emergency department Admission activity Adoption Adult Anti-Retroviral Agents Appointment Buprenorphine Caring Cessation of life Characteristics Client Clinical Clinical Data Clinical Research Clinical Trials Code Communities Consensus Continuity of Patient Care Data Data Analyses Data Set Diagnosis Dose Drops Drug Metabolic Detoxication Early treatment Electronic Health Record Emergency department visit Epidemiologic Methods Epidemiology Face Favorable Clinical Outcome Goals Grant HIV Health Care Reform Health Personnel Health Services Research Hepatitis C Heroin Home Individual Influentials Injections Insurance Intake Legal Link Logistics Maintenance Medicaid Methadone Methods Minority Modality Modeling Naltrexone Opioid Opioid replacement therapy Outcome Overdose Patient Dropouts Patient Self-Report Patients Persons Population Probability Program Evaluation Provider Publishing Recording of previous events Records Research Resistance Safety Sampling Schedule Severities Site Statistical Data Interpretation Training Trauma Treatment outcome Urine Viral Work Writing active method addiction base buprenorphine treatment clinical research site cocaine use comorbidity drug testing effective therapy experience flexibility follow-up improved improved outcome indexing individualized medicine insurance claims medication-assisted treatment model design mortality opioid epidemic opioid mortality opioid use opioid use disorder programs response substance abuse treatment treatment response treatment services

项目摘要

Project Summary: High quality evidence supports medication assisted treatment (MAT) as the first line treatment for opioid use disorder (OUD), especially opioid substitution therapy with buprenorphine or methadone as long-term maintenance of at least one year. Yet patient dropout (typically >50% at six months), and provider resistance remain major impediments to effective treatment. To date, few studies have examined patient characteristics that influence key steps in treatment initiation, stabilization, and long-term retention with buprenorphine. Most published studies assess outcomes for only 2-3 months of active treatment among highly selected patients in clinical trials. I will draw from the influential, sequential “cascade of care” framework from the HIV/AIDS field as a conceptual model to identify stage-specific barriers to continuity of buprenorphine treatment through an adapted OUD treatment cascade. A greater understanding of barriers at each sequential stage of the cascade including 1) initiation of buprenorphine, 2) stabilization of opioid use, and 3) retention with long-term treatment response, may inform clinical efforts to improve outcomes and mortality. Under healthcare reform and Medicaid redesign, increasing numbers of patients receive insurance reimbursement for substance abuse treatment. I propose to link clinical data from electronic health records (EHR) to insurance claims data to assess patient factors that promote continuity of care along the cascade. This strategy will capture critical information (ED visits, diagnoses, treatment services, mortality) that are outside of a given clinical site's records. Insurance claims data have the advantage of providing near complete follow up and objective outcomes that do not rely on self-report and reflect real-world clinical complexities. In order to accomplish these goals and achieve my long-term training objectives of developing expertise in quantitative methods, epidemiology, and the management and inferential analysis of large observational data sets, I have articulated five sequential training goals: 1) epidemiologic and statistical data analysis methods 2) services research, program evaluation, and model design 3) insurance claims data analysis 4) inferential methods with observational data, and 5) grant writing and administration. To fulfill my research aims, I will incorporate electronic records from a high-volume, multi-site MAT provider that has started 18,000 patients on buprenorphine since 2009 with frequent in-house urine drug testing. The research will identify patient characteristics associated with successful buprenorphine initiation, stabilization, and retention and will model barriers at each stage of the treatment cascade. With these findings, I also seek to evaluate the clinical utility of each stage by modeling associations between attaining each stage of treatment and improved clinical outcomes. The results, which will be based on a large, highly generalizable, community-based sample of adults with OUD presenting for treatment, will evaluate the clinical consequences of long-term MAT maintenance and help guide quality improvement initiatives.

项目摘要：高质量证据支持药物辅助治疗 (MAT) 作为一线治疗治疗阿片类药物使用障碍 (OUD)，尤其是丁丙诺啡或阿片类药物替代疗法美沙酮作为至少一年的长期维持治疗，但患者中途退出（通常在六个月时>50%），迄今为止，很少有研究对此进行了检验，而提供者的抵制仍然是有效治疗的主要障碍。影响治疗开始、稳定和长期保留的关键步骤的患者特征大多数已发表的研究高度评估了仅 2-3 个月积极治疗的结果。我将从临床试验中选定的患者中汲取有影响力的连续“护理级联”框架。将艾滋病毒/艾滋病领域作为概念模型，以确定丁丙诺啡连续性的特定阶段障碍通过适应的 OUD 治疗级联进行治疗更好地了解每个顺序的障碍。级联阶段包括 1) 开始使用丁丙诺啡，2) 稳定阿片类药物的使用，以及 3) 保留长期治疗反应可能会为改善结果和死亡率的临床努力提供信息。在医疗改革和医疗补助重新设计下，越来越多的患者获得保险我建议将电子健康记录中的临床数据链接起来。 (EHR) 到保险索赔数据，以评估促进级联护理连续性的患者因素。该策略将捕获关键信息（急诊就诊、诊断、治疗服务、死亡率）给定临床站点之外的保险索赔数据的优点是提供近乎完整的数据。不依赖于自我报告并反映现实世界临床复杂性的随访和客观结果。为了完成这些目标并实现我发展的长期培训目标定量方法、流行病学以及大规模数据管理和推理分析方面的专业知识观察数据集，我阐明了五个连续的训练目标：1）流行病学和统计数据分析方法 2) 服务研究、方案评估和模型设计 3) 保险理赔数据分析 4) 使用观察数据进行推理的方法，以及 5) 资助写作和管理来完成我的任务。为了研究目标，我将合并来自大容量、多站点 MAT 提供商的电子记录，该提供商已开始自 2009 年以来，该研究将对 18,000 名服用丁丙诺啡的患者进行频繁的内部尿液药物检测。确定与丁丙诺啡成功启动、稳定和保留相关的患者特征并将根据这些发现对治疗级联的每个阶段的障碍进行建模。通过对达到每个阶段的治疗和改善之间的关联进行建模来了解每个阶段的临床效用临床结果，该结果将基于大量、高度通用的、基于社区的样本。接受治疗的 OUD 成人将评估长期 MAT 的临床后果维护并帮助指导质量改进计划。