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

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) 是退伍军人发病和死亡的主要原因，也是一个高度优先的问题 退伍军人健康管理局 (VHA) 的 OUD 有效药物质量改进目标。 (MOUD) 可用，但 VHA 中对它们的采用情况差异很大。 美国在推广疼痛替代疗法方面走在前列，但这些疗法并不能始终适用于 非常需要他们的退伍军人：那些患有慢性疼痛和有害使用阿片类药物的人，通过其办公室。 心理健康和自杀预防，已为全系统范围内需要的所有退伍军人提供了 MOUD 访问权限 然而，成功实施面临无数障碍的复杂护理流程需要优先考虑。 由专家团队密切合作开展有意识的、结构化的、基于证据的实施工作 与当地领导。 因此，该项目的总体目标是传播和理解联盟 实施阿片类药物使用障碍治疗 (CONDUIT)——联合五个相互关联的 VISN/QUERI 试点 合作实施倡议项目，共同努力改善退伍军人获得 MOUD 的机会 将跨越 6 个 VISN 的 57 个 VHA 站点，使用 OUD 并获得替代疼痛疗法。 OUD 连续护理中的四个重症护理机构： 初级护理； 急症护理； 和急诊科）；和远程医疗将通过退伍军人参与联系起来， 实施和定量/经济核心将帮助 CONDUIT 团队协调指标， 还将设立一个由运营领导和人员组成的战略咨询小组。 退伍军人将帮助 CONDUIT 与 VHA 和退伍军人优先事项保持最大限度的一致。 还为网站提供实施新的基于证据的实践的机会（即不属于 初始启动）在项目期间的后半段。 每个 CONDUIT 团队部署的方法都是相似的：专家“外部协助”团队 将在名为“实施促进（IF）”的过程中领导当地站点的合作“内部促进”团队 – 一套多组件工具，旨在帮助网站有效地采用基于证据的实践。 项目在第一阶段进行了试点并系统地修改了综合框架战略，现在提议传播这些战略 未来三年在全国范围内强化战略，包括两个新的 VISN 和数十个 在评估方面，CONDUIT 将使用完善的形成性评估方法来评估。 此外，CONDUIT 将使用 IF 策略来评估其有效性并推动其改进。 最先进的定量方法来评估工作对重要临床目标的影响并评估 在整个项目期间，团队将开发和完善工作的成本与收益价值。 产品，例如患者和提供者教育材料、处方和沟通指南以及诊所 这些评估和产品开发工作将为成功的规模化和生产奠定基础。 整个 VHA 的传播工作。