Measuring Improvement in the Quality of ED-initiated Treatment for OUD using Observation

使用观察来衡量 ED 发起的 OUD 治疗质量的改善

基本信息

批准号：
10223255
负责人：
Ryan P McCormack
金额：
$ 81.94万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10223255
关键词：
Accident and Emergency department Accountability Adopted Adult Ambulatory Care Buprenorphine Caring Case Manager Characteristics Client satisfaction Clinical Protocols Clinical Trials Clinical Trials Network Collection Data Development Dose Drug usage Economics Effectiveness Emergency Department patient Emergency department visit Ensure Environment Evidence based treatment Health Health Care Costs Health Personnel Health Services Accessibility Hospitals Hour Housing Incentives Individual Infrastructure Insurance Intervention Kentucky Life Link Measures Methods Multicenter Studies National Institute of Drug Abuse Opioid Opioid agonist Outcome Outcome Measure Outpatients Overdose Paper Patient Care Patient Outcomes Assessments Patient Self-Report Patients Pharmaceutical Preparations Pharmacotherapy Phase Policies Population Process Process Measure Protocols documentation Provider Quality of Care Quality of life Randomized Randomized Clinical Trials Randomized Controlled Trials Recovery Resources Risk Adjustment Running Rural Community Safety Savings Services Site Structure Testing Third-Party Payer Time Transportation Universities Visit Work acute care cost disparity reduction economic evaluation effectiveness measure effectiveness study efficacious intervention experience functional status health care service improved interest mortality risk multidisciplinary opioid epidemic opioid use disorder overdose death patient oriented personalized approach primary outcome public health priorities relative effectiveness safety outcomes secondary outcome success treatment services trial comparing working group

项目摘要

Treatment of opioid use disorder (OUD) with buprenorphine (BUP) has significant individual and societal benefits, and decreases the risk of death from overdose. Yet, few individuals have access to these treatments. Narrowing the treatment gap by expanding access to treatment in Emergency Department (ED) settings is widely viewed to be a public health priority. It has been 3 years since D’Onofrio et al.’s landmark paper demonstrated the feasibility, safety, and efficacy of ED-initiated BUP, and, despite a highly visible opioid epidemic, few EDs have adopted this life-saving intervention. Coincident with the intensifying opioid epidemic, there have been increasing calls for development and use of quality measures to track and improve the quality of care for OUD and implement policy strategies to identify and incentivize use of best practices. Through our work, including leading two ongoing NIDA Clinical Trials Network multicenter studies of the implementation and effectiveness of ED-initiated BUP and referral, our team has identified unique challenges to implementation and collection of information about care quality. By providing an environment within and managed by the ED that allows sufficient time for enhanced care, beyond a 4-6 hour ED visit, protocol-driven ED Observation Units (EDOUs) would mitigate many identified challenges and promote better utilization of existing infrastructure. Further, it would enable patients presenting for overdose to remain in the ED long enough to receive their first dose of BUP prior to discharge. In the R61 phase, we will build on our existing clinical protocols as well as linked process and outcome measures of quality related to ED-initiated BUP and referral to be delivered during (1) a standard ED visit and (2) an enhanced ED visit in EDOU. Then, for the R33 phase, we propose a multicenter, randomized controlled trial in which patients with untreated OUD presenting to the University of Kentucky, NYU-Brooklyn (NYC), and Bellevue Hospital (NYC) EDs are randomized (1:1) to treatment though one of the two clinical protocols with outcomes assessed at the ED visit, 1, 3, and 6 months. We will evaluate processes and outcomes granularly to inform the development of reliable, valid measures using data that could be captured without undue burden. We will compare the relative effectiveness of the two approaches on the proportion of patients who receive ED- initiated BUP and referral, are linked to formal OUD treatment within 7 days and engaged in treatment at 30 days. We will assess changes in patient reported outcomes and drug use, and conduct an economic evaluation from a third-party payer perspective. Linking structural and process measures to population-level outcomes will allow us to guide and define quality improvement to inform accountability and policy. Evaluating the associations between patient-level characteristics, measure completion, and outcomes will help identify population needs and apply strategies to improve quality and reduce disparities.

用丁丙诺啡 (BUP) 治疗阿片类药物使用障碍 (OUD) 具有显着的个人和社会意义好处，并降低因过量服用而死亡的风险，然而，很少有人能够获得这些治疗。通过扩大急诊科 (ED) 环境中的治疗机会来缩小治疗差距是自从 D’Onofrio 等人发表具有里程碑意义的论文以来，该问题已被广泛视为公共卫生优先事项。证明了 ED 引发的 BUP 的可行性、安全性和有效性，并且尽管阿片类药物非常明显随着阿片类药物流行的加剧，很少有急诊室采取这种挽救生命的干预措施。人们越来越多地呼吁制定和使用质量措施来跟踪和提高质量关注 OUD 并实施政策战略，以识别和激励最佳实践的使用。工作，包括领导两项正在进行的 NIDA 临床试验网络多中心研究的实施和 ED 发起的 BUP 和转介的有效性，我们的团队发现了实施的独特挑战通过在 ED 内部提供一个环境并由其管理，收集有关护理质量的信息。除了 4-6 小时的急诊就诊、方案驱动的急诊观察单位之外，还可以有足够的时间进行加强护理（EDOU）将缓解许多已确定的挑战并促进更好地利用现有基础设施。此外，它将使因服药过量而出现的患者能够在急诊室停留足够长的时间，以便接受他们的第一次治疗。出院前服用 BUP 剂量。在 R61 阶段，我们将基于现有的临床方案以及相关的流程和结果与 ED 发起的 BUP 相关的质量衡量标准以及在 (1) 标准 ED 就诊期间提供的转诊 (2) EDOU 中的强化 ED 就诊然后，对于 R33 阶段，我们提出多中心、随机对照。试验中，未经治疗的 OUD 患者就诊于肯塔基大学、纽约大学布鲁克林分校 (NYC)，以及贝尔维尤医院 (NYC) 急诊室被随机 (1:1) 接受以下两种临床方案之一的治疗：在 ED 就诊时评估的结果、第 1、3 和 6 个月，我们将详细评估流程和结果。利用无需过度负担即可获取的数据，为制定可靠、有效的措施提供信息。我们将比较两种方法对接受 ED 治疗的患者比例的相对有效性启动 BUP 和转诊，在 7 天内与正式 OUD 治疗相关联，并在 30 岁时开始治疗我们将评估患者报告的结果和药物使用的变化，并进行经济分析。从第三方付款人的角度进行评估将结构和流程措施与人口水平联系起来。结果将使我们能够指导和定义质量改进，以评估问责制和政策。患者水平特征、测量完成情况和结果之间的关联将有助于识别人口需求并应用战略来提高质量并减少差距。