Leveraging social determinants via artificial intelligence and peer coaching to address racial disparities in primary care among people who use opioids

通过人工智能和同伴辅导利用社会决定因素来解决阿片类药物使用者初级保健中的种族差异

• 批准号: 10829058
• 负责人: CRYSTAL FULLER LEWIS
• 金额: $ 62.43万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2027-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10829058
• 关键词: Leveraging; social; determinants; via; artificial

PROJECT SUMMARY Black and Latinx people who use opioids (PWUO) bear a disproportionate burden of opioid overdose deaths. The economic burden faced by Black and Latinx PWUO has also risen due to costs associated with excess mortality and utilization of high-cost healthcare services. Compared to White PWUO, Black and Latinx PWUO are less likely to be initiated on buprenorphine in emergency department (ED) settings and establish care in primary care for the treatment of opioid use disorder (OUD). Racial disparities among PWUO in primary care are driven by social determinants of health (SDH; e.g., lack of peer support or health insurance) and may be partially addressed by adopting innovative mobile health and peer coaching strategies. With NIH support, we have validated a theory-driven, artificial intelligence (AI)-driven texting tool using natural language processing to facilitate real-time text responses to patient queries combined with automated texts facilitating receipt of buprenorphine in office-based opioid treatment (OBOT) and social services that address social determinants of health (SDH). This open source texting tool offers passive reminders, informational content, and interactive two- way response algorithms without personal staff contact. In addition, we have adapted an efficacious cultural and structural humility training for PRCs that goes beyond SDH to also address stigma reduction, discrimination, health habitus, and patient navigation to enhance uptake of primary care and social services for PWUO. Using a three-arm, comparative effectiveness trial design, our specific aims are to: (1) Assess the efficacy of PRC- supported text-based care/services coordination with PWUO + AI-driven SDH-enhanced text messaging (intervention arm-1) vs. AI-driven SDH-enhanced text messaging only (intervention arm-2) vs. TAU or printed social/medical services referrals (control) to enhance the receipt of buprenorphine in OBOT among ED-enrolled Black / Latinx PWUO (N=252); (2) Evaluate the implementation of the multimodal intervention (arm-1) guided by the RE-AIM and CFIR frameworks using in-depth interviews among 3 stakeholder groups: (1) frontline providers (n=10); (2) administrators (n=10); and (3) a subset of the Black and Latinx PWUO from the multimodal intervention arm-1 (n=30); and (3) Identify the resources and estimate the associated cost of implementing and sustaining the multimodal intervention and incorporate this information into a customizable budget-impact tool and conduct a comprehensive economic evaluation to calculate the relative economic value (e.g., cost-per quality-adjusted life years, cost-per OUD treatment days) of each study arm from the healthcare sector, state- policymaker, and societal perspectives which will also inform implementation framed by RE-AIM. Our team is poised to conduct this study given expertise in novel Cultural & Structural Humility Training designed for peers, in open source AI-driven mobile health innovations, and was instrumental in integrating mHealth and telemedicine solutions for patients initiating buprenorphine in primary care. If successful, a multisite effectiveness-implementation hybrid type 1 trial will follow. .

项目概要 使用阿片类药物 (PWUO) 的黑人和拉丁裔人因阿片类药物过量死亡而承受着不成比例的负担。 由于与过度消费相关的成本，黑人和拉丁裔 PWUO 面临的经济负担也有所增加 死亡率和高成本医疗服务的利用。与白人 PWUO、黑人和拉丁裔 PWUO 相比 不太可能在急诊室 (ED) 环境中开始使用丁丙诺啡，并在 治疗阿片类药物使用障碍 (OUD) 的初级保健。 PWUO 在初级保健方面的种族差异是 由健康的社会决定因素（SDH；例如，缺乏同伴支持或健康保险）驱动，并且可能部分是 通过采用创新的移动健康和同伴辅导策略来解决这个问题。在 NIH 的支持下，我们有 使用自然语言处理验证理论驱动、人工智能 (AI) 驱动的短信工具 促进对患者询问的实时文本响应，并结合自动文本，促进接收 丁丙诺啡用于基于办公室的阿片类药物治疗 (OBOT) 和解决阿片类药物社会决定因素的社会服务 健康（SDH）。这个开源短信工具提供被动提醒、信息内容和交互式两 无需个人人员接触的方式响应算法。此外，我们还采用了有效的文化和 针对 PRC 的结构性谦逊培训不仅限于 SDH，还涉及减少耻辱、歧视、 健康习惯和患者导航，以提高 PWUO 对初级保健和社会服务的吸收。使用 三臂、比较有效性试验设计，我们的具体目标是：（1）评估 PRC- 通过 PWUO + AI 驱动的 SDH 增强型短信支持基于文本的护理/服务协调 （干预臂 1）与仅人工智能驱动的 SDH 增强型短信（干预臂 2）与 TAU 或印刷 社会/医疗服务转介（对照），以提高 ED 注册患者在 OBOT 中接受丁丙诺啡的情况 黑人/拉丁裔 PWUO (N=252)； (2) 评估多模式干预（arm-1）的实施情况 RE-AIM 和 CFIR 框架使用 3 个利益相关者群体的深入访谈：(1) 一线提供商 (n=10)； (2) 管理员（n=10）； (3) 来自多模式的黑人和拉丁裔 PWUO 的子集 干预臂-1 (n=30)； (3) 确定资源并估计实施和实施的相关成本 维持多模式干预并将这些信息纳入可定制的预算影响工具 并进行综合经济评估，计算相对经济价值（例如，每单位成本） 医疗保健部门每个研究组的质量调整生命年（每 OUD 治疗天数的成本），国家- 政策制定者和社会观点也将为 RE-AIM 框架的实施提供信息。我们的团队是 鉴于为同行设计的新型文化和结构谦逊培训方面的专业知识，准备进行这项研究， 致力于开源人工智能驱动的移动医疗创新，并在整合移动医疗和 针对在初级保健中开始使用丁丙诺啡的患者的远程医疗解决方案。如果成功，多站点 随后将进行有效性-实施混合型 1 试验。 。