Identifying High Utilizing Patients with Opioid Use Disorder to Engage in Primary Care

识别患有阿片类药物使用障碍的高利用率患者以参与初级保健

基本信息

批准号：
10369935
负责人：
Brian Chan
金额：
$ 17.33万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10369935
关键词：
Address Area Caring Case Study Chronic Clinical Clinical Oncology Supplement (K12)Clinical Trials Design Communities Community Health Systems Complex Consolidated Framework for Implementation Research Data Diagnosis Discipline of Nursing Disease Enrollment Ensure Evidence based treatment Federally Qualified Health Center Future Goals Health Health Services Health Services Research Health system Heroin Intensive Care Internist Intervention Intervention Trial K-Series Research Career Programs Low income Measures Medical Medicine Mentored Patient-Oriented Research Career Development Award Mentors Methods Modeling National Institute of Drug Abuse Outcome Patient Care Patients Persons Pharmaceutical Preparations Pharmacy facility Physicians Population Primary Health Care Provider Quality of Care Randomized Research Research Methodology Research Personnel Resources SECTM1 gene Scientist Signal Transduction Site Strategic Planning Substance Use Disorder Testing Training Trust Work acceptability and feasibility addiction base care coordination care fragmentation career development cost effective intervention evidence base experience faculty mentor health care service utilization health service use high risk high risk population hospital utilization implementation determinants implementation science implementation strategy improved improved outcome interest medical complication mortality multidisciplinary novel opioid use disorder outreach patient engagement pilot test pilot trial pragmatic efficacy trial prescription pain reliever preventive intervention primary care setting psychosocial randomized trial risk stratification safety net social social determinants social health determinants social stigma substance use success therapy design treatment choice

项目摘要

PROJECT SUMMARY/ABSTRACT Brian Chan MD MPH is an internist and health services researcher passionate about improving health outcomes for vulnerable patients with opioid use disorder (OUD). This career development award will establish Dr. Chan as a clinician-investigator focused on implementing and disseminating novel primary care interventions that target high-risk patients with OUD in safety-net settings. The K23 award provides mentored training to develop expertise in 3 areas: 1) conduct of mixed-methods research to develop deployment-focused interventions; 2) clinical trial design and implementation science; and 3) addiction medicine treatment in federally qualified health center (FQHC) settings. To achieve these goals, Dr. Chan has assembled a multidisciplinary mentoring team with expertise in health services research, addiction medicine, intervention design and implementation science, and FQHC health systems, with success in mentoring faculty to research independence. In 2018, 2.1 million people had an opioid use disorder (OUD) related to heroin or prescription pain relievers. While the recognition of OUD is increasing, few patients receive evidence-based treatment. This is particularly true for medically complex patients with OUD in safety-net settings. OUD complicates management of other chronic medical conditions and is associated with high utilization of healthcare resources. Health systems are interested in risk stratifying complex patients to improve targeting of interventions, like ambulatory intensive care teams (A-ICU); these could be adapted for complex patients with OUD, but scalability limit dissemination. Informed by his clinical experience as an internist and data from his K12 award evaluating an A- ICU for medically complex high-utilizers in an FQHC, Dr. Chan will complete the following 3 aims: 1) Adapt an existing A-ICU intervention to address high complexity patients with OUD using community stakeholder engaged methods; 2) Refine the intervention through an iterative implementation case study, and identify measures of acceptability, feasibility, and implementation strategy; 3) Evaluate and pilot a randomized trial of the intervention to assess feasibility, acceptability, and preliminary efficacy of the refined intervention to improve clinical outcomes, and retention in OUD treatment at a FQHC using implementation and mixed- methods. The results provide preliminary data for a future R01 proposal pragmatic efficacy trial of the refined intervention at multiple FQHC sites. This proposal directly aligns with the priorities of the National Institute on Drug Abuse’s strategic planning workgroup on the “complexity of substance use disorders” and its priority to “develop and test strategies for effectively and sustainably implementing evidence-based treatments.” Completion of these studies will pave the way for implementing scalable primary care interventions to narrow OUD treatment gaps and improve care for high-risk populations.

项目概要/摘要 Brian Chan MD MPH 是一位热衷于改善健康的内科医生和健康服务研究员该职业发展奖将设立阿片类药物使用障碍 (OUD) 弱势患者的结果。陈博士作为一名临床研究者，专注于实施和传播新型初级保健 K23 奖提供针对安全网环境中 OUD 高危患者的干预措施。培训以发展 3 个领域的专业知识：1) 进行混合方法研究，以开发以部署为重点的技术干预措施；2) 临床试验设计和实施科学；3) 成瘾药物治疗为了实现这些目标，陈博士组建了联邦合格健康中心 (FQHC)。多学科指导团队，拥有健康服务研究、成瘾医学、干预方面的专业知识设计和实施科学以及 FQHC 卫生系统，成功指导教师进行研究独立。 2018 年，有 210 万人患有与海洛因或处方疼痛相关的阿片类药物使用障碍 (OUD) 虽然 OUD 的认知度不断提高，但很少有患者接受循证治疗。对于在安全网环境下进行 OUD 并发症管理的病情复杂的 OUD 患者尤其如此。其他慢性疾病的发生，并与医疗资源的高利用率相关。系统感兴趣的是对复杂患者进行风险分层，以提高干预措施的针对性，例如门诊重症监护团队（A-ICU）；这些可以适应 OUD 的复杂患者，但可扩展性有限通过他作为内科医生的临床经验和他的 K12 奖项评估 A- 的数据获得信息。在 FQHC 中针对医疗复杂的高利用率患者的 ICU，陈医生将完成以下 3 个目标： 1) 适应现有的 A-ICU 干预措施利用社区利益相关者来解决 OUD 的高复杂性患者 2) 通过迭代实施案例研究完善干预措施，并确定可接受性、可行性和实施策略的衡量标准；3) 评估和试点随机试验评估细化干预措施的可行性、可接受性和初步效果通过实施和混合，改善临床结果并保留 FQHC 的 OUD 治疗结果为未来R01提案细化后的实用功效试验提供了初步数据。该提案与国家研究所的优先事项直接一致。药物滥用战略规划工作组关于“物质使用障碍的复杂性”及其优先事项 “制定和测试有效且可持续实施循证治疗的策略。” 这些研究的完成将为实施可扩展的初级保健干预措施铺平道路，以缩小 OUD 治疗差距并改善对高危人群的护理。