CHASE: An Innovative County-Level Public Health Response to the Opioid Epidemic in New York State

CHASE：针对纽约州阿片类药物流行病的创新县级公共卫生应对措施

基本信息

批准号：
10391484
负责人：
Nabila El-Bassel
金额：
$ 868万
依托单位：
COLUMBIA UNIV NEW YORK MORNINGSIDE
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-17 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10391484
关键词：
Accident and Emergency department Address Adoption Affect Alcohol abuse Attention Back Biological Models Buprenorphine Calibration Cessation of life Clinic Cluster randomized trial Collaborations Communities Consolidated Framework for Implementation Research Continuity of Patient Care County Custom Data Data Coordinating Center Data Science Death Rate Drug Prescriptions Effectiveness Evidence based intervention Failure Feedback Future Geography Goals Government HIV Harm Reduction Health Health Services Health Status Healthcare Hepatitis C virus Hot Spot Improve Access Incidence Individual Information Systems Interdisciplinary Study Intervention Jail Justice Leadership Learning Level of Evidence Link Maintenance Methadone Methods Modeling Monitor Naloxone Naltrexone New York Opioid Outcome Overdose Overdose reduction Persons Pharmaceutical Preparations Pharmacology Prevention Prevention program Prevention strategy Primary Health Care Process Provider Public Health Public Sector Recovery Research Research Personnel Risk Rural Schools Science Service setting Services Social Work Substance Use Disorder Substance abuse problem System Testing Time Training Vermont Work Youth addiction base behavioral health community based participatory research community engagement community setting comorbidity cost cost effectiveness cost-effectiveness evaluation dashboard effective therapy effectiveness evaluation empowerment evidence base experience implementation barriers implementation efforts implementation evaluation implementation facilitation implementation fidelity implementation research implementation science improved innovation multidisciplinary opioid epidemic opioid mortality opioid overdose opioid use opioid use disorder opioid user overdose death overdose education overdose prevention peer prescription opioid prevention service primary care setting primary outcome programs racial diversity response scale up screening and brief intervention secondary outcome social media social stigma synthetic opioid theories tool treatment services treatment strategy trend trial design uptake

项目摘要

PROJECT SUMMARY New York State (NYS) ranks second in the nation in absolute numbers of opioid overdose deaths. From 2015- 2016, opioid overdose deaths in NYS increased by 32%, including an 88% increase in synthetic opioid-related deaths. The proposed research will develop and test a County-system Hub and Spoke Empowerment model (“CHASE”) to reduce incidence of fatal overdoses in 15 geographically and racially diverse counties in NYS that averaged 28.2 deaths per 100,000 in 2017 and meet all the UM1 RFA-DA-19-016 criteria. CHASE is a modified Hub and Spoke model that is adaptable to the unique needs of any particular county with the aim of developing a blueprint that could be applied to counties across the U.S. CHASE is a coordinated multi-system, multi-sector public health response to the opioid epidemic, directed by County Health Commissioners, and driven by robust community engagement and real-time learning based on data science and systems science. CHASE addresses structural barriers to decreasing opioid deaths by engaging underutilized county systems “Spokes” (e.g., jails, other justice settings, emergency departments (EDs), and other health and social service settings ) will be linked to “hubs” which will include federally qualified health care clinics, primary care settings and addiction programs. CHASE will target gaps in the opioid prevention and treatment cascade by (1) expanding number of medications for opioid use disorder (MOUD) providers and addiction expertise; (2) identifying people at risk of opioid use disorder (OUD) using evidence-based screening, brief intervention and referral tools and linking and retaining them in MOUD using peer navigation; (3) scaling up overdose education and naloxone distribution (OEND) in community settings; (4) improving access to MOUD in jails and EDs, (5) deploying evidence-based prevention programs in schools, social media and other venues; and (6) scaling up prescription monitoring and prescription take-back programs. The county leadership will work with a county community advisory board of key stakeholders to customize and calibrate the intervention components of CHASE. This calibration process will be guided by an interactive dashboard that facilitates data-driven system modelling to identify the combination of evidence-based strategies to best address specific gaps and opioid overdose trends in their county. This dashboard will also provide real-time feedback on how to improve and optimize implementation efforts. The study will employ mixed methods to rigorously identify multi-level theory- driven factors that impede or facilitate the implementation and sustainability of CHASE in each county. If effective, CHASE can be scaled up as comprehensive public health response to the opioid epidemic in counties across the U.S. This study will build on the extensive research of the multidisciplinary team on OUD and other substance use disorders, HIV, HCV and other comorbid conditions, opioid overdose prevention, pharmacology, data and system science, implementation science, and community-based participatory research and will include government investigators from NYS Department of Health.

项目概要 2015 年以来，纽约州 (NYS) 因阿片类药物过量死亡的绝对人数位居全国第二。 2016 年，纽约州阿片类药物过量死亡人数增加了 32%，其中与合成阿片类药物相关的死亡人数增加了 88% 拟议的研究将开发和测试县系统中心辐射赋权模型。 (“CHASE”) 旨在减少纽约州 15 个地理和种族多元化县的致命用药过量发生率 2017 年平均每 10 万人中有 28.2 人死亡，符合 UM1 RFA-DA-19-016 的所有标准。修改后的中心辐射模型，可适应任何特定县的独特需求，旨在制定可应用于美国各县的蓝图 CHASE 是一个协调的多系统，由县卫生专员指导，针对阿片类药物流行病采取多部门公共卫生应对措施，以及由强大的社区参与和基于数据科学和系统科学的实时学习驱动。大通银行通过利用未充分利用的县系统来解决减少阿片类药物死亡的结构性障碍 “发言人”（例如监狱、其他司法机构、急诊室 (ED) 以及其他卫生和社会服务机构）设置）将链接到“中心”，其中包括联邦合格的医疗保健诊所、初级保健机构 CHASE 将通过 (1) 解决阿片类药物预防和治疗级联中的缺口。扩大阿片类药物使用障碍 (MOUD) 提供者的药物数量和成瘾专业知识 (2) 通过基于证据的筛查、简短的干预和（三）加大服药过量教育力度和纳洛酮在社区环境中的分发 (OEND)；(4) 改善监狱和急诊室获取 MOUD 的机会，(5) 在学校、社交媒体和其他场所部署循证预防计划；(6) 扩大规模；处方监测和处方回收计划县领导将与县合作。由主要利益相关者组成的社区咨询委员会定制和校准干预措施 CHASE 的校准过程将由交互式仪表板指导，该仪表板有利于数据驱动系统。建模以确定基于证据的策略组合，以最好地解决特定差距和阿片类药物该仪表板还将提供有关如何改进和改善的实时反馈。优化实施工作。该研究将采用混合方法来严格识别多层次的理论。阻碍或促进 CHASE 在每个县的实施和可持续性的驱动因素。有效后，CHASE 可以扩大规模，作为针对阿片类药物流行病的全面公共卫生应对措施这项研究将建立在 OUD 多学科团队广泛研究的基础上和其他物质使用障碍、HIV、HCV 和其他合并症、阿片类药物过量预防、药理学、数据和系统科学、实施科学和社区参与研究人员将包括纽约州卫生部的政府调查人员。