Reward-based technology to improve opioid use disorder treatment initiation after an ED visit

基于奖励的技术可改善急诊就诊后阿片类药物使用障碍治疗的启动

• 批准号: 10414138
• 负责人: Edwin D Boudreaux
• 金额: $ 90.28万
• 依托单位: Q2I, LLC
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10414138
• 关键词: Abstinence; Accident and Emergency department; Adherence; Ambulatory Care; Behavior; Behavior Therapy; Cessation of life; Clinical; Computer software; Cost Savings; Data; Devices; Drug Metabolic Detoxication; Economic Burden; Economics; Education; Emergency Situation; Emergency department visit; Feedback; Health; Individual; Inpatients; Intake; Intervention; Intervention Studies; Maintenance; Medical Care Team; Methods; Monitor; Morbidity - disease rate; Opiate Addiction; Opioid; Outcome; Outpatients; Participant; Patient Recruitments; Patients; Persons; Pharmaceutical Preparations; Phase; Population; Positioning Attribute; Protocols documentation; Provider; Randomized; Randomized Controlled Trials; Records; Recovery Support; Registries; Research; Rewards; Schedule; Small Business Technology Transfer Research; Suboxone; System; Technology; Telephone; Testing; Training; Treatment Protocols; Treatment outcome; Update; Urine; Visit; Work; acceptability and feasibility; acute care; base; contingency management; cost; cost effectiveness; design; evidence base; experience; flexibility; follow up assessment; group intervention; improved; indexing; innovation; mHealth; medication-assisted treatment; meetings; mobile application; mortality; novel; opioid misuse; opioid use; opioid use disorder; patient oriented; patient population; preference; programs; public health relevance; recruit; screening, brief intervention, referral, and treatment; smartphone Application; software systems; tool; treatment adherence; treatment as usual; usability; user centered design

Project Summary/Abstract Millions of people in the US misuse opioids each year, leading to thousands of deaths and costing billions of dollars in total economic burden. Medication assisted treatment (MAT) for opioid use disorder (OUD) is highly efficacious, but only a fraction of OUD persons access MAT, and treatment non-adherence is common and associated with poor outcomes. This STTR Fast Track proposal is designed to increase rates of Suboxone (buprenorphine/naloxone) treatment initiation and adherence among OUD patients recruited from emergency and inpatient acute care. To accomplish these aims, the project will enhance the Opioid Addiction Recovery Support (OARS), an existing Q2i company technology, with a new evidence-based reward, contingency management (CM) function. CM interventions systematically reward (reinforce) specific behaviors like treatment initiation and adherence with therapy attendance and drug-free urine tests, and are highly efficacious. An OARS solution enhanced with a CM component (OARS+CM) that allows for the automatic calculation, delivery, and redemption of rewards contingent on objective evidence of treatment behaviors may be key to improving Suboxone initiation and adherence. In Phase 1 of this proposal, the existing OARS clinician portal and patient mobile application will be modified to accommodate entry into the software system from an acute care setting and to automatically manage and deliver rewards to create OARS+CM using patient-centered design principles. Usability sessions with OUD patients and other key stakeholders will inform design. Primary usability outcomes will be examined and the program iteratively updated. On meeting milestones, there will be proof-of-concept pilot of usability, acceptability, and effects on initial behavior targets with approximately 20 patients and at least 4 providers. On meeting milestones, a RCT will follow, in which acute care OUD patients appropriate for outpatient Suboxone (N = 150) are recruited and allocated to one of three study conditions: 1) treatment as usual (TAU), comprised of screening, brief intervention, and referral to treatment by a trained clinician, 2) OARS, and 3) OARS+CM. The active intervention window for the two intervention groups will be 12 weeks. Patients will be onboarded prior to discharge from acute care. In the outpatient Suboxone setting, data on treatment adherence and opioid use will be captured from clinical records for six months. Telephone follow-up assessments and vital statics registry reviews will be at month 1, month 3 (end-of-study intervention period), and month 6. Primary Suboxone treatment initiation outcomes will be scheduling and completing the Suboxone intake. Primary Suboxone treatment outcomes will be sustained abstinence at Month 6 and longest duration of abstinence. Analysis will examine data on cost avoidance and cost savings through reduced acute care visits between study conditions.

项目摘要/摘要 美国每年数以百万计的人滥用阿片类药物，导致数千人死亡，造成数十亿人 美元总负担。阿片类药物使用障碍（OUD）的药物辅助治疗（MAT）高度 有效的，但只有一小部分的Oud访问垫，不遵守治疗是常见的，并且 与不良结果有关。此STTR快速提案旨在提高亚oxone的速率 （丁丙诺啡/纳洛酮）在紧急情况下招募的OUD患者的治疗启动和依从性 和住院急性护理。为了实现这些目标，该项目将增强阿片类药物成瘾的恢复 现有Q2I公司技术支持（OARS），具有新的基于证据的奖励，应急性 管理（CM）功能。 CM干预措施系统地奖励（增强）特定行为，例如治疗 启动和遵守治疗的出席性和无药物测试，并且具有高效。桨 使用CM组件（OARS+CM）增强的解决方案，该组件允许自动计算，交付和 赎回奖励取决于客观的治疗行为证据可能是改善的关键 亚智酮的启动和依从性。在本提案的第1阶段，现有的桨临床门户和患者 将修改移动应用程序以适应急性护理设置进入软件系统 并自动管理和交付奖励，以使用以患者为中心的设计原理创建桨+CM。 与OUD患者和其他主要利益相关者的可用性会议将为设计提供信息。主要的可用性结果 将检查并迭代更新程序。在开会里程碑时，将有概念证明飞行员 对大约20例患者和至少4个患者的最初行为目标的可用性，可接受性和影响 提供者。在遇到里程碑时，将接下RCT，其中适合门诊的急性护理OUD患者 亚毒素（n = 150）被募集并分配给三个研究条件之一：1）照常治疗（tau）， 包括筛查，简短的干预以及训练有素的临床医生的治疗，2）桨和3） 桨+厘米。两个干预组的主动干预窗口将为12周。患者会 在急性护理中出院之前登上船。在门诊亚恶酮的设置中，有关治疗依从性的数据 并将阿片类药物使用从临床记录中捕获六个月。电话随访评估和重要 静态注册表审查将在第1个月，第3个月（培养终止干预期）和第6个月。 亚智酮治疗开始结果将是调度和完成亚oxone摄入量。基本的 亚智酮治疗结果将在第6个月和节制持续时间持续持续。 分析将通过减少研究之间的急性护理访问来检查有关避免成本和节省成本的数据 状况。