ADAPT: Adaptive Decision support for Addiction Treatment

ADAPT：成瘾治疗的自适应决策支持

• 批准号: 10810953
• 负责人: Edward Robert Melnick
• 金额: $ 122.58万
• 依托单位: YALE UNIVERSITY
• 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 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10810953
• 关键词: Accident and Emergency department; Achievement; Address; Adoption; Biometry; Buprenorphine; Caring; Characteristics; Cluster randomized trial; Consumption; Data; Electronic Health Record; Emergency Care; Emergency Medicine; Emergency department visit; Equity; Evaluation; Event; Evidence based practice; Feedback; Fentanyl; Health Services Accessibility; Illicit Drugs; Intervention; Measurement; Measures; Medicine; Methods; Mus; Nature; Nurses; Outcome Measure; Pain management; Pathway interactions; Patients; Persons; Physicians; Prevalence; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Reproducibility; Resources; Sentinel; Speed; Standardization; Testing; Time; Variant; Vendor; Withdrawal; addiction; analog; care delivery; clinical decision support; comparative efficacy; computerized; data infrastructure; effective intervention; effectiveness evaluation; evidence base; experience; health equity; implementation research; implementation science; implementation strategy; improved; innovation; multiphase optimization strategy; novel; opioid epidemic; opioid overdose; opioid use disorder; prescription opioid; randomized trial; routine care; success; support tools; treatment disparity; uptake; usability

Project Summary The opioid crisis is dynamic. To overcome barriers to addiction treatment, implementation research must keep pace with the changing landscape of the opioid crisis by more rapidly adapting to emerging evidence. Clinical decision support (CDS) offers a promising implementation strategy to more efficiently operationalize and scale evidence-based practices. Patients are motivated to initiate addiction treatment after sentinel events, such as an emergency department (ED) visit for opioid overdose. Unfortunately, clinicians rarely initiate addiction treatment. To that end, we recently conducted the EMBED pragmatic cluster-randomized trial. This trial evaluated the effectiveness of non-interruptive electronic health record (EHR)-based CDS to facilitate patient assessment and automate EHR activities to implement ED-initiation of buprenorphine in the routine care of people with opioid use disorder (OUD). The EMBED CDS increased the proportion of physicians who initiated buprenorphine leading to national dissemination of EMBED. Post-trial analysis identified disparities in treatment as well as opportunities to increase reach and adoption. However, CDS interventions typically remain unchanged while being studied and traditional methods for evaluation are time-consuming, resulting in missed opportunities for progress and delays in implementing effective interventions. These limitations must be addressed to speed the implementation of evidence-based solutions to the opioid crisis in general and the the nationally scaled EMBED CDS specifically. The EHR can both deliver CDS interventions and offer a non- obtrusive, rigorous way to study care delivery at scale utilizing EHR use measurement with automated log data capture. Current quantitative CDS use and usability metrics are limited to alert dismissal rates and descriptive measures of CDS characteristics but are not capable of evaluating CDS interfaces and workflows such as granular assessment of CDS uptake and usability. Therefore, we will adapt CDS of best practices in the care of people with OUD using a Multiphase Optimization STrategy (MOST) framework including rapid, serial randomized testing, measured by scalable, pragmatic EHR use metrics to achieve the following specific aims: (1) Refine and validate reproducible, scalable outcome measures for assessing CDS uptake and usability to implement ED-initiation of buprenorphine for OUD and (2) Refine and evaluate a multicomponent CDS intervention to improve ED-initiation of buprenorphine in patients with OUD via increased CDS uptake, usability, and equity. Achievement of these specific aims will offer a pathway to scalable, equitable interventions for the opioid crisis by innovating data-driven, adaptive approaches that increase treatment access and engagement for people with OUD. With expertise in emergency medicine, addiction medicine, clinical decision support, pragmatic evaluation, biostatistics, health equity, and data, measurement, and implementation science, Dr. Melnick and the ADAPT team are uniquely poised to achieve these aims.

项目摘要 阿片类药物危机是动态的。为了克服成瘾治疗的障碍，实施研究必须保持 随着阿片类药物危机不断变化的景观，更快地适应了新兴的证据。临床 决策支持（CD）提供了有希望的实施策略，以更有效地进行操作和扩展 循证实践。患者被激励在哨兵事件发生后开始成瘾治疗，例如 急诊科（ED）访问阿片类药物过量。不幸的是，临床医生很少开始成瘾 治疗。为此，我们最近进行了嵌入的务实群集伴随试验。这个试验 评估了基于非间断的电子健康记录（EHR）CD的有效性以促进患者 评估和自动化EHR活动，以实施丁丙诺啡在常规护理中的介绍 患有阿片类药物使用障碍（OUD）的人。嵌入CD增加了发起的医生的比例 丁丙诺啡导致全国传播嵌入。试验后分析确定了 治疗以及增加覆盖范围和采用的机会。但是，CD通常是 在研究过程中保持不变，评估的传统方法很耗时，导致 错过了进步的机会和实施有效干预措施的延迟。这些限制必须是 致力于加快对阿片类药物危机的实施，以加快循证解决方案的实施 全国范围的嵌入CD。 EHR既可以提供CD干预措施，又可以提供非 使用EHR使用EHR使用自动日志数据的EHR使用测量的严格，严格的学习护理分娩方式 捕获。当前的定量CD使用和可用性指标仅限于提醒解雇率和描述性 CD特征的度量，但无法评估CD的界面和工作流程（例如 CD摄取和可用性的颗粒状评估。因此，我们将适应最佳实践的CD 使用多相优化策略（大多数）框架，包括快速，串行的人 随机测试，通过可扩展的务实EHR使用指标来实现以下特定目的： （1）提炼和验证可重复可重复的可扩展结果指标，以评估CD的吸收和可用性 实施对OUD的丁丙诺啡的介绍，（2）完善和评估多组分CD 干预措施以改善OUD患者的丁丙诺啡的介绍，以增加CD的吸收， 可用性和公平性。这些特定目标的实现将为可扩展，公平提供途径 通过创新以数据驱动的自适应方法来增加治疗方法，对阿片类药物危机进行干预措施 有Oud的人的访问和参与。具有急诊医学，成瘾医学方面的专业知识， 临床决策支持，务实评估，生物统计学，健康公平和数据，测量和测量 实施科学，梅尔尼克（Melnick）博士和适应团队有独特的准备来实现这些目标。