Implementing a patient navigation intervention across a health system to address treatment entry inequities

在整个卫生系统中实施患者导航干预，以解决治疗进入不平等问题

• 批准号: 10812628
• 负责人: Karen Alexander
• 金额: $ 94.68万
• 依托单位: FRIENDS RESEARCH INSTITUTE, INC.
• 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 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812628
• 关键词: Address; Adoption; Agreement; Awareness; Buprenorphine; COVID-19 pandemic; Clinical; Clinical Trials; Communities; Complex; Consult; Continuity of Patient Care; Data; Dedications; Effectiveness; Emergency department visit; Ensure; Epidemic; Ethnic Origin; Evidence based intervention; Feedback; Goals; Health Services Accessibility; Health system; Hospitalization; Hospitals; Human Resources; Hybrids; Inequity; Inpatients; Institution; Intervention; Manuals; Maps; Methadone; Minority Groups; Morbidity - disease rate; Outcome; Overdose; Overdose reduction; Participant; Patient-Focused Outcomes; Patients; Performance; Persons; Phase; Philadelphia; Population; Preparation; Probability; Process; Proctor framework; Protocols documentation; Public Health; Quality of life; Race; Randomized; Research; Resources; Scoring Method; Services; Site; Social support; System; Testing; Training; Translations; acceptability and feasibility; access disparities; addiction; care systems; community based treatment; cost effective; data sharing; design; effectiveness evaluation; effectiveness trial; effectiveness/implementation study; effectiveness/implementation trial; evidence base; follow-up; geographic disparity; high risk; hospital readmission; hospital utilization; implementation barriers; implementation facilitation; implementation intervention; implementation process; implementation strategy; implementation study; improved; innovation; mortality; navigator intervention; novel; operation; opioid agonist therapy; opioid epidemic; opioid overdose; opioid use disorder; patient navigation; patient navigator; pilot test; pilot trial; poor health outcome; post implementation; prevent; randomized trial; research to practice; scale up; socioeconomic disparity; substance use; success; theories; treatment as usual

Project Summary/Abstract Opioid agonist treatment (OAT) is protective against overdose, yet less than 20% of people with opioid use disorder (OUD) engage in such treatment. Hospital utilization is high among people with OUD and can be a ‘reachable moment’ to initiate OAT. However, most hospitals lack the capacity to follow up with patients after discharge. Theory-based, empirically supported patient navigator (PN) interventions following hospital discharge reduce inequities in accessing community-based OAT by helping patients navigate complex systems of care. However, challenges persist in implementing PN interventions on a wide scale, as they require coordination across institutions, data sharing, dedicated personnel, and community resources. This is especially true in settings that reach diverse, resource-challenged communities. To bring these interventions to scale, strategies are needed to assess factors that influence PN implementation in hospitals to increase feasibility, reach, and sustainability. Testing innovative implementation strategies for PN interventions has the potential for significant impact, as it will demonstrate implementation success of an intervention that can address the opioid epidemic in real-world settings and close the research-to-practice translation gap. The proposed study is a type II hybrid implementation-effectiveness trial of Navigation Services To Avoid Rehospitalization (NavSTAR). Our research team showed in a single-site randomized trial with 400 participants that NavSTAR significantly increased OAT entry, reduced readmissions, and was highly cost- effective compared to treatment as usual. The present study will test an Implementation Facilitation (IF) strategy following Proctor’s conceptual model using an external facilitator and an internal local clinical champion to provide training, resources, and performance feedback to implement NavSTAR in four hospitals. We hypothesize that engaging stakeholders (including patients, clinicians, and community leaders) in an IF strategy will create and test an implementation process that is feasible, acceptable, and effective in expanding access to OAT post-discharge. The R61 phase will conduct process mapping to identify existing hospital workflow and then refine an IF strategy through sequential pilot trials at 4 hospital sites in preparation for the R33 phase. The team’s NavSTAR operations manual will be adapted to the sites to train the existing staff. R61 milestones include the creation of an implementation toolkit and data sharing agreements. During the R33 phase, we will conduct a type II hybrid-implementation-effectiveness trial (N=720) of NavSTAR using a randomized stepped-wedge design with augmented inverse probability weighting to compare outcomes pre- and post-implementation. This study will develop an effective IF strategy to increase the reach and sustainability of NavSTAR and provide a path to scale-up this intervention to address the opioid epidemic.

项目摘要/摘要 阿片类药物的激动剂治疗（OAT）受到保护，免受过量的侵害，但不到20％的阿片类药物使用 疾病（OUD）进行这种治疗。 OUD的人中医院的利用率很高，可以是 “到达的时刻”来发起燕麦。但是，大多数医院都缺乏跟进患者之后的能力 释放。医院后基于理论的，基于经验支持的患者导航器（PN）干预措施 出院通过帮助患者导航复杂系统来减少访问社区燕麦的不平等 照顾。但是，由于需要 机构之间的协调，数据共享，专门的人员和社区资源。这是 在吸引潜水员，资源挑战的社区的环境中尤其如此。使这些干预措施 规模，需要策略来评估影响医院实施PN的因素以增加 可行性，覆盖范围和可持续性。测试PN干预措施的创新实施策略具有 产生重大影响的潜力，因为它将证明可以实施干预的成功 在现实世界中解决阿片类药物的流行，并缩小研究对实践翻译差距。 拟议的研究是导航服务的II型混合实施效应试验，以避免 重新住院（NAVSTAR）。我们的研究小组在一项单点随机试验中显示，400 NAVSTAR的参与者大大增加了燕麦的进入，减少了再入院，并且成本高 - 与往常一样，与治疗相比有效。本研究将测试实施促进（如果） 使用外部促进器和内部本地临床的Proctor概念模型之后的策略 冠军提供培训，资源和绩效反馈，以在四家医院实施NAVSTAR。 我们假设与利益相关者（包括患者，临床医生和社区领袖）吸引 策略将创建和测试可行，可接受且有效扩展的实施过程 访问燕麦送道后。 R61阶段将进行过程映射以识别现​​有医院 工作流程，然后通过在4个医院站点进行的顺序试验来完善IF策略，以准备 R33阶段。该团队的NAVSTAR操作手册将适应网站以培训现有员工。 R61 里程碑包括创建实施工具包和数据共享协议。在R33期间 阶段，我们将使用A NAVSTAR进行II型杂种效应试验（n = 720） 随机阶梯式设计设计具有增强的反可能性加权，以比较预先的结果 和实施后。如果增加覆盖范围的策略，这项研究将制定有效的有效 NAVSTAR的可持续性，并提供了扩大此干预措施以解决OID流行的途径。