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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要阿片类药物激动剂治疗 (OAT) 可防止用药过量，但阿片类药物使用人数不足 20% OUD 患者接受此类治疗的医院利用率很高，并且可能是一种治疗方法。然而，大多数医院缺乏后续跟进患者的能力。出院后基于理论、经验支持的患者导航 (PN) 干预。出院通过帮助患者驾驭复杂的系统，减少获得基于社区的 OAT 的不平等然而，大规模实施 PN 干预措施仍面临挑战。跨机构协调、数据共享、专职人员和社区资源。在覆盖多元化、资源匮乏的社区的环境中尤其如此。规模，需要制定策略来评估影响医院 PN 实施的因素，以增加测试 PN 干预措施的创新实施策略具有可行性、影响范围和可持续性。具有重大影响的潜力，因为它将证明干预措施的实施是否成功解决现实世界中阿片类药物的流行问题，并缩小研究与实践之间的差距。拟议的研究是导航服务避免的 II 类混合实施效果试验我们的研究团队在一项针对 400 名患者的单中心随机试验中显示。参与者认为 NavSTAR 显着增加了 OAT 入学率、减少了再入院率，并且成本很高与常规治疗相比，本研究将测试实施促进（IF）。遵循 Proctor 概念模型的策略，使用外部促进者和内部局部临床冠军提供培训、资源和绩效反馈，以在四家医院实施 NavSTAR。我们让利益相关者（包括患者、倡导者和社区领袖）参与 IF 战略将创建并测试可行、可接受且有效扩展的实施流程出院后访问 OAT R61 阶段将进行流程图以确定现有医院。工作流程，然后通过在 4 个医院地点进行的连续试点试验来完善 IF 策略，为 R33 阶段。团队的 NavSTAR 操作手册将根据现场情况进行调整，以培训现有员工。里程碑包括在 R33 期间创建实施工具包和数据共享协议。阶段，我们将使用 NavSTAR 进行 II 型混合实施有效性试验（N = 720）随机阶梯楔形设计与增强逆概率加权比较预本研究将制定有效的 IF 策略，以扩大覆盖面和影响力。 NavSTAR 的可持续性，并为扩大这种干预措施以解决阿片类药物流行问题提供了途径。