A multi-team system implementation strategy to improve buprenorphine adherence for patients who initiate treatment in the emergency department

多团队系统实施策略，以提高在急诊科开始治疗的患者的丁丙诺啡依从性

• 批准号: 10740793
• 负责人: Stephen G Henry
• 金额: $ 100.52万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10740793
• 关键词: Abstinence; Accident and Emergency department; Address; Administrator; Adoption; Affect; Alcohols; Buprenorphine; California; Caring; Clinical; Clinical Trials; Complex; Consolidated Framework for Implementation Research; Data; Data Collection; Drug Addiction; Drug usage; Elements; Emergency Care; Emergency department visit; Frequencies; Funding; Goals; Health system; Hospitals; Hybrids; Individual; Insurance; Interview; Knowledge; Leadership; Legal patent; Low income; Maintenance; Medicaid; Mission; Modeling; Outpatients; Overdose reduction; Patient Care; Patient-Focused Outcomes; Patients; Peripheral; Pharmaceutical Preparations; Phase; Primary Care; Professional counselor; Protocols documentation; Public Health; Randomized; Science; Site; Surveys; System; Systems Theory; Testing; Treatment outcome; United States Agency for Healthcare Research and Quality; United States National Institutes of Health; Work; addiction; bridge program; buprenorphine treatment; candidate identification; care coordination; care fragmentation; care seeking; compliance behavior; design; effective therapy; effectiveness measure; effectiveness outcome; effectiveness/implementation study; implementation measures; implementation outcomes; implementation research; implementation science; implementation strategy; implementation study; improved; innovation; lens; member; novel; opioid mortality; opioid overdose; opioid use disorder; overdose death; patient population; patient safety; post implementation; prescription monitoring program; primary care clinic; primary care patient; primary care team; primary care visit; programs; prospective; retention rate

PROJECT SUMMARY/ABSTRACT Drug overdose deaths continue to rise in the US due largely to opioid-related deaths, despite availability of buprenorphine, a highly effective treatment for opioid use disorder (OUD). Starting buprenorphine for OUD in emergency departments is an increasingly common practice across the US. A large clinical trial found that emergency department-initiated buprenorphine plus referral to primary care for ongoing treatment significantly increased buprenorphine treatment rates, but effects were not sustained past two months. Effective strategies to help patients start, restart, and sustain buprenorphine treatment are urgently needed to reduce overdose deaths. To increase buprenorphine treatment, California established CA Bridge, a state-funded program in >200 hospitals that offers same-day buprenorphine initiation plus referral to primary care for patients with OUD who seek care in emergency departments. However, suboptimal care coordination persists, especially for low- income patients. This study’s overarching hypothesis is that an implementation strategy that encourages coordination involving ongoing partnerships rather than one-time handoffs between emergency department and primary care teams will improve buprenorphine treatment and retention rates for patients who start buprenorphine in the emergency department. The objective is to refine an implementation strategy informed by multiteam systems theory that is focused on improving OUD care coordination between emergency department and primary care teams and then test this strategy in a hybrid type III effectiveness-implementation study using a stepped wedge design randomized at the site level. The R61 phase will involve collecting and analyzing data from two CA Bridge sites to identify core and peripheral elements of this implementation strategy and develop an implementation strategy, a preliminary implementation blueprint, and data collection protocols for the R33 phase. The stepped wedge study during the R33 phase will involve four CA Bridge sites. Implementation outcomes will include between-team coordinating activities and care transitions. Effectiveness outcomes will include rates of outpatient buprenorphine initiation (filling ≥1 outpatient prescription) and sustained buprenorphine treatment 3, 6, and 12 months after patients leave the emergency department, assessed with data from California’s prescription drug monitoring program. Factors associated with successful implementation and sustainability will be identified through pre- and post-implementation interviews with patients, staff, and managers at each emergency department and primary care clinic and through engagement with relevant stakeholders, including patients, CA Bridge statewide leadership and prospective payers. Study results will be used to develop an implementation blueprint that hospitals in California and across the US can use to improve OUD treatment outcomes for patients who start buprenorphine in emergency departments. This study will advance efforts to improve long-term buprenorphine treatment rates at scale for low-income and other vulnerable patients who disproportionately seek OUD care in emergency departments.

项目摘要/摘要 药物过量死亡在美国继续增加，这在很大程度上是由于阿片类药物相关的死亡，目的地的可用性 丁丙诺啡是阿片类药物使用障碍（OUD）的高效治疗方法。启动丁丙诺啡的OUD 急诊部门是整个美国越来越普遍的做法。一项大型临床试验发现 急诊室发起的丁丙诺啡加上转介给初级保健，以进行正在进行的治疗 丁丙诺啡治疗率提高，但在过去两个月中的影响没有持续。有效的策略 为了帮助患者开始，重新启动和维持丁丙诺啡治疗以减少过量 死亡人数。为了增加丁丙诺啡治疗，加利福尼亚建立了CA Bridge，这是一项由国家资助的计划 > 200医院提供当天丁丙诺啡倡议​​，并为OUD患者转诊至初级保健 在急诊室寻求护理的人。但是，次优的护理协调持续存在，特别是对于低 - 收入患者。这项研究的总体假设是一种鼓励的实施策略 涉及持续合作伙伴关系而不是急诊室之间的交接的协调 初级保健团队将改善开始的患者的丁丙诺啡治疗和保留率 急诊室的丁丙诺啡。目的是完善由 多立场系统理论的重点是改善紧急情况之间的OUD护理协调 部门和初级保健团队，然后在混合III型实施中测试此策略 使用在现场级别随机进行阶梯楔形设计的研究。 R61阶段将涉及收集和 分析来自两个CA桥接站点的数据，以识别此实现的核心和外围元素 策略和开发实施策略，初步实施蓝图和数据收集 R33阶段的协议。 R33期间的坡度研究将涉及四个CA桥接位。 实施成果将包括团队之间的协调活动和护理过渡。效力 结果将包括门诊贝班确实载倡议（填充≥1个门诊处方）和 患者离开急诊科后，持续的丁丙诺啡治疗3、6和12个月， 通过加利福尼亚处方药监测计划的数据进行评估。与成功相关的因素 实施和可持续性将通过实施前后的访谈来确定 每个急诊科和初级保健诊所的患者，员工和经理以及通过参与 与包括患者在内的相关利益相关者，CA桥梁全州领导层和潜在付款人。学习 结果将用于开发加利福尼亚州和美国各地医院的实施蓝图 用于改善在急诊部门开始丁丙诺啡的患者的OUD治疗结果。这 研究将在低收入和 其他不成比例地在急诊室寻求OUD护理的弱势患者。