The OUD Cascade of Care and Critical Outcomes: Longitudinal Linkage with Opioid Use

OUD 护理和关键成果级联：与阿片类药物使用的纵向联系

基本信息

批准号：
10741268
负责人：
Arthur R Williams
金额：
$ 71.07万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, 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：
2023-06-15 至 2028-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10741268
关键词：
Accounting Address Aftercare Attenuated Buprenorphine Caring Cessation of life Characteristics Clinical Communities Data Data Set Databases Development Disease remission Drops Drug Controls Drug usage Electronic Health Record Emergency department visit Exposure to Fentanyl Force of Gravity Geography Goals Harm Reduction Health system Healthcare Illicit Drugs Improve Access Individual Intake Knowledge Link Literature Long-Term Care Measurement Measures Medicaid Modeling Opioid Opioid agonist Outcome Overdose Pathway interactions Patient Discharge Patient risk Patients Pattern Penetration Pharmaceutical Preparations Pharmacotherapy Policies Population Predictive Factor Prevalence Prognosis Provider Public Health Recording of previous events Records Research Risk Risk Estimate Risk Reduction Role Service provision Single-Payer System Site System Test Result Time Toxicology addiction adverse event risk adverse outcome buprenorphine treatment care episode clinical care clinical decision support clinical practice demographics design drug testing evidence base experience fentanyl exposure improved improved outcome indexing individual patient insurance claims longitudinal analysis mortality mortality risk opioid epidemic opioid use opioid use disorder overdose death overdose risk patient population patient retention personalized approach prognostic significance protective effect psychostimulant research clinical testing risk stratification support tools treatment as usual treatment duration treatment response

项目摘要

The OUD Cascade of Care and Critical Outcomes: Longitudinal Linkage with Drug Use Dramatic increases in overdose deaths in the US have created an urgent need to improve access to and retention in evidence-based care for opioid use disorder (OUD) with medication (MOUD), under the OUD Cascade of Care framework. The Cascade model emphasizes key stages or transitions during the treatment of individuals with OUD to reduce risks of adverse outcomes: critically, successful MOUD initiation and long-term retention. However, it has thus far been agnostic towards concurrent opioid use. In the era of rising fentanyl prevalence in the illicit drug supply, public health frameworks need to adjust for environmental conditions that may impact clinical outcomes. Our research approach draws from a conceptualization of opioid use, treatment response, and adverse outcomes as evolving along trajectories, over varying timeframes emphasizing the need for harm reduction approaches tailored to patient goals as they evolve over time. While we hypothesize that greater exposure to fentanyl in the local drug supply will impede successful treatment engagement, we also expect longer durations of buprenorphine treatment to protect against overdose risk, even among patients with intermittent opioid use while in care. However, patients with opioid use in care will likely experience attenuated risk reductions following treatment discontinuation. There is a critical need for longitudinal analyses of treatment pathways and outcomes, including the intersecting roles and prognostic significance of toxicology results and treatment retention, and their relationship to overdose risk during and following treatment. Because current evidence concerning optimal durations of care, especially at the individual patient or sub-population level, is lacking, there is currently little empirical evidence to guide clinicians and health systems regarding how to best tailor service provision and estimate risks of adverse events at the patient level. Our proposal seeks to fill these critical gaps in knowledge. We will link EHR records for 95,000 individuals from a multi-state buprenorphine provider-- the nation’s largest OBOT provider-- with Medicaid claims and National Death Index (NDI) data to create a new, unique, integrated database spanning 2014-2022 in a dozen states to observe patients before intake, at baseline, and while in care over multiple years, accounting for mortality during the onslaught of fentanyl. Medicaid is now the largest payer for MOUD. Our findings will have broad implications for clinical care, policy, systems design, quality measurement development, and healthcare administration. Our goal is to establish an empirical evidence base to inform clinical evaluations of patient risks (e.g. adverse outcomes including overdose) at the individual level. Against the scale and gravity of the evolving opioid epidemic, it is vital that clinical and policy strategies are informed by careful consideration of rigorous analyses of empirical data with large, usual-care populations across state lines.

OUD级联护理和关键结果：与吸毒的纵向连接美国过量死亡人数的急剧增加已经迫切需要改善进入的机会在OUD下，在对阿片类药物使用障碍（OUD）（MOUD）的基于证据的护理（OUD）中保留。级联护理框架。级联模型强调在处理期间的关键阶段或过渡降低不良结果风险的人：批判性，成功的穆德开始和长期保留。但是，到目前为止，它对并发阿片类药物的使用不可知。在芬太尼上升的时代非法药物供应中的患病率，公共卫生框架需要适应环境条件可能会影响临床结果。我们的研究方法借鉴了阿片类药物的概念化，治疗在不同的时间范围内，反应和不良后果随着轨迹的发展而强调随着时间的推移，对患者目标量身定制的损害减少方法的需求。当我们假设在当地药物供应中，更大的芬太尼接触将阻碍成功的治疗参与，我们还期望丁丙诺啡治疗的持续时间更长，即使在患者中，也可以预防过量风险在护理时使用间歇性阿片类药物。但是，在护理中使用阿片类药物的患者可能会经历治疗停止后，降低风险的减弱。迫切需要对治疗途径和结果进行纵向分析，包括与毒理学结果和保留率的角色相交和预后意义及其在治疗期间和之后与过量风险的关系。因为目前有关最佳的证据缺乏护理持续时间，尤其是在个体患者或子人群水平上，目前几乎没有指导临床医生和卫生系统的经验证据，以了解如何最佳量身定制服务提供和估计患者级别不良事件的风险。我们的建议旨在填补知识中的这些关键差距。我们将链接来自多州丁丙诺啡提供商的95,000个人的EHR记录 - 该国的最大的Obot提供商 - 具有医疗补助索赔和国家死亡指数（NDI）数据，以创建一个新的，独特的，跨越2014 - 2022年的综合数据库在摄入量，基线和在多年的照料期间，在芬太尼袭击中占死亡率。医疗补助现在是 MOUD的最大付款人。我们的发现将对临床护理，政策，系统设计，质量测量开发和医疗保健管理。我们的目标是建立经验证据基础，以告知患者风险的临床评估（例如，不良结果包括过量）个人级别。反对不断发展的阿片类药物流行的规模和重力，临床和政策至关重要通过仔细考虑对经验数据的严格分析，以大型，通常的护理来了解策略跨州线的种群。