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 护理和关键成果级联：与吸毒的纵向联系美国服药过量死亡人数急剧增加，迫切需要改善获得药物的机会并根据 OUD 保留对阿片类药物使用障碍 (OUD) 进行药物治疗 (MOUD) 的循证护理级联护理框架。级联模型强调治疗过程中的关键阶段或过渡。具有 OUD 的个体可降低不良结果的风险：至关重要的是，成功的 MOUD 启动和长期然而，在芬太尼兴起的时代，目前对阿片类药物的同时使用尚不可知。由于非法药物供应普遍存在，公共卫生框架需要根据环境条件进行调整我们的研究方法源自阿片类药物使用和治疗的概念。反应和不良结果沿着轨迹、在不同的时间范围内演变，强调随着时间的推移，需要根据患者目标量身定制减少伤害的方法。当地药物供应中芬太尼的接触量增加将阻碍成功的治疗，我们还期望延长丁丙诺啡治疗的持续时间，以防止用药过量的风险，即使在患者中也是如此在护理期间间歇性使用阿片类药物然而，在护理期间使用阿片类药物的患者可能会遇到这种情况。停止治疗后风险降低程度减弱。迫切需要对治疗途径和结果进行纵向分析，包括毒理学结果和治疗保留的交叉作用和预后意义及其因为目前的证据涉及最佳治疗期间和治疗后的过量风险。护理持续时间缺乏，特别是在个体患者或亚人群水平上，目前几乎没有指导羊群和卫生系统如何最好地调整服务提供和我们的建议旨在填补这些关键的知识空白。我们将链接来自多州丁丙诺啡提供商（美国最大的丁丙诺啡提供商）的 95,000 人的 EHR 记录。最大的 OBOT 提供商——利用医疗补助索赔和国家死亡指数 (NDI) 数据创建一个新的、独特的、涵盖 2014 年至 2022 年十几个州的综合数据库，以在入院前、基线和在多年的护理期间，现在要考虑的是芬太尼猛烈攻击期间的死亡率。 MOUD 的最大支付者。我们的研究结果将对临床护理、政策、系统设计产生广泛的影响。我们的目标是建立一个实证的质量测量开发和医疗保健管理系统。证据基础，为患者风险（例如不良后果，包括过量）的临床评估提供信息鉴于阿片类药物流行病的规模和严重性，临床和政策至关重要。通过仔细考虑对大量常规护理经验数据的严格分析来制定策略跨州人口。