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.

项目概要/摘要 尽管有可用的阿片类药物，但美国药物过量死亡人数继续上升，主要原因是与阿片类药物相关的死亡 丁丙诺啡，一种治疗阿片类药物使用障碍 (OUD) 的高效药物。 一项大型临床试验发现，急诊科在美国越来越普遍。 急诊科启动的丁丙诺啡加上转诊至初级保健机构进行持续治疗显着 丁丙诺啡治疗率有所提高，但效果在过去两个月内并未持续。 帮助患者开始、重新开始和维持丁丙诺啡治疗，以减少用药过量 为了增加丁丙诺啡治疗，加利福尼亚州建立了 CA Bridge，这是一项由州资助的项目。 > 200 家医院为 OUD 患者提供当日丁丙诺啡起始治疗和转诊至初级保健服务 然而，护理协调仍然不理想，特别是对于低收入人群。 这项研究的总体假设是鼓励收入患者的实施策略。 协调涉及持续的伙伴关系，而不是急诊科之间的一次性交接 初级保健团队将改善开始使用丁丙诺啡的患者的治疗和保留率 急诊科使用丁丙诺啡的目的是完善实施策略 多团队系统理论，专注于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 型有效性实施中测试该策略 R61 阶段将采用随机的阶梯式楔形设计进行收集和研究。 分析来自两个 CA Bridge 站点的数据，以确定该实施的核心和外围元素 战略并制定实施策略、初步实施蓝图和数据收集 R33 阶段的阶梯式楔形研究将涉及四个 CA Bridge 站点。 实施结果将包括团队间协调活动和护理过渡的有效性。 结果将包括门诊丁丙诺啡起始使用率（配药≥1份门诊处方）和 患者离开急诊科后 3、6 和 12 个月持续接受丁丙诺啡治疗， 根据加州处方药监测计划的数据进行了评估。 将通过实施前和实施后的访谈来确定实施和可持续性 每个急诊科和初级保健诊所的患者、工作人员和管理人员以及通过参与 与相关利益相关者，包括患者、CA Bridge 主席领导和潜在付款人研究。 研究结果将用于制定实施蓝图，加州和美国各地的医院可以 用于改善在急诊室开始使用丁丙诺啡的患者的 OUD 治疗结果。 研究将推动努力提高低收入人群的长期丁丙诺啡治疗率 其他弱势患者在急诊科寻求 OUD 护理的比例过高。