PROCare: Cloud Process Support for Opioid Recovery Participation and Learning

项目摘要 该项目将开发和评估基于奖励的阿片类药物康复管理平台（PROCare） 旨在解决阿片类药物治疗环境面临的两个普遍存在的问题：药物依从性差/ 保留，以及缺乏标准化和有效的结果监测系统，以告知护理。虽然 药物治疗是阿片类药物使用障碍（OUD）的标准治疗，依从性差是一个普遍存在的问题 与许多不良后果相关。阿片类药物治疗环境中的另一个普遍问题是 缺乏标准化和客观的工具。虽然监测治疗反应是标准的 由于对许多慢性病的治疗方法，成瘾治疗提供者在采用这些方法方面进展缓慢。 从标准化、有效和可靠的远程患者监护系统收集的结果数据具有很大的 推动临床决策的潜力，并最终帮助付款人，患者和家庭确定计划 根据经验发现患者从中获得缓解并经历康复。尽管 在跟踪依从性和记录结果方面具有巨大价值，但监控工作往往受到以下因素的阻碍： 依靠传统方法和利用现有工作人员收集结果。PROCare面向患者的应用程序 面向提供商的仪表板将利用两个已建立但未充分利用的基于证据的功能 激励恢复和加强遵守的方法（应急管理/自我监测） 丁丙诺啡和参与护理计划。通过自动化和提示，PROCare寻求解决 传统障碍阻碍了这两种有效干预措施的采用和广泛采用。 提供者将同时获得实时的、有临床意义的结果数据， 与国家标准和最佳做法（基于测量的护理）。远程依从性跟踪和 结果监测有可能将护理延伸到治疗办公室之外，并延伸到患者家中。 患者/提供者将从佛罗里达州迈阿密的一个大型国家资助的行为健康网络招募， 药物治疗OUD。将使用构建-测试-重建的迭代过程来开发PROCare (Aim 1）。个人深入访谈将遵循创新团队（I-Corps）方法， 使用精益Launchpad方法来开发假设，然后快速转移到持续的客户 的发现将对有执照的丁丙诺啡提供者样本（n=5）进行访谈，并将样本 接受丁丙诺啡的OUD患者（n=10）。一项为期4周的随机概念验证试点研究将 使用至少40名患者评估PROCare beta（目标2）的可行性、可接受性和有效性， 4名门诊处方者（目标2样本将不包括目标1访谈的任何患者）。数据将 在诱导和整个护理过程中使用具有强大心理测量特性的仪器收集，以测量 坚持、参与、参与常规结果评估和其他相关健康结果。

Project Summary This project will develop and evaluate a reward-based opioid recovery management platform (PROCare) designed to address two ubiquitous problems facing opioid treatment settings: poor medication adherence/ retention, and a lack of standardized and valid outcomes monitoring systems to inform care. Although medication is the standard of care for opioid use disorder (OUD), poor adherence is a pervasive problem associated with numerous adverse outcomes. Another widespread problem in opioid treatment settings is the absence of standardized and objective instruments. Although monitoring of treatment response is standard practice for many chronic conditions, addictions treatment providers have been slow to adopt these practices. Outcomes data collected from a standardized, valid, and reliable remote patient monitoring system holds great potential to drive clinical decision-making, and ultimately help payers, patients, and families identify programs from which patients have been empirically found to achieve remission and experience recovery. Despite the tremendous value in tracking adherence and documenting outcomes, monitoring efforts are often hindered by relying on traditional methods and using existing staff to collect outcomes. The PROCare patient-facing app and provider-facing dashboard will leverage the power of two established, but underutilized, evidence-based approaches (contingency management/self-monitoring) to incentivize recovery and increase adherence to buprenorphine and engagement in care plans. With automation and prompts, PROCare seeks to address traditional barriers that have precluded uptake and widespread adoption of these two effective interventions. Providers will simultaneously be afforded with real-time, clinically meaningful outcomes data in accordance with national standards and best practices (measurement-based care). Remote adherence tracking and outcomes monitoring has the potential to extend care outside the treatment office and into the patient's home. Patients/providers will be recruited from a large state-funded behavioral health network in Miami, FL offering medication treatment for OUD. An iterative process of build-test-rebuild will be used to develop PROCare (Aim 1). Individual in-depth interviews will be guided by the Innovation Corps (I-Corps) methodology, which uses the Lean Launchpad approach to developing hypotheses, then rapidly moving to continuous customer discovery. Interviews will be conducted with a sample of licensed buprenorphine providers (n=5), and a sample of OUD patients receiving buprenorphine (n=10). A 4-week randomized proof-of-concept pilot study will assess feasibility, acceptability, and effectiveness of PROCare beta (Aim 2) using a minimum of 40 patients and 4 outpatient prescribers (Aim 2 sample will not include any patients from Aim 1 interviews). Data will be collected at induction and throughout care using instruments with strong psychometric properties to measure adherence, engagement, participation in routine outcomes assessment, and other relevant health outcomes.