PROCare: Cloud Process Support for Opioid Recovery Participation and Learning

项目总结

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.