PROCare: Cloud Process Support for Opioid Recovery Participation and Learning

项目摘要 该项目将开发和评估一个基于奖励的阿片类药物回收管理平台(ProCare) 旨在解决阿片类药物治疗环境中普遍存在的两个问题：服药依从性差/ 保留，以及缺乏标准化和有效的结果监测系统来向护理提供信息。虽然 药物治疗是治疗阿片类药物使用障碍的标准，依从性差是一个普遍存在的问题 与许多不良后果有关。阿片类药物治疗环境中另一个普遍存在的问题是 缺乏标准化和客观的文书。虽然监测治疗反应是标准的 对于许多慢性病来说，成瘾治疗提供者采用这些做法的速度一直很慢。 从标准化、有效和可靠的远程患者监控系统收集的结果数据具有 有潜力推动临床决策，并最终帮助付款人、患者和家庭确定计划 从经验上发现，患者可以从中获得缓解和康复。尽管 在跟踪遵守情况和记录结果方面具有巨大价值，但监测工作往往受到以下因素的阻碍 依靠传统方法，利用现有工作人员收集成果。面向患者的ProCare应用程序 面向提供商的控制面板将利用两个成熟但未得到充分利用的基于证据的控制面板的力量 采取措施(应急管理/自我监测)以激励恢复和增加遵守 丁丙诺啡和参与护理计划。通过自动化和提示，ProCare寻求解决 妨碍采纳和广泛采用这两种有效干预措施的传统障碍。 将同时向提供者提供实时的、具有临床意义的结果数据 符合国家标准和最佳做法(基于测量的护理)。远程合规性跟踪和 结果监测有可能将护理扩展到治疗办公室之外，进入患者的家中。 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中招募 乌德的药物治疗。将使用构建-测试-重建的迭代过程来开发ProCare (目标1)。个人深入访谈将遵循创新兵团(i-Corps)的方法，该方法 使用精益LaunchPad方法开发假设，然后快速转移到连续客户 发现号。访谈将对5名有执照的丁丙诺啡提供者进行，并对样本 丁丙诺啡治疗组(n=10)。为期4周的随机概念验证试点研究将 评估ProCare beta(目标2)的可行性、可接受性和有效性，使用至少40名患者和 4名门诊处方医生(AIM 2样本将不包括AIM 1访谈中的任何患者)。数据将是 在入院和整个护理过程中使用具有很强心理测量学特性的仪器进行测量 坚持、参与、参与常规结果评估，以及其他相关的健康结果。

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.