Understanding the role of community determinants in opioid use disorder and program implementation factors influencing patient adherence to opioid agonist therapy

项目总结/摘要 为有效应对阿片类药物流行提供信息，了解影响阿片类药物流行的多层次因素， 阿片类药物使用障碍（OUD）的风险至关重要。此外，虽然药物辅助治疗的疗效 (MAT)对于OUD已被证实，长期保留治疗一直是一个挑战。因此，需要努力 确定可以加强以改善OUD治疗结果的计划实施因素。的 K 01奖将为候选人提供必要的技能和必要的指导研究经验，以满足 她的长期目标是对OUD及其治疗进行独立，创新的研究， 战略投资，以防止OUD，并告知MAT计划的实施，以增加患者 坚持。该提案包括一个5年计划，其中包括韦德Berrettini，医学博士，博士， Brian Schwartz，MD，MS，H. Lester Kirchner，博士，硕士，Danielle Mowery，博士，硕士和Alanna Kulchak 拉姆，博士，硕士;教学培训活动，以满足候选人的培训目标;并进行两个阶段 一个研究项目，将提供候选人与领导流行病学研究的实质性经验 使用电子健康记录（EHR）数据和实施科学。拟议的研究将是 在Geisinger进行，这是一个综合医疗保健系统，服务于地理位置多样化的大区域， 宾夕法尼亚州，利用其研究资产-包括丰富的健康相关的EHR数据和链接 基因数据以及将研究整合到临床环境中的能力。研究的目的是 双重的目标1集中于导致OUD脆弱性的社会决定因素， 与OUD的社会经济、社会和物理条件相关的社区背景因素， 个体水平的遗传风险因素、医疗保健因素和共病医疗条件在这些疾病中的作用 关系目标1将利用Geisinger患者（n = 18，728）的EHR和遗传数据， 数据表征社区因素进行巢式病例对照研究。目标2旨在了解 影响患者对MAT for OUD依从性的计划实施因素。目标2是一种混合方法 一项研究，将涉及与关键信息提供者的访谈（n = 30），以确定多层面的障碍和促进因素 影响MAT成功，随后对Geisinger MAT诊所的成人患者（n = 500）进行调查，以量化 从患者的角度来看，影响MAT依从性的因素。这项研究的完成将实现 通过提供以下方面的培训来实现候选人的短期目标：（1）OUD，其治疗和物质使用障碍 研究;（2）自然语言处理;（3）上下文因素的测量;（4）统计分析 包括多层次建模和中介分析;（5）基因-环境相互作用研究;（6） 执行科学。拟议的研究将产生证据，以了解新的，未充分研究的风险 OUD的因素，对社区一级预防干预措施的投资的影响，以及健康 系统可以改善OUD患者的治疗保留率。

PROJECT SUMMARY/ABSTRACT To inform an effective response to the opioid epidemic, understanding the multilevel factors that influence risk of opioid use disorder (OUD) is critical. In addition, although the efficacy of medication-assisted treatment (MAT) for OUD is proven, long-term retention in treatment has been a challenge. Thus, efforts are needed to identify program implementation factors that can be strengthened to improve OUD treatment outcomes. The K01 Award will provide the candidate the requisite skills and mentored research experience necessary to meet her long-term goal of conducting independent, innovative research on OUD and its treatment that can guide strategic investment to prevent OUD and inform implementation of MAT programs to increase patient adherence. This proposal comprises a 5-year plan that includes mentorship by Wade Berrettini, MD, PhD, Brian Schwartz, MD, MS, H. Lester Kirchner, PhD, MS, Danielle Mowery, PhD, MS, and Alanna Kulchak Rahm, PhD, MS; didactic training activities to meet the candidate's training goals; and conduct of a two-phase research project that will provide the candidate with substantive experience leading epidemiologic research using electronic health record (EHR) data and in implementation science. The proposed research will be conducted at Geisinger, an integrated healthcare system serving a large geographically diverse region of Pennsylvania, leveraging its research assets—including a wealth of health-related EHR data and linked genetic data—and the ability to integrate research into the clinical environment. The aims of the research are twofold. Aim 1 centers on the social determinants that engender vulnerability to OUD, evaluating associations of community contextual factors related to socioeconomic, social, and physical conditions with OUD, and the role individual-level genetic risk factors, healthcare factors, and comorbid medical conditions play in these relations. Aim 1 will utilize EHR and genetic data from Geisinger patients (n = 18,728) coupled with secondary data characterizing community factors to conduct a nested case-control study. Aim 2 seeks to understand program implementation factors that impact patient adherence to MAT for OUD. Aim 2 is a mixed methods study that will involve interviews with key informants (n ≈ 30) to identify multilevel barriers and facilitators influencing MAT success, followed by a survey of adult patients (n = 500) in Geisinger's MAT clinics to quantify factors influencing MAT adherence from a patient perspective. Completion of this research will fulfill the candidate's short-term goals by providing training in: (1) OUD, its treatment, and substance use disorder research; (2) natural language processing; (3) measurement of contextual factors; (4) statistical analysis including multilevel modeling and mediation analysis; (5) gene-environment interaction research; and (6) implementation science. The proposed research will generate evidence to understand novel, understudied risk factors for OUD, with implications for investment in community-level prevention interventions, and how health systems can improve treatment retention among individuals with OUD.