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

项目摘要/摘要 有效应对阿片类药物流行，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)的风险很大。此外，虽然药物辅助治疗的疗效 (MAT)对于已被证实的OUD来说，在治疗中长期保留一直是一个挑战。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。这个 K01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，以指导 战略投资以预防OUD并告知实施MAT计划以增加患者 坚持不懈。这项提案包括一项为期5年的计划，其中包括由韦德·贝雷蒂尼博士、医学博士、 Brian Schwartz，医学博士，硕士，H.莱斯特·基什内尔，博士，硕士，Danielle Mowery，博士，硕士和Alanna Kulchak Rahm，PhD，MS；为达到候选人的培训目标而进行的指导性培训活动；以及实施两个阶段 将为候选人提供领导流行病学研究的丰富经验的研究项目 在实施科学中使用电子健康记录(EHR)数据。拟议的研究将是 在盖辛格实施，这是一个集成的医疗系统，服务于地理位置不同的大片地区 宾夕法尼亚州，利用其研究资产-包括大量与健康相关的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 两重。目标1集中于导致OUD易感性的社会决定因素，评估关联 与社会经济、社会和身体状况有关的社区背景因素，以及 个人水平的遗传风险因素、医疗保健因素和并存的医疗条件在这些因素中发挥的作用 关系。AIM 1将利用来自盖辛格患者(n=18,728)的EHR和遗传数据，并结合第二次 描述社区因素的资料进行嵌套式病例对照研究。目标2试图理解 影响患者对MAT依从性的计划实施因素。目标2是一种混合方法 这项研究将涉及与关键信息提供人的面谈(n≈30)，以确定多层次障碍和促进者 影响MAT成功，随后对盖辛格MAT诊所的成年患者(n=500)进行调查以量化 从患者的角度影响垫片依从性的因素。这项研究的完成将满足 应聘者的短期目标通过提供以下方面的培训：(1)OUD、其治疗和药物使用障碍 研究；(2)自然语言处理；(3)语境因素测量；(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) 实施科学。拟议中的研究将产生证据来理解新的、未被研究的风险。 OUD的因素，对社区一级预防干预措施的投资的影响，以及如何 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.