Stagewise Implementation-To-Target- Medications for Addiction Treatment (SITT-MAT)

项目摘要/摘要 为了抗击美国的阿片类药物流行，大规模的努力一直集中在扩大药物获得方面 阿片类药物使用障碍(Moud)。虽然有迹象表明覆盖面和采用率有所改善，但具有讽刺意味的是， 持续-只有大约三分之一的专业成瘾治疗组织提供Moud。这项提议， 分阶段实施针对目标的药物治疗成瘾(Sitt-MAT)，不仅 推进了实施的科学，但也促进了我们对如何最好地应对 一种与物质有关的流行病。这是针对PAR-19-274：传播和 实施健康研究“，并与国家药物滥用研究所战略计划保持一致 “确保科学研究成果的有效翻译和实施，以改进预防 以及药物使用障碍的治疗。在自适应实施策略试验设计中，使用 创新的分阶段实施到目标的方法，72个社区成瘾治疗计划将 参与进来。阶段性实施到目标、阶梯式“关怀”类型的方法越来越多地部署 只有在需要的时候才会采取密集的战略。实施战略的顺序是：1)加强监测 和反馈；2)“NIATx/MAT Academy”，为期两天的关于Moud和NIATx(改善网络)的研讨会 成瘾治疗)-循证过程改进策略；3)随机化到NIATx 内部促进或NIATx外部促进；以及，4)如果NIATx没有实现成果目标 内部促进臂，分配给NIATx外部促进。我们评估了5个方面的相对影响 关于RE-AIM目标成果的实施战略的可能路径：覆盖范围、有效性、采用率和 实施质量。对维持成果进行评估是为了维持。多层次措施 背景决定因素是严格和系统的。在打开实施战略的“黑匣子”时， 我们使用标准化的衡量标准详细说明程序、保真度、参与度和成本。的集体专业知识 研究小组与国家护理和成瘾治疗系统建立了合作伙伴关系 组织，预测项目的成功执行。在我们提交这份申请的同时，美国仍在应对 柯萨奇病毒19大流行。在接下来的几个月里，全球卫生状况可能会反弹到相对正常的水平。 2020年12月。与此同时，疾控中心、SAMHSA、CMS和华盛顿州卫生保健管理局 已做好一切准备，继续为接受治疗的患者启动和管理Moud 成瘾治疗服务。因此，即使目前的检疫限制继续存在，我们预计 除亲自执行支助活动外，对研究方案的主要修改将是 过渡到视频会议格式。在这场大流行期间，对阿片类药物患者来说更加关键 利用障碍获得需要与提供者进行最低限度身体接触的药物干预。 这项研究有可能改变公共卫生和实施研究的范式。

PROJECT SUMMARY/ABSTRACT To combat the US opioid epidemic, massive efforts have been focused on expanding access to medications for opioid use disorder (MOUD). While there are indications of improved reach and adoption, an ironic gap persists—only about one-third of specialty addiction treatment organizations offer MOUD. This proposal, Stagewise Implementation-To-Target – Medications for Addiction Treatment (SITT-MAT), not only advances the science of implementation, but advances our empirical understanding of how to best respond to a substance-related epidemic. This is a revised application in response to PAR-19-274: Dissemination and Implementation Research in Health” and aligned with the National Institute on Drug Abuse Strategic Plan “ensuring the effective translation and implementation of scientific research findings to improve the prevention and treatment of substance use disorders.” Within an adaptive implementation strategy trial design, using an innovative stagewise implementation-to-target approach, 72 community addiction treatment programs will participate. The stagewise implementation-to-target, stepped “care” type approach, deploys increasingly intensive strategies only if needed. The sequence of implementation strategies are: 1) Enhanced Monitoring and Feedback; 2) “NIATx/MAT Academy,” a 2-day workshop on MOUD and NIATx (Network for Improvement of Addiction Treatment)—an evidence-based process improvement strategy; 3) Randomization to either NIATx Internal Facilitation or NIATx External Facilitation; and, 4) If outcome targets are not achieved in the NIATx Internal Facilitation arm, assignment to NIATx External Facilitation. We evaluate the relative impact of 5 possible paths of implementation strategies on RE-AIM target outcomes: reach, effectiveness, adoption, and implementation quality. Maintenance of outcomes is evaluated for sustainment. Measures of multi-level contextual determinants are rigorous and systematic. In opening the “black box” of implementation strategies, we detail procedures, fidelity, participation and costs using standardized measures. The collective expertise of the research team, the established partnership with a state system of care and addiction treatment organizations, forecasts successful project execution. As we submit this application, the US is still coping with the COVID19 pandemic. The global health situation may rebound to relative normalcy in the months from December 2020. Meanwhile, the CDC, SAMHSA, CMS, and the State of Washington Health Care Authority have all made accommodations to continue the initiation and management of MOUD for patients receiving addiction treatment services. Therefore, even if the current quarantine restrictions persist, we do not anticipate major modifications to the study protocol, except in-person implementation support activities would be transitioned to videoconference formats. During this pandemic, it is even more critical for patients with opioid use disorders to access pharmacological interventions that require minimal physical contact with providers. This study has the potential to shift the paradigm in public health and implementation research.