Reward-based technology to improve opioid use disorder treatment initiation after an ED visit

项目总结/摘要 美国每年有数百万人滥用阿片类药物，导致数千人死亡，并造成数十亿美元的损失。 美元的经济负担。阿片类药物使用障碍（OUD）的药物辅助治疗（MAT）是高度 有效，但只有一小部分OUD患者获得MAT，治疗不依从性很常见， 与不良结果相关。这个STTR快速通道提案旨在提高Suboxone的价格 从急诊室招募的OUD患者中的（丁丙诺啡/纳洛酮）治疗开始和依从性 和住院急症护理。为了实现这些目标，该项目将加强阿片类药物成瘾康复 支持（OARS），一个现有的Q2 i公司技术，与一个新的基于证据的奖励，应急 管理（CM）功能。CM干预系统地奖励（加强）特定行为，如治疗 开始和坚持治疗出勤和无药物尿检，是非常有效的。桨 通过CM组件（OARS+CM）增强的解决方案，允许自动计算、交付和 根据治疗行为的客观证据兑现奖励可能是改善治疗效果的关键。 Suboxone启动和依从性。在该提案的第1阶段，现有的OARS临床医生门户和患者 将修改移动的应用程序，以适应从急性护理环境进入软件系统 并自动管理和提供奖励，以使用以患者为中心的设计原则创建OARS+CM。 与OUD患者和其他关键利益相关者的可用性会议将为设计提供信息。主要可用性结局 将被检查和程序迭代更新。在达到里程碑时，将进行概念验证试点 可用性、可接受性和对初始行为目标的影响，约20例患者和至少4例 提供商在达到里程碑后，将进行RCT，其中急性护理OUD患者适合门诊治疗 招募Suboxone（N = 150）并将其分配至三种研究条件之一：1）照常治疗（TAU）， 包括筛查、短暂干预和由经过培训的临床医生转诊治疗，2）OARS，以及3） 桨+CM。两个干预组的积极干预窗口期为12周。患者将 在离开急诊室之前入职。在门诊Suboxone设置中，治疗依从性数据 阿片类药物的使用将从临床记录中记录六个月。电话随访评估和 将在第1个月、第3个月（研究干预期结束）和第6个月进行静态登记研究审查。初级 Suboxone治疗开始结局将是安排和完成Suboxone摄入。初级 Suboxone治疗结局为第6个月时的持续戒烟和最长戒烟持续时间。 分析将检查通过减少研究之间的急性护理访视来避免和节省成本的数据 条件

Project Summary/Abstract Millions of people in the US misuse opioids each year, leading to thousands of deaths and costing billions of dollars in total economic burden. Medication assisted treatment (MAT) for opioid use disorder (OUD) is highly efficacious, but only a fraction of OUD persons access MAT, and treatment non-adherence is common and associated with poor outcomes. This STTR Fast Track proposal is designed to increase rates of Suboxone (buprenorphine/naloxone) treatment initiation and adherence among OUD patients recruited from emergency and inpatient acute care. To accomplish these aims, the project will enhance the Opioid Addiction Recovery Support (OARS), an existing Q2i company technology, with a new evidence-based reward, contingency management (CM) function. CM interventions systematically reward (reinforce) specific behaviors like treatment initiation and adherence with therapy attendance and drug-free urine tests, and are highly efficacious. An OARS solution enhanced with a CM component (OARS+CM) that allows for the automatic calculation, delivery, and redemption of rewards contingent on objective evidence of treatment behaviors may be key to improving Suboxone initiation and adherence. In Phase 1 of this proposal, the existing OARS clinician portal and patient mobile application will be modified to accommodate entry into the software system from an acute care setting and to automatically manage and deliver rewards to create OARS+CM using patient-centered design principles. Usability sessions with OUD patients and other key stakeholders will inform design. Primary usability outcomes will be examined and the program iteratively updated. On meeting milestones, there will be proof-of-concept pilot of usability, acceptability, and effects on initial behavior targets with approximately 20 patients and at least 4 providers. On meeting milestones, a RCT will follow, in which acute care OUD patients appropriate for outpatient Suboxone (N = 150) are recruited and allocated to one of three study conditions: 1) treatment as usual (TAU), comprised of screening, brief intervention, and referral to treatment by a trained clinician, 2) OARS, and 3) OARS+CM. The active intervention window for the two intervention groups will be 12 weeks. Patients will be onboarded prior to discharge from acute care. In the outpatient Suboxone setting, data on treatment adherence and opioid use will be captured from clinical records for six months. Telephone follow-up assessments and vital statics registry reviews will be at month 1, month 3 (end-of-study intervention period), and month 6. Primary Suboxone treatment initiation outcomes will be scheduling and completing the Suboxone intake. Primary Suboxone treatment outcomes will be sustained abstinence at Month 6 and longest duration of abstinence. Analysis will examine data on cost avoidance and cost savings through reduced acute care visits between study conditions.