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

项目摘要/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 美元的总经济负担。药物辅助治疗(MAT)治疗阿片类药物使用障碍(OUD)是非常重要的 有效，但只有一小部分人接触垫子，治疗不坚持是常见的和 与糟糕的结果相关。此STTR快速通道提案旨在提高Suboxone的费率 (丁丙诺啡/纳洛酮)急诊OUD患者的治疗开始和依从性 和住院急诊护理。为了实现这些目标，该项目将加强阿片成瘾的康复 支持(OARS)，一项现有的Q2i公司技术，具有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)特定的行为，如治疗 开始和坚持治疗出诊和无药物尿检，是非常有效的。一把桨 使用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换奖励可能是改善的关键 亚伯克松的启动和黏附。在本计划的第一阶段，现有的OARS临床医生门户和患者 移动应用程序将被修改，以适应从急性护理环境进入软件系统 并使用以患者为中心的设计原则自动管理和提供奖励，以创建OARS+CM。 与OUD患者和其他关键利益相关者举行的可用性会议将为设计提供信息。主要可用性结果 将被检查并迭代地更新程序。在达到里程碑时，将进行概念验证试验 对大约20名患者和至少4名患者的可用性、可接受性和对初始行为目标的影响 供应商。在达到里程碑时，将紧随其后的是RCT，其中急诊患者适合门诊 亚伯克松(N=150)被招募并被分配到三种研究条件之一：1)照常治疗(TAU)， 包括筛查、简短干预和由训练有素的临床医生转介治疗，2)划桨，3) 桨+厘米。两个干预组的积极干预窗口为12周。病人将会是 在急救出院前登船的。在门诊Suboxone设置中，关于治疗依从性的数据 阿片类药物的使用将从六个月的临床记录中记录下来。电话跟踪评估和重要 静态注册审查将在1个月、3个月(研究结束干预期)和6个月进行。 Suboxone治疗开始的结果将是计划和完成Suboxone的摄入。主要 亚伯酮治疗的结果将是在6个月时持续戒断，并持续最长时间的戒断。 分析将检查通过减少两次研究之间的急性护理就诊来避免成本和节省成本的数据 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.