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

基于奖励的技术可改善急诊就诊后阿片类药物使用障碍治疗的启动

• 批准号: 10337501
• 负责人: Edwin D Boudreaux
• 金额: $ 49.9万
• 依托单位: Q2I, LLC
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10337501
• 关键词: Abstinence; Accident and Emergency department; Adherence; Ambulatory Care; Behavior; Behavior Therapy; Cessation of life; Clinical; Computer software; Cost Savings; Data; Devices; Drug Metabolic Detoxication; Economic Burden; Economics; Education; Emergency Situation; Emergency department visit; Feedback; Health; Individual; Inpatients; Intake; Intervention; Intervention Studies; Maintenance; Medical Care Team; Methods; Monitor; Morbidity - disease rate; Opiate Addiction; Opioid; Outcome; Outpatients; Participant; Patient Recruitments; Patients; Persons; Pharmaceutical Preparations; Phase; Population; Positioning Attribute; Protocols documentation; Provider; Randomized; Randomized Controlled Trials; Records; Recovery; Registries; Research; Rewards; Schedule; Small Business Technology Transfer Research; Suboxone; System; Technology; Telephone; Testing; Training; Treatment Protocols; Treatment outcome; Update; Urine; Visit; Work; acceptability and feasibility; acute care; base; contingency management; cost; cost effectiveness; design; evidence base; experience; flexibility; follow up assessment; group intervention; improved; indexing; innovation; mHealth; medication-assisted treatment; meetings; mobile application; mortality; novel; opioid misuse; opioid use; opioid use disorder; patient oriented; patient population; preference; programs; public health relevance; recruit; screening, brief intervention, referral, and treatment; smartphone Application; software systems; tool; treatment adherence; treatment as usual; usability; user centered design

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.

项目总结/文摘