Understanding Factors that Limit Access to Opioid Use Disorder Treatment in the Hospital to Inform Innovative Approaches to Expand Hospital-Based Treatment

项目摘要的职业目标是成为一名独立的卫生服务研究人员。 苏珊·卡尔卡特拉描述了一个有指导的研究项目和一个严格的职业发展计划，这将 让她做好准备，成为医院整合阿片使用障碍(OUD)治疗的领导者 与出院后的护理挂钩。2017年，美国每天有近200人死于服药过量 美国(美国)。2012年，有527,000人因使用阿片类药物而住院，费用超过15美元 数十亿美元的医疗费用。对于有OUD的患者，在OUD患者中开始应用丁丙诺啡有被证实的好处 医院转介治疗，出院时开纳洛酮。不幸的是，OID通常不是 在医院解决，导致错过了为患者提供循证治疗的机会。 在美国，有5万名驻医院的医生(住院医生)在照顾住院患者。这片辽阔 Workforce提供了一个潜在的解决方案，在医院启动丁丙诺啡，在出院时提供纳洛酮， 并确保患者被转介到正在进行的OUD治疗。迫切需要确定为什么 丁丙诺啡和纳洛酮不是住院患者的常规处方，并可持续 利用现有的劳动力在医院内整合循证治疗。如果没有这方面的知识， 许多住院患者将无法获得挽救生命的药物。拟议的研究集中在 假设患者的知识和信念影响我们的治疗和医院目前的结构 并且进程不支持OUD处理。研究目标包括：1)对关键问题进行定性调查 三所学术医院循证护理与医院实践整合的障碍 医院医生、精神病学家、药剂师、社会工作者和护士；2)发展多要素 通过解决报告的障碍使循证乌德治疗适应医院环境的干预措施 在目标1中，通过系统地满足医院医生、护士、药剂师和社会工作者的需求 在他们的工作流程中；以及3)试点测试多组分干预以改善一家医院的OUD治疗 超过12个月。使用RE-AIM框架测量丁丙诺啡和纳洛酮处方的变化 (REACH)和获得处方丁丙诺啡(领养)前/后许可的提供者数量的变化 干预措施的实施。与医院提供商面谈，以确定持续实施的障碍并 了解对干预进行的调整，以提高其效率和易用性。要完成 为了达到这些目标，卡尔卡特拉博士将在1)定性研究方法方面进行培训，以便为干预提供信息 发展，2)干预发展以改变医疗保健提供者的行为，以及3)传播和 未来干预传播的实施科学。在完成这些活动后，以及 在密集的指导下，卡尔卡特拉博士将进行一项更大规模的比较有效性试验 进一步实施、测试和改进干预的保真度(未来版本01)。

PROJECT ABSTRACT With the career goal of becoming an independent health services researcher, Dr. Susan Calcaterra describes a mentored research project and a rigorous career development plan which will prepare her to become a leader in the integration of opioid use disorder (OUD) treatment in the hospital setting with linkage to OUD care post discharge. Nearly 200 people died every day from an overdose in 2017 in the United States (US). In 2012, there were 527,000 hospitalizations due to opioid use which cost more than $15 billion in medical care. For patients with OUD, there are proven benefits to initiating buprenorphine in the hospital with treatment referrals and prescribing naloxone at discharge. Unfortunately, OUDs are often not addressed in the hospital resulting in a missed opportunity to provide patients evidence-based treatment. There are 50,000 hospital-based physicians (hospitalists) caring for hospitalized patients in the US. This vast workforce offers a potential solution to initiate buprenorphine in the hospital, provide naloxone at discharge, and ensure patients are referred to ongoing OUD treatment. There is a critical need to determine why buprenorphine and naloxone are not routinely prescribed to hospitalized patients with OUD and to sustainably integrate evidence-based OUD treatment in the hospital using the existing workforce. Without this knowledge, many hospitalized patients will fail to receive lifesaving medication. The proposed research centers on the hypothesis that hospitalist’s knowledge and beliefs impact OUD treatment and the hospital’s current structures and processes do not support OUD treatment. Study Aims include: 1) a qualitative investigation into key barriers to the integration of evidence-based OUD care into hospital practice in three academic hospitals with hospitalists, psychiatrists, pharmacists, social workers and nurses; 2) the development of a multicomponent intervention that adapts evidence-based OUD treatment to the hospital setting by addressing reported barriers in Aim 1 and by systematically meeting the needs of hospitalists, nurses, pharmacists and social workers within their workflow; and 3) pilot test a multicomponent intervention to improve OUD treatment in one hospital over 12 months. Use the RE-AIM framework to measure changes in buprenorphine and naloxone prescribing (Reach) and changes in the number of providers licensed to prescribe buprenorphine (Adoption) pre/post intervention implementation. Interview hospital providers to identify ongoing Implementation barriers and to learn about adaptations made to the intervention to improve its efficiency and ease of use. To accomplish these aims, Dr. Calcaterra will pursue training in 1) qualitative research methods to inform the intervention development, 2) intervention development to modify healthcare provider behaviors, and 3) dissemination and implementation science for future intervention dissemination. Upon completion of these activities, along with intensive mentorship, Dr. Calcaterra will be positioned to conduct a larger comparative effectiveness trial to further implement, test and refine the intervention’s fidelity (future R01).