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

随着职业目标成为一个独立的卫生服务研究员，博士。 Susan Calcaterra描述了一个指导研究项目和一个严格的职业发展计划， 准备她成为阿片类药物使用障碍（OUD）治疗在医院环境整合的领导者 与出院后的OUD护理有关。2017年，每天有近200人死于过量用药。 United States（US）. 2012年，有527，000人因使用阿片类药物而住院，费用超过15美元 亿元医疗保健。对于OUD患者，已证实在治疗期间开始丁丙诺啡治疗的益处 医院治疗转诊和处方纳洛酮出院。不幸的是，OUD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50，000名医院医生（住院医师）照顾住院患者。这片广袤 劳动力提供了一个潜在的解决方案，在医院开始丁丙诺啡，在出院时提供纳洛酮， 并确保患者接受持续的OUD治疗。迫切需要确定为什么 丁丙诺啡和纳洛酮不是OUD住院患者的常规处方， 利用现有劳动力在医院整合循证OUD治疗。如果没有这些知识， 许多住院病人得不到救命的药物。拟议的研究中心在 假设住院医师的知识和信念影响OUD治疗和医院的现有结构 并且工艺不支持OUD处理。研究目的包括：（1）对关键问题进行定性研究。 在三所学术医院中，将循证OUD护理纳入医院实践的障碍， 医院医生、精神科医生、药剂师、社会工作者和护士; 2）发展一个多成分的 通过解决报告的障碍，使循证OUD治疗适应医院环境的干预措施 通过系统地满足住院医生、护士、药剂师和社会工作者的需求， 在他们的工作流程中;和3）在一家医院试点测试多组分干预以改善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 （覆盖范围）和获得丁丙诺啡处方许可的提供者数量的变化（收养） 干预实施。与医院供应商进行访谈，以确定持续的实施障碍， 了解对干预措施进行的调整，以提高其效率和易用性。完成 为了实现这些目标，Calcaterra博士将继续接受定性研究方法的培训，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，和3）传播和 未来干预传播的实施科学。这些活动完成后，沿着 在密集的指导下，Calcaterra博士将进行更大规模的比较有效性试验， 进一步实施、测试和完善干预的保真度（未来R 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).