Chronic Disease and Health Outcomes of Older Adults with Opioid Use Disorders

! 项目概要/摘要： 这个项目是一个指导病人为导向的研究职业发展奖的修订申请。我 长期目标是成为衰老和成瘾研究的领导者，并在发展慢性病护理方面拥有专业知识 在老年人物质使用治疗中协调的交付模式。这个职业奖将提供 额外的培训，并促进完成拟议的指导研究，以继续我的职业生涯 发展成为一名独立的临床研究者。拟议的研究解决了一个关键的知识 在老年人药物使用障碍流行病背景下的差距。尽管认识到 患有阿片类药物使用障碍（OUD）的老年人通常在医学和社会方面很复杂， 这一弱势群体的具体健康状况和需求。我的职业规划 发展计划将使我能够通过与导师团队以及 与纽约市健康和心理卫生部和纽约市健康+医院合作， 一个综合保健系统，将监督和合作实现以下培训目标：（1）实现 应用于成瘾健康大型管理数据集的先进定量方法的专业知识 服务研究;（2）发展定性研究理论和实践的技能;（3）达到熟练程度 以及制定护理干预措施的经验。我将在以下指导下实现这些培训目标： 我的导师团队辅以正式的课程和研讨会，并进行研究， （1）说明艾滋病毒/艾滋病的流行情况， 急性医疗保健的高利用率、高医疗费用、多种慢性疾病和死亡率的风险因素 （2）检查工作人员和患者对OUD的态度、接受程度和障碍， 将老年护理模式纳入阿片类药物治疗计划;（3）开发和试点可行性， 老年人护理模式，用于老年疾病和老年OUD患者的慢性病管理 在R 01中进行测试。这项建议与国家药物管制研究所的优先事项直接一致， 滥用的战略规划--关于“物质使用障碍的复杂性和 物质使用问题”，以更好地了解物质使用的个人与复杂的条件。 这项研究将为广泛整合老年医学的循证模型制定未来的研究议程- 基于慢性病评估和管理纳入现有的物质使用治疗计划。 !

! Project Summary/Abstract: This project is a revised application for a Mentored Patient-Oriented Research Career Development Award. My long-term goal is to be a leader in aging and addiction research with expertise in developing chronic care delivery models coordinated within substance use treatment for older adults. This career award will provide additional training and facilitate the completion of the proposed mentored research to continue my career development into an independent clinician investigator. The proposed research addresses a critical knowledge gap in the setting of an epidemic of older adults with substance use disorders. Although it is recognized that older adults with opioid use disorders (OUD) are often medically and socially complex, very little is known regarding their specific health status and needs of this vulnerable population. My proposed career development plan will allow me to address this knowledge gap by working with a team of mentors as well as with the New York City Department of Health and Mental Hygiene and the New York City Health + Hospitals' integrated healthcare system who will supervise and collaborate on the following training goals: (1) to achieve expertise in advanced quantitative methods as applied to large administrative datasets for addiction health services research; (2) to develop skills in qualitative research theory and practice; and (3) to attain proficiency and experience in the development of a care intervention. I will attain these training goals with guidance from my mentorship team complemented by formal coursework and seminars, and by conducting a research agenda that uses a mixed methods approach with the following specific aims: (1) describe the prevalence and risk factors for high utilization of acute healthcare, high medical costs, multiple chronic conditions, and mortality among older adults with OUD; (2) examine staff and patient attitudes, acceptance, and barriers regarding the integration of geriatric models of care into opioid treatment programs; (3) develop and pilot for feasibility, a geriatric-based care model for geriatric conditions and chronic disease management for older adults with OUD to be tested in an R01. This proposal is directly aligned with the priorities of the National Institute on Drug Abuse’s strategic planning workgroup on the "Complexity of Substance Use Disorders and the Continuum of Substance Use Problems" to better understand substance use among individuals with complex conditions. This research will set a future research agenda for widely integrating an evidence-based model of geriatric- based chronic disease assessment and management into existing substance use treatment programs. !