C-DIAS RP 2: Implementing contingency management for stimulant use in specialty addiction treatment organizations

C-DIAS研究项目2：项目总结/摘要 这项严格的实验解决了一个关键的公共卫生问题-兴奋剂/阿片类药物流行病的上升。它 通过对多层次实施战略的评估推进实施科学，并具体说明 结果的背景决定因素。兴奋剂构成了阿片类药物新的致命的第四波浪潮 疫情在阿片类药物使用障碍患者中，兴奋剂的使用与更持久的 阿片类药物使用;艾滋病毒感染风险较高;家庭、医疗、法律的和职业问题水平较高;以及 过量致死的风险更高应急管理是对兴奋剂最有效的干预措施 是阿片类药物使用障碍（MOUD）的循证辅助药物。然而， 提供MOUD的阿片类药物治疗计划（OTP）仍然很低：事实上，可以说，获得CM是 成瘾治疗服务领域最大的研究与实践差距。C-DIAS研究的目标 项目2是进行第三类混合有效性-实施试验，以评估多层次的 在实施战略方面，科学服务实验室（SSL），安装CM用于OTP中的兴奋剂。的 SSL有三个核心组成部分：教学培训;绩效反馈;和外部促进。项目 使用通用的C-DIAS框架、度量和方法来指导SSL评估。利用步进式 楔形设计，一个由10个公共部门OTP组成的区域队列将随机接受五个不同的SSL 时间点。每隔六个时间，10个OTP中的每一个都将提供CM上所有可用患者图表的数据 分娩和患者结局。每个OTP还将招募10例患者/楔形（n = 500例患者）完成 基线访谈和3个月随访。此外，每个检察官办公室的工作人员将报告检察官办公室的背景情况， 在三个时间点确定执行成果的决定因素。这项研究将严格评估是否 由历史最悠久的国家中介供应商之一制定的多层次执行战略 组织-SAMHSA技术转移中心，将改善实施和病人 结果。实施结果由RE-AIM指导，包括CM覆盖、采用和实施 和维持，而患者结局包括CM有效性的测量，如兴奋剂戒断 和治疗保留。这项研究将通过打开黑盒子来推进C-DIAS的科学目标。 实施策略，并探讨了环境的中介和调节影响， 执行成果。该研究项目侧重于积极的实施阶段，利用了一个双- 与C-DIAS的定向协同关系。这方面的一些但不是所有例子包括：1）标准化 战略实施背景、成果和程序细节的衡量标准; 2）PI（Becker）在以下方面的作用 C-DIAS研究核心; 3）关键项目之间的密切合作和指导网络 人员和C-DIAS PI;以及4）可用于C-DIAS Research建模的数据的协调 核心专家。

C-DIAS RESEARCH PROJECT 2: PROJECT SUMMARY/ABSTRACT This rigorous experiment addresses a critical public health problem--the rising stimulant/opioid epidemic. It advances implementation science through the evaluation of a multi-level implementation strategy and specifies of contextual determinants of outcomes. Stimulants constitute a new and deadly fourth wave of the opioid epidemic. Among persons with opioid use disorder, stimulant use has been associated with more persistent opioid use; higher risk of HIV infection; higher levels of family, medical, legal, and vocational problems; and higher risk of lethal overdose. Contingency management (CM) is the most effective intervention for stimulant use and is an evidence-based adjunct to medication for opioid use disorder (MOUD). Yet, uptake of CM in opioid treatment programs (OTPs) that provide MOUD remains low: in fact, access to CM is arguably one of the greatest research-to-practice gaps in the addiction treatment services field. The goal of C-DIAS Research Project 2 is to conduct a type III hybrid effectiveness-implementation trial to evaluate a multi-level implementation strategy, the Science to Service Laboratory (SSL), to install CM for stimulant use in OTPs. The SSL has three core components: didactic training; performance feedback; and external facilitation. The project employs common C-DIAS frameworks, measures, and methods to guide SSL evaluation. Utilizing a stepped wedge design, a regional cohort of 10 public sector OTPs will be randomized to receive SSL at five distinct time points. At six intervals, each of the 10 OTPs will provide data from all available patient charts on CM delivery and patient outcomes. Each OTP will also recruit 10 patients per wedge (n = 500 patients) to complete a baseline interview and 3-month follow-up. In addition, staff from each OTP will report on contextual determinants of implementation outcomes at three timepoints. This study will rigorously evaluate whether a multi-level implementation strategy developed by one of the longest-standing national intermediary purveyor organizations--the SAMHSA Technology Transfer Centers, will improve both implementation and patient outcomes. Implementation outcomes are guided by RE-AIM and include CM Reach, Adoption, Implementation and Sustainment, while patient outcomes include measures of CM Effectiveness such as stimulant abstinence and treatment retention. The study will advance the C-DIAS scientific aims by unpacking the black box of implementation strategies and exploring the mediational and moderating influence of context on implementation outcomes. Focused on the active IMPLEMENT phase, this Research Project leverages a bi- directional synergistic relationship with C-DIAS. Some but not all examples of this include: 1) standardized measures of implementation context, outcomes and procedural details of strategies; 2) PI (Becker)’s role on the C-DIAS Research Core; 3) a close network of collaboration and mentoring among the key project personnel and C-DIAS PI; and 4) harmonization of data that can be used for modeling by C-DIAS Research Core experts.