C-DIAS RP3: Scaling-out app-based treatments: a multi-level strategy to promote equity across primary care patients with substance use

C-DIAS 研究项目 3：项目摘要/摘要 在维持阶段，C-DIAS 研究项目 3 解决了一个关键的科学和公共卫生差距：如何 在向物质使用障碍 (SUD) 患者提供数字治疗时，我们能否提高公平性 初级保健？针对 SUD 和的各种有效的数字治疗（应用程序或基于网络的干预措施） 共病可用于初级保健，并且许多已在不同的领域进行了评估 人口。 SUD 的数字化处理可能会减少不平等，因为它们：1）有潜力 减少准入障碍，惠及更多人； 2）可以规避SUD的耻辱； 3）允许患者开始 从舒适和私密的家中进行干预。与此同时，数字化治疗也可能会放大 “数字鸿沟”因素造成的不平等。我们将严格评估实施情况 向弱势群体“扩展”数字治疗的策略，作为潜在改善的方法 为 SUD 患者提供数字护理的公平性，并作为如何在道德上维持数字治疗的模型 现实世界的医疗保健。之前的务实试验发现，基于证据的实践和其他举措很难 在没有领导力和诊所支持的情况下维持下去，因此我们的多层次研究设计和分析计划侧重于 这些问题。我们位于华盛顿 Kaiser Permanente 的交付系统合作伙伴致力于合作 与我们一起研究在 32 个初级保健诊所扩大现有数字化治疗的多层次策略 华盛顿州应对预期的公平挑战。所有诊所都将收到由 3 部分组成的系统级套件 适合初级保健的实施策略： 1) 全系统审计和反馈； 2）病人 弱势群体成员的故事； 3) 让主要利益相关者参与解决问题 减少弱势群体使用数字治疗的障碍。测试临床水平 实施策略中，12 个诊所的子集将被随机分配以接受外部协助或接受对照 1:1 平行组设计中的条件（无促进）。将通过比较覆盖范围来评估公平结果 跨由关键社会决定因素（例如种族/民族）定义的患者亚组。具体目标是：1) 估计多层次实施策略（系统和诊所层面）对增加公平性的影响 初级保健诊所的 SUD 患者接受数字化治疗的范围； 2) 描述成本 并遵守实施策略，并研究背景决定因素如何影响公平 实施和患者结果。研究项目 3 利用与 C 的双向关系 DIAS，部分通过以下方式证明：1）实施背景、结果和程序的标准化衡量标准 策略细节； 2）PI（Glass）在C-DIAS研究核心中的作用； 3）紧密的合作网络 对关键项目人员和 C-DIAS PI 进行指导； 4）可用于协调的数据 由 C-DIAS 研究核心专家建模； 5) 用于决策的数字治疗实施成本数据- 制造商； 6) 通过 C-DIAS 扩大研究结果的传播和影响的选择。

C-DIAS RESEARCH PROJECT 3: PROJECT SUMMARY/ABSTRACT At the SUSTAIN phase, C-DIAS Research Project 3 addresses a critical scientific and public health gap: How can we improve equity when offering digital treatments to patients with substance use disorders (SUDs) in primary care? A wide range of effective digital treatments —app or web-based interventions—for SUDs and comorbid conditions are available for use in primary care, and many have been evaluated in diverse populations. Digital treatments for SUDs could potentially reduce inequities, as they: 1) have the potential to reach more people by reducing access barriers; 2) can circumvent SUD stigma; and 3) allow patients to initiate interventions from the comfort and privacy of home. At the same time, digital treatments may also magnify inequities due to factors stemming from the “digital divide.” We will rigorously evaluate an implementation strategy to “scale-out” digital treatments to disadvantaged populations as an approach to potentially improve equity in digital care for people with SUDs, and as a model for how to ethically sustain digital treatments in real-world healthcare. Prior pragmatic trials found that evidence-based practices and other initiatives are hard to sustain without leadership and clinic buy-in, so our multi-level study design and analytic plan focuses on these issues. Our delivery system partners in Kaiser Permanente Washington are committed to collaborating with us to study multi-level strategies for scaling-out existing digital treatments in 32 primary care clinics in Washington State to address expected equity challenges. All clinics will receive a 3-part system-level set of implementation strategies that are suitable for primary care: 1) system-wide audit and feedback; 2) patient stories from members of disadvantaged populations; and, 3) engaging key stakeholders in problem solving to reduce barriers to the use of digital treatments among disadvantaged populations. To test a clinic-level implementation strategy, a subset of 12 clinics will be randomized to receive external facilitation or to a control condition (no facilitation) in a 1:1 parallel-groups design. Equity outcomes will be assessed by comparing reach across subgroups of patients defined by key social determinants (e.g., race/ethnicity). Specific Aims are to: 1) estimate the impact of a multi-level implementation strategy (system- and clinic-level) in increasing equity in the reach of digital treatments among patients with SUD in primary care clinics; and 2) describe the costs of and adherence to the implementation strategies, and examine how contextual determinants can impact equity in implementation and patient outcomes. Research Project 3 leverages a bi-directional relationship with C- DIAS, demonstrated in part by: 1) standardized measures of implementation context, outcomes and procedural details of strategies; 2) PI (Glass)’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; 4) harmonization of data that can be used for modeling by C-DIAS Research Core experts; 5) data on digital treatment implementation costs for decision- makers; and 6) expanded options for dissemination and impact of study findings through C-DIAS.