Implementation Evaluation of an Emergency Department Community Health Worker-Peer Recovery Specialist Program for People with Opioid Use Disorder

针对阿片类药物使用障碍患者的急诊科社区卫生工作者同伴康复专家计划的实施评估

• 批准号: 10566046
• 负责人: Elizabeth ANNE Samuels
• 金额: $ 35.62万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10566046
• 关键词: Implementation; Evaluation; Emergency; Department; Community

The emergency department (ED) is on the front lines of the overdose epidemic, treating an increasing number of people with opioid use disorder (OUD). In the year after an ED visit for an opioid overdose, more than one in twenty patients will die. Each visit represents a crucial opportunity to link patients to harm reduction and treatment services, there are significant gaps in service provision across Rhode Island EDs with less than half receiving take home naloxone, less than one in three receiving behavioral counseling, and one in five linked to addiction treatment. To improve provision of lifesaving harm reduction and treatment services in the ED, we launched a multidisciplinary ED community health worker (CHW)-peer recovery specialist program, the Substance Misuse Assistance Response Team (SMART), at a large, academic, urban medical center which cares for the majority of opioid overdose patients in Rhode Island. Drawing from models of existing peer recovery specialist, CHW, and health promotion advocate programs, SMART is a novel ED-based program that provides people with a substance-use related ED visit individualized support, short term case management, navigation to substance use treatment, harm reduction services, and social services both in and out of the ED. In recent years there has been a proliferation of ED peer recovery programs, but little is known about their effectiveness and implementation potential. In this study, we will conduct a hybrid type 1 effectiveness-implementation study to assess the effectiveness of an ED CHW-peer recovery specialist program and identify barriers and facilitators of successful implementation in the acute care setting. In this mixed methods study, we will use hospital and state administrative databases, surveys, and qualitative interviews to evaluate the effectiveness of the ED CHW/peer recovery program on a range of patient and program outcomes, including provision of harm reduction and treatment services and changes in acute care utilization, repeat overdose, and mortality among people receiving SMART. Consistent with best practices in hybrid type 1 trials, we will simultaneously gather data on inner and external factors influencing implementation potential in the acute care setting. This study will provide pilot effectiveness data for a subsequent R01 application for a multilevel, comprehensive implementation study to identify implementation strategies for program enhancement, dissemination, and sustainability.

急诊科（艾德）处于药物过量流行的第一线，治疗越来越多的人 阿片类药物使用障碍（OUD）在因阿片类药物过量而前往艾德就诊后的一年内，超过二十分之一的患者会 死的每次访问都是将患者与减少伤害和治疗服务联系起来的重要机会， 罗得岛急诊室的服务提供存在显著差距，不到一半的急诊室接受纳洛酮带回家，不到一半的急诊室接受纳洛酮带回家， 三分之一的人接受行为咨询，五分之一的人接受成瘾治疗。改善提供 为了在艾德提供减少伤害和治疗服务，我们启动了一个多学科的艾德社区卫生工作者 （CHW）-同侪康复专家计划，物质滥用援助反应小组（SMART），在一个大的， 学术，城市医疗中心，照顾大多数阿片类药物过量患者在罗得岛。借鉴 现有的同行恢复专家，CHW和健康促进倡导计划的模型，SMART是一种新的基于ED的 为人们提供物质使用相关的艾德访问个性化支持，短期病例管理， 导航到物质使用治疗，减少伤害服务，以及ED内外的社会服务。 多年来，艾德同伴康复计划一直在扩散，但对其有效性知之甚少， 实施潜力。在这项研究中，我们将进行一项混合1型有效性-实施研究，以评估 一个艾德CHW同行恢复专家计划的有效性，并确定成功的障碍和促进因素 在急性护理环境中实施。在这种混合方法的研究中，我们将使用医院和国家行政 数据库，调查和定性访谈，以评估艾德CHW/同行恢复计划对一个 患者和项目结果的范围，包括提供减少伤害和治疗服务以及 急性护理利用率、重复用药过量和接受SMART治疗的患者的死亡率。符合以下方面的最佳做法 混合1型试验，我们将同时收集影响实施潜力的内部和外部因素的数据， 急诊护理环境。本研究将为随后的R 01多层次应用提供试点有效性数据， 全面的实施研究，以确定方案增强、传播和 持续发展