Strategies to improve Utilization of Post-overdose Evidence-based Risk mitigation among Non-fatal Overdoses in VA (SUPER NOVA)

提高药物过量后利用率的策略 基于证据的 VA 非致命药物过量风险缓解策略 (SUPER NOVA)

基本信息

项目摘要

Background: Drug overdose is a leading cause of death, accounting for 70,630 deaths in the United States (US) in 20193. The majority of drug overdoses involve opioids, and opioid-involved stimulant deaths are rising with 3 out of every 4 cocaine-related deaths involving opioids and 53% of psychostimulant-related deaths involving opioids7. Drug overdose mortality among Veterans mirror these trends5,6. In Massachusetts, among individuals who died of an opioid overdose, 1 in 6 had a non-fatal overdose in the preceding 12 months17. These non-fatal overdoses serve as a promising target for opioid overdose prevention efforts, especially for evidence-based treatments such as medications for opioid use disorder (MOUD). The increase in stimulant- involved opioid overdoses also highlights the need to investigate strategies to improve uptake of evidence- based treatments for stimulant use disorders. Significance: In March 2019, the VHA Office of Mental Health and Suicide Prevention released a national clinical note template, the Suicide Behavior and Overdose Report (SBOR). The SBOR standardizes the reporting process, enhances the visibility of suicide and overdose events in the medical record, and is intended to improve clinical care after these events (e.g., by incorporating risk factors for overdose and strategies to mitigate risk, including referrals for care). However, the SBOR is currently mandated for intentional overdose and only recommended for unintentional overdose. Moreover, it is unclear the extent to which it is being used and whether its use improves post-overdose care as intended. Innovation and Impact: The proposed study will characterize non-fatal opioid-, stimulant-, and combined opioid and stimulant overdoses among VHA patients and the extent to which they receive recommended post- overdose care. Given that the SBOR will soon be mandated for all overdoses, and to ensure that VHA is doing everything it can to prevent overdose mortality among Veterans, it is critical to understand whether the SBOR is improving post-overdose care as intended and if additional strategies may be needed. Specific Aims: The proposed study will pursue the following specific aims: Aim 1: Characterize non-fatal opioid and/or stimulant overdoses within VHA and patient-, prescriber-, and setting-related factors associated with post-overdose treatment utilization. Aim 2: Describe utilization of the SBOR among providers of patients with non-fatal opioid and/or stimulant overdoses and associations between SBOR use, post-overdose treatment utilization, and treatment outcomes. Aim 3: Identify barriers and facilitators of post-overdose care and ways to improve it via interviews with VHA patients, patients’ concerned others, and treatment providers. Methodology: The Reach, Effectiveness, Adoption, Implementation, and Maintenance—RE-AIM—framework will guide our study. Aim 1: VHA patients with non-fatal overdoses will be identified using Corporate Data Warehouse (CDW), Community Care, and Medicare data from Fiscal Years 2014 to 2021 (FY2014-2021). Regression models will describe patient, prescriber, and setting factors associated with post-overdose care. Aim 2: Using CDW, Community Care, and Medicare data combined with VA Mortality Data Repository data, primary analyses will examine whether providers’ SBOR use is associated with patients’ post-overdose treatment utilization and reduced mortality using marginal structural Cox mediational models. Aim 3: Up to 60 total interviews will be conducted with VHA patients who experienced a non-fatal overdose, their concerned others, and VHA providers who documented a non-fatal overdose. Rapid and in-depth qualitative analytic approaches will be used; the former allows for rapid provision of actionable feedback to operations partners. Next Steps/Implementation: Our research team has strong operational partnerships and helped develop and implement the SBOR. Our team will ensure that findings are quickly translated to improve post-overdose care.
背景:药物过量是导致死亡的主要原因,在美国有70,630人死亡 (US)在20193年。大多数药物过量涉及阿片类药物,而阿片类药物涉及的兴奋剂死亡人数正在上升 每4例可卡因相关死亡中就有3例涉及阿片类药物, 涉及阿片类药物7.退伍军人中药物过量死亡率反映了这些趋势5,6。在马萨诸塞州, 在死于阿片类药物过量的个人中,六分之一的人在过去12个月内有非致命性过量17。 这些非致命性过量是阿片类药物过量预防工作的一个有希望的目标,特别是对于 基于证据的治疗,如阿片类药物使用障碍(MOUD)。兴奋剂的增加- 涉及阿片类药物过量也强调了研究改善证据吸收的策略的必要性- 治疗兴奋剂使用障碍 意义:2019年3月,VHA心理健康和自杀预防办公室发布了一份全国性的 自杀行为和药物过量报告(SBOR)SBOR将 报告过程,提高了自杀和用药过量事件在医疗记录中的可见性, 为了改善这些事件后的临床护理(例如,通过纳入过量的风险因素和策略, 降低风险,包括转诊)。然而,SBOR目前规定故意过量 而且只推荐用于无意中过量服用此外,目前还不清楚它被使用的程度 以及它的使用是否如预期的那样改善了过量用药后的护理。 创新和影响:拟议的研究将描述非致命性阿片类药物,兴奋剂和联合 VHA患者中阿片类药物和兴奋剂过量,以及他们接受推荐的治疗后的程度, 过量治疗鉴于SBOR将很快被授权用于所有过量,并确保VHA正在做 尽一切努力防止退伍军人过量死亡,关键是要了解SBOR是否 正在按照预期改善过量用药后的护理,以及是否需要其他策略。 具体目标:拟议的研究将追求以下具体目标: 目的1:描述VHA和患者、处方者和 与用药过量后治疗利用相关的环境相关因素。 目的2:描述SBOR在非致命性阿片类和/或兴奋剂患者提供者中的使用情况 过量用药以及SBOR使用、过量用药后治疗利用和治疗结果之间的相关性。 目标3:通过与VHA的访谈,确定过量后护理的障碍和促进因素以及改善方法 患者、患者关心的其他人和治疗提供者。 方法论:可及性、有效性、采用、实施和维护-RE-AIM-框架 将指导我们的研究。目的1:将使用公司数据识别非致死性药物过量的VHA患者 2014 - 2021财年(FY 2014 - 2021)的仓库(CDW)、社区护理和医疗保险数据。 回归模型将描述患者、开药者和与用药过量后护理相关的设置因素。 目标2:使用CDW、社区护理和医疗保险数据与VA死亡率数据存储库数据相结合, 主要分析将检查提供者的SBOR使用是否与患者的过量用药有关 使用边际结构考克斯中介模型分析治疗利用率和死亡率降低。目标3:高达60 将对经历非致命性过量的VHA患者进行总访谈, 其他人和VHA提供者记录了非致命性过量。快速深入的定性分析 将采用各种方法;前者可迅速向业务伙伴提供可采取行动的反馈。 下一步/实施:我们的研究团队拥有强大的运营合作伙伴关系,并帮助开发和 执行SBOR。我们的团队将确保调查结果迅速转化,以改善用药过量后的护理。

项目成果

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Elizabeth M. Oliva其他文献

Randomized Policy Evaluation of the Veterans Health Administration Stratification Tool for Opioid Risk Mitigation (STORM)
  • DOI:
    10.1007/s11606-022-07622-1
  • 发表时间:
    2022-06-17
  • 期刊:
  • 影响因子:
    4.200
  • 作者:
    Taeko Minegishi;Melissa M. Garrido;Eleanor T. Lewis;Elizabeth M. Oliva;Steven D. Pizer;Kiersten L. Strombotne;Jodie A. Trafton;Kertu Tenso;Pooja S. Sohoni;Austin B. Frakt
  • 通讯作者:
    Austin B. Frakt

Elizabeth M. Oliva的其他文献

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{{ truncateString('Elizabeth M. Oliva', 18)}}的其他基金

Effectiveness of a Rescue Medication in Preventing Opioid Overdose in Veterans
救援药物在预防退伍军人阿片类药物过量方面的有效性
  • 批准号:
    9757711
  • 财政年份:
    2017
  • 资助金额:
    --
  • 项目类别:

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