Integrated Collaborative Care for Substance Use Disorders

药物滥用障碍的综合协作护理

• 批准号: 8677857
• 负责人: Katherine E Watkins
• 金额: $ 81.01万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8677857
• 关键词: Address; Adoption; Alcohol or Other Drugs use; Alcohols; Caring; Case Manager; Cessation of life; Chronic; Chronic Care; Clinic; Clinical; Communities; Comorbidity; Complex; Comprehensive Health Care; Consent; Consult; County; Criminal Justice; Data; Diabetes Mellitus; Diagnosis; Disease; Economics; Education; Educational Materials; Effectiveness; Elements; Enrollment; Evaluation; Evidence based practice; Evidence based treatment; Family; Federally Qualified Health Center; Focus Groups; Group Interviews; Health; Health Personnel; Health Professional; Healthcare; Healthcare Systems; Hospitals; Individual; Information Systems; Malignant Neoplasms; Measures; Medical; Mental Depression; Mental Health; Methods; Modeling; Morbidity - disease rate; Opiates; Outcome; Patient Care Team; Patients; Pharmaceutical Preparations; Population; Primary Health Care; Printing; Process; Process Measure; Productivity; Provider; Randomized; Randomized Controlled Trials; Records; Relative (related person); Resources; Services; Solutions; Substance Use Disorder; Substance abuse problem; Surveys; System; Testing; Training; United States; Visit; Work; alcohol use disorder; base; behavioral health; chronic care model; collaborative care; comparative effectiveness; cost; cost effectiveness; design; effective therapy; evidence base; follow-up; health care service organization; hospital readmission; implementation research; improved; mortality; motivational enhancement therapy; physical conditioning; premature; primary care setting; role model; tool

DESCRIPTION (provided by applicant): Most individuals with opiate and alcohol-use disorders (OAUD) do not receive treatment. Primary care is an ideal setting in which to deliver OAUD treatment, yet evidence-based OAUD treatment is rarely provided. Barriers to delivery include insufficient organizational support and lack of provider role models and clinical support. We propose to evaluate the effectiveness of two strategies for increasing use of evidence-based treatment for OAUD within primary care: integrated collaborative care (ICC) and education and resources (E&R). While both strategies provide primary care practices with the same clinical information, ICC addresses these barriers by including organizational and technical support for delivering evidence-based care. ICC is grounded in the chronic care model and includes a behavioral health provider working as part of the care team. Essential elements of ICC strategy include a decision support component to help providers with complex patients, and a restructuring of the delivery and clinical information systems to support the delivery of evidence-based care. Our approach to implementing ICC is based on the organizational transformation model and quality improvement. We define the E&R strategy as providing printed educational materials and access to resources along with provider education. Both strategies are designed to increase the delivery of two evidence-based practices: motivational enhancement therapy and medication assisted therapy. We propose a 5-year mixed methods study and will conduct a RCT, with randomization occurring at the level of the care team and patient. We partner with 5 Venice Family Clinic (VFC) clinics, two hospitals in LA County, and COPE Health Solutions. VFC is a large federally qualified health center (FQHC) and the largest free clinic in the United States. Our approach includes document review, focus groups, interviews, and surveys for obtaining data on the adoption process and implementation outcomes; analysis of patient records and patient surveys on service system and patient outcomes; and analysis of provider financial records and patient records and surveys for estimating costs. We will enroll 400 patients with an OAUD diagnosis and follow them at 3 and 12 months. Our specific aims are: 1) To measure the process and extent of ICC and E&R implementation; 2) To test the effectiveness of ICC compared to an E&R strategy in promoting A. Implementation outcomes B. Service system outcomes and C. Patient outcomes; and 3) To estimate provider costs for each strategy. We define implementation outcomes as measures of the acceptability, adoption, appropriateness, feasibility, and sustainability of evidence-based OAUD treatment. We define service system outcomes as 1) process measures of treatment quality and 2) treatment co-morbidities. We define patient outcomes as hospital readmissions, OAUD outcomes, patient functioning, negative consequences from substance use, and unmet need. We define cost outcomes as start-up costs, operating costs and medical/psychiatric cost offsets.

描述（由申请人提供）：大多数患有阿片类药物和酒精疾病的人（OAUD）不接受治疗。初级保健是提供OAUD治疗的理想环境，但很少提供基于证据的OAUD治疗。交付的障碍包括组织支持不足以及缺乏提供者的榜样和临床支持。我们建议评估两种策略在基于循证使用基于循证的治疗中的OAUD的有效性：综合协作护理（ICC）和教育和资源（E＆R）。尽管两种策略都提供了具有相同临床信息的初级保健实践，但ICC通过包括提供基于证据的护理的组织和技术支持来解决这些障碍。 ICC以慢性护理模型为基础，其中包括作为护理团队一部分工作的行为健康提供者。 ICC策略的基本要素包括一个决策支持部分，以帮助提供者患有复杂患者的提供者，以及对支持提供循证护理的交付和临床信息系统的重组。我们实施ICC的方法基于组织转型模型和质量改进。我们将E＆R策略定义为提供印刷的教育材料以及提供者教育以及提供资源的机会。两种策略旨在增加两种基于证据的实践的交付：动机增强疗法和药物辅助治疗。我们提出了一项为期5年的混合方法研究，并将进行RCT，并在护理小组和患者的水平上进行随机分组。我们与5家威尼斯家庭诊所（VFC）诊所，洛杉矶县的两家医院和Cope Health Solutions合作。 VFC是一个大型联邦合格的健康中心（FQHC），也是美国最大的免费诊所。我们的方法包括文档审查，焦点小组，访谈和调查，以获取有关采用过程和实施结果的数据；分析有关服务系统和患者预后的患者记录和患者调查；以及提供者财务记录以及患者记录和调查的分析，以估算成本。我们将招募400名患有OAUD诊断的患者，并在3个月和12个月的时间关注他们。我们的具体目的是：1）衡量ICC和E＆R实施的过程和程度； 2）与E＆R策略相比，测试ICC的有效性。 3）估计每个策略的提供商成本。我们将实施成果定义为衡量可接受性，采用，适当性，可行性和可持续性的衡量循证OAUD治疗方法。我们将服务系统的结果定义为1）处理质量的过程度量和2）治疗合并症。我们将患者结局定义为医院的再入院，OAUD结果，患者功能，药物使用的负面后果以及未满足的需求。我们将成本成本定义为启动成本，运营成本和医疗/精神病学成本偏移。