A systems science approach for improving continuity of service in substance use disorder treatment

项目总结/摘要 增加获得物质使用障碍（SUD）治疗的机会是一项重要的公共卫生 由于药物滥用和依赖与严重的发病率有关， mortality.虽然循证治疗可用于治疗SUD患者，但只有11%的人 的需要专业治疗的人得到了治疗。治疗中的一个主要服务缺口是 SUD，特别是酒精和阿片类药物使用障碍，是患者参与治疗 或初步排毒（排毒）后的康复。从戒毒所出来的时候， 患者复发的风险很高，因此容易受到系统故障的影响。单独戒毒 如果患者在服药后不过渡到康复治疗， 放电到目前为止，关于戒毒后服务连续性问题的研究主要集中在 病人的特点和属性的组织，没有考虑到动态 在这种情况下，发生SUD治疗。迄今尚未探讨的是 戒毒后进入SUD治疗的服务项目之间的转介网络。目标 这项试点研究的目的是确定系统级预测因素（如网络）的影响 洛杉矶县SUD处理系统服务连续性的结构。的 中心假设将通过追求三个具体目标进行测试：1）描述的生态 公共资助的SUD治疗系统在洛杉矶县使用社会网络分析，2） 确定网络结构对从排毒到SUD治疗的服务连续性的影响 使用计算机仿真模型，以及3）为服务实现设计协议 网络干预，以增加戒毒后服务的连续性。的独特优势， 研究是由经验丰富的研究团队，理论驱动的方法，和应用系统 科学方法，如社会网络分析和基于代理的建模。实现 研究的目的将创造更好的了解程序的相互依赖性， 治疗系统，并展示系统层面的伙伴关系和转诊模式如何能够 影响患者结局。研究结果将用于计划R34研究，以测试 SUD治疗服务实施网络模型的实施和有效性。

Project Summary/Abstract Increasing access to substance use disorder (SUD) treatment is an important public health priority because substance abuse and dependence is associated with significant morbidity and mortality. While evidence-based treatments are available to care for people with SUDs, only 11% of individuals who need professional treatment receive it. One major service gap in the treatment of SUDs, particularly alcohol and opioid use disorders, is the engagement of patients in treatment or rehabilitation after an initial detoxification (detox). At the point of discharge from detox, patients are at high risk of relapse and therefore vulnerable to system failures. Detox alone increases patients' risk of mortality from overdose if they do not transition to rehabilitation after discharge. To date, research on the problem of continuity of service after detox has focused on patient characteristics and attributes of organizations with no consideration to the dynamic contexts within which SUD treatment occurs. What has not been explored to date is the impact of referral networks between service programs on entry into SUD treatment after detox. The goal of this pilot study is to determine the impact of systems-level predictors such as network structures on continuity of service in the SUD treatment system in Los Angeles County. The central hypothesis will be tested by pursuing three specific aims: 1) Describe the ecology of the publicly-funded SUD treatment system in Los Angeles County using social network analysis, 2) Determine the impact of network structure on continuity of service from detox to SUD treatment using computer simulation models, and 3) Design a protocol for a service implementation network intervention to increase continuity of service after detox. The unique strengths of the study are the experienced research team, theory-driven approach, and application of systems science methodologies such as social network analysis and agent-based modeling. Achieving the study aims will create greater understanding of the interdependency of programs within the treatment systems and demonstrate how partnerships and referral patterns at a system level can impact patient outcomes. The results of the study will be used to plan an R34 study to test the implementation and effectiveness of a service implementation network model for SUD treatment.