Unintended Prolonged Opioid Use

意外长期使用阿片类药物

• 批准号: 9891122
• 负责人: W. Michael Hooten
• 金额: $ 141.12万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-15 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9891122
• 关键词: Address; Adoption; Adult; Attitude; Belief; Biochemical; Characteristics; Clinic; Clinical; Clinical Research; County; Data Set; Data Sources; Databases; Development; Disincentive; Electronic Health Record; Elements; Enrollment; Environment; Equation; Geography; Guidelines; Health; Healthcare; Incentives; Institution; Intervention; Knowledge; Literature; Measures; Mediating; Medical; Medical Record Linkage; Michigan; Minnesota; Modeling; Opioid; Pain; Pain management; Patient Recruitments; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacy facility; Population; Prevention strategy; Prospective Studies; Public Health; Questionnaires; Recording of previous events; Records; Research; Research Personnel; Retrospective Studies; Risk; Sampling; Secure; Site; Source; Structure; Study Subject; System; Testing; Time; Training; Translational Research; Universities; Work; clinical research site; cloud based; data mining; design; health care settings; innovation; interoperability; mHealth; medical schools; opioid epidemic; opioid use; patient population; prescription opioid; prescription opioid abuse; prescription opioid misuse; prevent; prospective; psychologic; recruit; social; wearable device

PROJECT SUMMARY Misuse of prescription opioids remains a public health crisis. Appropriate short-term use of these medications in opioid-naïve patients is indicated in select health care settings, but intentional short-term use is emerging as a previously under-recognized segue to unintended prolonged opioid use (UPOU). Clinical strategies aimed at preventing UPOU in health care settings are lacking due, in part, to absence of information about how this poorly-understood clinical phenomenon develops. Investigators at Mayo Clinic recently organized a group of thought leaders to develop a conceptual framework to explain UPOU. Such a framework is essential both to guide the study of this problem and to identify potential targets for interventions to reduce UPOU. The framework is comprised of three domains, including (1) patient characteristics; (2) practice environment characteristics; and (3) opioid prescriber characteristics that interact to either facilitate or impede UPOU. Within each domain, potential factors, drawn from the relevant literature, moderate or mediate the influence of each domain. However, much of the information needed to evaluate this framework does not currently exist. The widespread adoption of electronic health records (EHR) provides unique potential opportunities for translational research, including identifying subjects eligible for study participation and serving as a data sources for retrospective or prospective studies. However, interoperability between EHRs poses a considerable challenge to taking advantage of these opportunities. Researchers at the Yale School of Medicine recently launched Hugo, a secure mobile personal health (mHealth) platform that enables patients to access their information from multiple EHRs and other healthcare information sources, including commercial pharmacy records. The Hugo platform has tremendous potential to facilitate clinical research, especially research conducted across multiple centers – as information from diverse source systems at each institution can be easily integrated into a common dataset. In this application, four CTSA hubs (Mayo Clinic, University of Minnesota, University of Michigan, and Yale) will explore the Hugo platform's potential to facilitate clinical research, with the UPOU study as a use case. We will use the Hugo platform to identify incident cases of UPOU and prospectively recruit patients and opioid prescribers for assessments, as well as to evaluate the proposed conceptual framework using structural equation models. At this study's conclusion, we will have successfully deployed a highly innovative mHealth platform across multiple centers and this platform will be immediately available for widespread dissemination across the entire CTSA consortium and other clinical research sites. The information gained about UPOU will significantly advance core knowledge about this poorly understood clinical phenomenon. This newly acquired information will be used design, test, and deploy prevention strategies aimed at mitigating the risks of UPOU.

项目概要 滥用处方阿片类药物仍然是一场公共卫生危机。适当短期使用这些药物 在某些医疗保健机构中，未使用过阿片类药物的患者需要使用阿片类药物，但有意短期使用正在出现 此前未被充分认识到意外长期使用阿片类药物 (UPOU)。临床策略旨在 医疗保健机构中缺乏预防 UPOU 的措施，部分原因是缺乏有关如何预防 UPOU 的信息。 出现了难以理解的临床现象。 梅奥诊所的研究人员最近组织了一组思想领袖来开发一个概念框架 解释 UPOU。这样的框架对于指导该问题的研究和识别潜在的问题至关重要 减少 UPOU 的干预措施目标。该框架由三个领域组成，包括 (1) 患者 特征; （二）执业环境特点； (3) 相互作用的阿片类药物处方者特征 促进或阻碍 UPOU。在每个领域内，从相关文献中提取的潜在因素， 调节或调解每个领域的影响。然而，评估这一点所需的大部分信息 框架目前不存在。电子健康记录 (EHR) 的广泛采用提供了 转化研究的独特潜在机会，包括确定符合研究资格的科目 参与并作为回顾性或前瞻性研究的数据来源。然而，互操作性 电子病历之间的差异对利用这些机会提出了相当大的挑战。 耶鲁大学医学院的研究人员最近推出了 Hugo，一款安全的移动个人健康产品 (mHealth) 平台，使患者能够从多个电子病历和其他医疗保健中访问其信息 信息来源，包括商业药房记录。 Hugo 平台具有巨大的潜力 促进临床研究，特别是跨多个中心进行的研究——来自不同的信息 每个机构的源系统都可以轻松集成到通用数据集中。 在此申请中，四个 CTSA 中心（梅奥诊所、​​明尼苏达大学、密歇根大学和耶鲁大学）将 以 UPOU 研究作为用例，探索 Hugo 平台促进临床研究的潜力。我们将 使用 Hugo 平台识别 UPOU 事件案例并前瞻性招募患者和阿片类药物 处方者进行评估，并使用结构性评估拟议的概念框架 方程模型。根据本研究的结论，我们将成功部署高度创新的移动医疗 跨多个中心的平台，该平台将立即可供广泛传播 涵盖整个 CTSA 联盟和其他临床研究中心。获得的有关 UPOU 的信息将 显着提高了关于这种知之甚少的临床现象的核心知识。这个新收购的 信息将用于设计、测试和部署旨在减轻 UPOU 风险的预防策略。