Hub and Spoke Opioid Treatment Networks: 2nd Generation Approaches to Improve Medication Treatment for Opioid Use Disorders

阿片使用障碍(OUD)的药物治疗仍然是一种未得到充分利用的循证做法。 华盛顿州使用联邦阿片类药物-STR资金开发和实施华盛顿州中心和 分支模式(H&S)，一种综合护理模式，以扩大获得OUD药物的机会(丁丙诺啡， 美沙酮、纳曲酮)。他们的模式是一种灵活的方法，结合了初级保健和物质使用 治疗方案、转介组织、护士护理经理和护理导航员。基于初始的 在最初的6个H&S网络中取得成功，旨在增加服务不足和边缘化的人的机会 人口，华盛顿又资助了5个H&S网络，并开发了第二代低壁垒H&S网络 模式，在急诊科等17个非传统环境中设置用药启动点， 交换注射器、监狱和无家可归者收容所，与社区合作伙伴建立联系，这些合作伙伴将提供 药物维护。拟议的研究扩大了研究小组在RFA DA下资助的活动- 18-005通过研究新H&S模型的实施和有效性。我们维持着一款混合动力车 有效性-实施方法，并利用社交网络分析了解如何以及如何更好地 H&S网络的发展是为了服务于大学人口。因此，拟议研究的具体目标是：1) 审查扩展的第一代和第二代H&S模型在#年的实施和效果 处理OUD(例如，开始和保留OUD药物治疗、过量用药、就业、犯罪 司法介入)，扩展了我们最初的NIDA研究。2)对所有H&S进行社交网络分析 描述组织之间的连接、协调和集成模式的网络；如何 两种类型的H&S网络相互构建，它们有何不同；以及OUD药物治疗的途径是什么 客户在网络内部和跨网络使用的治疗。3)测试识别出的网络要素之间的关系 在目标2(例如，网络特征和治疗路径)和第一和第二- H&S一代模特。这项研究将集中在华盛顿注册的ODS成年人(18岁以上)。 医疗补助计划，大约90%的ODS患者在华盛顿接受治疗。将使用统计方法来 确保严格的准实验设计。这些发现将使我们能够理解是什么让H&S 有效增加OUD药物治疗并改善OUD患者预后的模式 谁以及如何将覆盖范围扩大到可能不寻求治疗的个人。广泛的传播努力在 问题简报和指南的形式将支持各州和供应商实施灵活的H&S模式， 包括护士护理经理、护理导航员和低障碍OUD用药启动。因此，我们将成为 能够帮助确保“不走错门”进入治疗，并获得最佳治疗模式 成功地促进了复苏。

Medication treatment for opioid use disorder (OUD) remains an underutilized evidence-based practice. Washington State used federal Opioid-STR funding to develop and implement the Washington State Hub and Spoke Model (H&S), an integrated care model to expand access to OUD medications (buprenorphine, methadone, naltrexone). Their model is a flexible approach incorporating primary care and substance use treatment programs, referral organizations, nurse care managers and care navigators. Based on the initial success in an original 6 H&S networks and aiming to increase access in underserved and marginalized populations, Washington funded 5 more H&S networks and developed a second-generation, low-barrier H&S model, to place medication initiation sites in 17 non-traditional settings such as emergency departments, syringe exchanges, jails, and homeless shelters, with connections to community partners who will offer OUD medication maintenance. The proposed study expands the research team’s activities funded under RFA DA- 18-005 by studying implementation and effectiveness of the new H&S model. We maintain a hybrid effectiveness-implementation approach, and utilize social network analysis to understand how and how well H&S networks develop to serve the OUD population. Thus, the specific aims for the proposed study are: 1) Examine the implementation and effectiveness of the expanded first- and second-generation H&S models in addressing OUD (e.g., initiation of and retention in OUD medication treatment, overdose, employment, criminal justice involvement), extending our original NIDA study. 2) Conduct a social network analysis among all H&S networks that will describe patterns of connection, coordination, and integration among organizations; how the two types of H&S networks build upon each other and how they differ; and what pathways of OUD medication treatment clients use within and across networks. 3) Test the relationships between network features identified in Aim 2 (e.g. network characteristics and treatment pathways) and effectiveness of the first- and second- generation H&S models. The study will focus on adults (18+) with OUDs in Washington who are enrolled in Medicaid, about 90% of people with OUDs in treatment in Washington. Statistical methods will be used to ensure a rigorous quasi-experimental design. The findings will enable us to understand what makes the H&S model effective for increasing OUD medication treatment and improving outcomes for people with OUD, for whom, and how to expand the reach to individuals who may not seek treatment. Wide dissemination efforts in the form of issue briefs and guidelines will support states and providers to implement flexible H&S models that incorporate nurse care managers, care navigators, and low-barrier OUD medication initiation. Thus, we will be able to help ensure “no wrong door” to enter treatment and access to the treatment models with the best success for promoting recovery.