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

中心辐射型阿片类药物治疗网络：改善阿片类药物使用障碍药物治疗的第二代方法

• 批准号: 9894581
• 负责人: SHARON REIF
• 金额: $ 278.51万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9894581
• 关键词: Accident and Emergency department; Address; Adult; Alcohol or Other Drugs use; American Indians; Buprenorphine; Care given by nurses; Caring; Case Manager; Cessation of life; Characteristics; Client; Communities; Criminal Justice; Data; Effectiveness; Employment; Enrollment; Ensure; Evaluation; Evidence based practice; Evolution; Experimental Designs; Funding; Generations; Goals; Grant; Guidelines; Health Personnel; Health Services Accessibility; Health Services Research; Homelessness; Hybrids; Individual; Infrastructure; Jail; Knowledge; Link; Maintenance; Medicaid; Methadone; Methods; Modeling; Naltrexone; National Institute of Drug Abuse; Needle-Exchange Programs; Opioid; Overdose; Pathway Analysis; Pathway interactions; Patients; Pattern; Pharmaceutical Preparations; Population; Primary Health Care; Provider; Ramp; Recommendation; Recovery; Research; Research Activity; Rural; Rural Community; Shelter facility; Site; Social Network; Statistical Methods; Study models; Testing; Thinking; Treatment outcome; United States Substance Abuse and Mental Health Services Administration; Veterans; Washington; addiction; base; comparison group; evidence base; flexibility; improved; improved outcome; network models; opioid epidemic; opioid use disorder; programs; response; success; treatment program

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.

阿片类药物使用障碍（OUD）的药物治疗仍然是一种未充分利用的循证实践。 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， 辐条模式（H&S），一种综合护理模式，以扩大获得OUD药物（丁丙诺啡， 美沙酮、纳洛酮）。他们的模式是一种灵活的方法，包括初级保健和物质使用 治疗计划、转诊组织、护理管理人员和护理导航员。基于初始 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人群的接入 华盛顿资助了5个以上的H&S网络，并开发了第二代低障碍H&S 模式，将药物起始点放在17个非传统环境中，如急诊室， 注射器交换，监狱和无家可归者收容所，与提供OUD的社区合作伙伴建立联系 药物维持。拟议的研究扩大了研究小组在RFA DA下资助的活动， 18-005通过研究新的H&S模式的实施和有效性。我们维持一个混合动力车 有效性实施方法，并利用社会网络分析来了解如何以及如何 H&S网络发展为OUD人口服务。因此，拟议研究的具体目标是：1） 检查扩展的第一代和第二代H&S模型的实施和有效性， 寻址OUD（例如，OUD药物治疗的开始和保留，过量，就业，犯罪 司法参与），扩展了我们最初的NIDA研究。2)在所有H&S中进行社交网络分析 描述组织间联系、协调和整合模式的网络; 两种类型的H&S网络建立在彼此之上，以及它们如何不同;以及OUD药物的途径 客户在网络内和网络间使用的治疗。3)测试已识别的网络要素之间的关系 目标2（例如网络特征和治疗途径）和第一和第二目标的有效性 H&S车型该研究将重点关注华盛顿的成人（18岁以上）OUD患者，他们参加了 医疗补助，大约90%的人与OUD在治疗华盛顿。统计方法将用于 确保严格的准实验设计。这些发现将使我们能够了解是什么使H&S 有效增加OUD药物治疗和改善OUD患者结局的模型， 谁，以及如何扩大覆盖面，以个人谁可能不寻求治疗。广泛传播工作， 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模型， 将护理管理者、护理导航员和低障碍OUD药物启动纳入其中。因此，我们将 能够帮助确保“不走错门”进入治疗，并获得最佳的治疗模式 成功促进复苏。