Evaluation of Community-based Drug User Health Hubs to Reduce Opioid Overdoses in NY State

对纽约州社区吸毒者健康中心减少阿片类药物过量的评估

• 批准号: 9895484
• 负责人: KITTY H GELBERG
• 金额: $ 75万
• 依托单位: CENTER OF ENVIRONMENTAL HEALTH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9895484
• 关键词: Evaluation; Community; based; Drug; User

Project Summary/Abstract New York State (NYS) has been heavily impacted by the nation’s increasing opioid crisis, experiencing a nearly 40 percent increase in opioid overdose deaths from 2,166 in 2015 to 3,009 deaths in 2016. To address this issue, NYS created community-based Drug User Health Hubs to increase access to appropriate health, mental health, and medication-assisted treatment services for persons who use drugs. Hubs are located at Syringe Exchange Programs and expand and enhance their services, a change that is expected to reduce opioid overdoses and improve the overall health and well-being of people who use drugs. The objectives of the proposed project are to: 1) construct a complete and rich description of the service elements offered at established Hubs to support assessment of their efficacy and guide replication efforts; 2) assess and compare the effectiveness of a sample of SEPs to the Hubs in a) reducing fatal and non- fatal opioid overdoses and b) improving various health and social indicators for clients; and 3) examine service utilization and costs to estimate the potential overdose reduction and economic impact of implementing the Hub model at SEPs in NYS. Project objectives will be achieved through three specific aims. Aim 1: Construct a complete and rich description of the service elements offered at established Hubs to support assessment of their efficacy and guide replication efforts. Service offerings are unique to the communities the Hubs and SEPs serve. We will employ quantitative and qualitative measures (surveys, state records review, and interviews with site service coordinators) to construct a full description of service elements and mechanisms of operation for three Hubs and three comparison SEPs in NYS, excluding New York City (NYC). We will explore Hub/SEP organization and administrative capacity, community referral network structure and function, and resources required to deliver services. Aim 2: Compare effectiveness of Hubs and SEPs in reducing overdose incidence and improving other client health and social indicators. We will assess the effectiveness of the expanded service elements of Hubs over and above those offered by SEPs in reducing fatal/non-fatal overdose (primary aim) and changing substance use-related behaviors; improving physical health, psychosocial functioning, and social determinants of health, and decreasing involvement in the justice system. We will administer client surveys at four time points over one year (enrollment; 4 months, 8 months; and 12 months) to measure client overdose risk level at entry, engagement with services during the subsequent 12 months, and change/success on outcome indicators after 12 months. Aim 3: Examine service utilization and costs at Hubs to estimate the potential overdose and economic impact of implementing the Hub model at SEPs in NYS. Using site records, participant survey results, site visit interviews, and records from state and local health department registries and databases, we will determine on-site service utilization and costs associated with operating the Hubs; estimate the additional costs and cost savings to the healthcare system in the Hub models compared to SEPs; and forecast the potential impact on opioid overdoses and healthcare system costs if Hubs were expanded statewide (excluding NYC).

项目总结/摘要 纽约州（NYS）受到全国日益严重的阿片类药物危机的严重影响，经历了近40年的 阿片类药物过量死亡人数从2015年的2,166人增加到2016年的3,009人。为了解决这个问题，纽约 创建了以社区为基础的吸毒者健康中心，以增加获得适当健康、心理健康和 为吸毒者提供药物辅助治疗服务。集线器位于注射器交换计划， 扩大和加强他们的服务，这一变化预计将减少阿片类药物过量并改善整体健康状况。 以及吸毒者的幸福感该项目的目标是：1）建立一个完整的，丰富的 描述在已建立的枢纽提供的服务要素，以支持对其效力的评估，并指导 复制工作; 2）评估和比较SEP样本与中心在以下方面的有效性：a）减少致命性和非致命性 致命的阿片类药物过量和B）改善客户的各种健康和社会指标;和3）检查服务利用率 和成本，以估计潜在的过量减少和经济影响，实施中心模式在SEP， 纽约州项目目标将通过三个具体目标实现。 目标1：对已建立的中心提供的服务元素进行完整而丰富的描述，以支持 评估其功效并指导推广工作。提供的服务是社区独有的， SEPS服务我们将采用定量和定性的方法（调查、州记录审查和访谈 与现场服务协调员），以构建三个服务要素和操作机制的完整描述 在纽约州（不包括纽约市（NYC））的中心和三个比较SEP。我们将探索Hub/SEP组织， 行政能力、社区转诊网络的结构和功能以及提供服务所需的资源。 目的2：比较中心和SEP在降低过量发生率和改善其他客户健康方面的有效性， 社会指标。我们会评估枢纽中心除了上述服务外， SEP在减少致命/非致命过量（主要目的）和改变物质使用相关行为方面提供的服务; 改善身体健康，心理社会功能和健康的社会决定因素，减少参与 司法系统我们将在一年内的四个时间点进行客户调查（注册; 4个月，8个月; 和12个月），以衡量客户过量的风险水平，在进入，参与服务在随后的12个月 个月，12个月后结果指标发生变化/成功。 目标3：检查中心的服务利用率和成本，以估计潜在的过量和经济影响， 在纽约州的SEPs实施中心模式。利用现场记录、参与者调查结果、现场访问访谈， 从州和地方卫生部门登记处和数据库的记录，我们将确定现场服务利用率 以及与运营中心相关的成本;估计医疗保健系统的额外成本和成本节约， 与SEP相比的Hub模型;并预测对阿片类药物过量和医疗保健系统成本的潜在影响， 枢纽扩展到全州（不包括纽约市）。