Integrating Addiction Research in Health Systems: The Addiction Research Network

摘要 超过2000万美国成年人和青少年患有物质使用障碍（SUD）和物质使用（SU） 相关问题。然而，大多数SUD患者从未接受过SUD治疗。从历史上看， SUD的重点是少数SUD患者，他们正在寻求或已经参与， 专业SUD治疗。2010年12月25日，拟议的成瘾研究网络（ARN）节点的总体目标是： 临床试验网络将进行尖端研究，以改善所有患者的结果， SU/SUD在医疗环境中看到的人。ARN包括美国15个大型卫生系统， HMO研究网络（HMORN）的虚拟数据仓库，提供地理和种族/民族 医疗和SU/SUD护理系统的多样性和变化。拟议的ARN节点有3个广泛的 议程-1）评估识别、参与和治疗SU患者的有效实践，或 医疗环境中的SUD; 2）开发和测试实施这些实践的有效实用方法 作为日常医疗护理的一部分; 3）开发和传播创新的 SU和SUDs的研究方法。三个PI将领导ARN节点，每个PI都具有对我们的 研究议程。Weisner博士拥有超过25年的领导SUD研究的经验， 私人医疗机构，将领导ARN在凯撒永久高级PI。她是凯撒的合伙人 永久与博士.坎贝尔，在阿片类药物滥用和以病人为中心的研究和比较专家 有效性研究，以及布拉德利博士，在集团健康，谁拥有20年的研究经验，高级PI 针对非寻求治疗的酒精滥用患者和医疗环境中的SUD。ARN将拥有 3个核心：1）管理核心将支持ARN节点的所有方面; 2）实现核心将 支持以患者为中心设计实用、可持续的方法，以在常规中实施SUD护理 使用电子健康记录（EHR）的医疗环境; 3）具有以下专业知识的分析核心 编程，使用EHR数据的生物统计学和经济学，将支持创新方法研究， 研究设计. ARN的工作将利用HMORN 20年来进行务实的临床试验， 使用EHR和全国虚拟数据进行跨卫生系统的比较有效性研究 仓库ARN节点将为基于人口的研究提供坚实的基础， 随机对照试验，比较有效性研究和实施研究-这可以 评估长期健康结果。此外，通过我们与15个学习型医疗保健系统的连接， 研究将设计方法，以提高在现实世界的医疗环境中SU和SUD的护理质量。 通过这种方式-与其他CTN节点一起-ARN节点将帮助构建下一个 成瘾健康服务研究的时代。

ABSTRACT Over 20 million US adults and youth suffer from substance use disorders (SUDs) and substance use (SU) related problems. However, most people with SUDs never receive SUD treatment. Historically, research on SUDs has focused on the small minority of patients with SUDs who are seeking, or already engaged in, specialty SUD treatment. The overall goal of the proposed Addictions Research Network (ARN) node of the Clinical Trials Network will be to conduct cutting edge research to improve outcomes in all patients with SU/SUD who are seen in medical settings. The ARN includes 15 large health systems across the US that use the HMO Research Network’s (HMORN’s) Virtual Data Warehouse, providing geographic and racial/ethnic diversity as well as variation in systems of medical and SU/SUD care. The proposed ARN node has 3 broad agendas—1) to evaluate effective practices for identifying, engaging and treating patients with SU or SUDs in medical settings; 2) to develop and test effective, practical ways to implement these practices in a sustained manner as part of routine medical care; and 3) to develop and disseminate innovative research methods on SU and SUDs. Three PIs will lead the ARN node, each with expertise critical to our research agenda. Dr. Weisner, who has more than 25 years of experience leading SUD research in public and private medical settings, will lead the ARN as Senior PI at Kaiser Permanente. She partners at Kaiser Permanente with Dr. Campbell, an expert in research on opioid misuse and patient-centered and comparative effectiveness research, and Dr. Bradley, Senior PI at Group Health, who has 20 years of research experience targeting non-treatment-seeking patients with alcohol misuse and SUDs in medical settings. The ARN will have 3 Cores: 1) an Administrative Core will support all aspects of the ARN node; 2) an Implementation Core will support patient-centered design of practical, sustainable approaches to implementing SUD care in routine medical settings using electronic health records (EHRs), and; 3) an Analytics Core with expertise in programming, biostatistics using EHR data, and economics, will support innovative methods research and study design. ARN work will leverage the HMORN’s 20 years of conducting pragmatic clinical trials and comparative effectiveness research across health systems using EHRs and the nationwide Virtual Data Warehouse. The ARN node will provide a robust foundation for population-based studies—including pragmatic randomized controlled trials, comparative effectiveness studies, and implementation research—that can evaluate long-term health outcomes. Moreover, through our connection to 15 learning healthcare systems, our research will design approaches to improve the quality of care for SU and SUDs in real-world medical settings. In this way—with the other CTN nodes—the ARN node will help build the infrastructure required for the next era of addictions health services research.