Implementing statewide emergency department care pathways for addiction recovery after opioid overdose

实施全州范围内阿片类药物过量后成瘾康复的急诊科护理途径

• 批准号: 9910907
• 负责人: Janette Baird
• 金额: $ 76.76万
• 依托单位: RHODE ISLAND HOSPITAL
• 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 2022-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9910907
• 关键词: Implementing; statewide; emergency; department; care

PROJECT SUMMARY Rhode Island (RI) has one of the highest rates of opioid overdose death in the United States and has been a leader in innovative strategies to reduce opioid overdose deaths. In March 2017, the Rhode Island (RI) Department of Health (RIDOH) and the RI Department of Behavioral Health, Developmental Disabilities, and Hospitals (BHDDH) released hospital and emergency department (ED) treatment standards for care of adult patients with opioid use disorder and opioid overdose: Levels of Care for RI Emergency Departments and Hospitals for Treating Overdose and Opioid Use Disorder (Levels of Care). These standards specify three levels for hospital and ED treatment of opioid use disorder, overdose prevention, referral to treatment, and epidemiologic surveillance. Each of the three Levels of Care (LoCs) require EDs to prescribe naloxone, provide peer recovery support services, and offer referrals to treatment for patients that have experienced an opioid overdose. Facilities certified at the highest level (Level 1) provide more comprehensive treatment services, including initiation of medication for addiction treatment (MAT). Individual components of the LoCs have been examined, but the effectiveness of the state’s overall policy has not been evaluated. A rigorous policy evaluation is needed to inform ongoing policy, practice, and strategy. Since implementation of the statewide-mandate, there has been high reported offering-of-services to patients treated after opioid overdose, but uptake of ED behavioral counseling, MAT initiation, and referral to treatment have not significantly increased (<50% of overdose cases in EDs receive all recommended components of post-overdose care). Despite these gaps, RI’s rate of opioid overdose has plateaued in recent years despite rising rates nationally and pilot data suggest that policy changes have resulted in increased treatment engagement after an ED visit for opioid overdose. Given the fast pace and high stakes of the opioid epidemic, we will simultaneously examine both the implementation and effectiveness of RI’s policy in a fully powered type III implementation-effectiveness study conducted at 9 EDs throughout RI. These 9 EDs care for >95% of all opioid overdoses that present to RI EDs annually (n~1500), creating tremendous opportunity to prevent opioid overdose deaths and also evaluate RI’s standards of care. Investigators from RI’s largest health care system, Brown University’s School of Public Health, and RIDOH are partnering to perform a hybrid implementation-effectiveness study that will: (1) refine and test an implementation strategy that aims to improve the fidelity of ED post-overdose care as it relates to the state’s Levels of Care policy, and (2) to test the effectiveness of policy-driven ED-based post-overdose care. We will specifically target implementation of 4 ED metrics: naloxone received at discharge; receipt of peer recovery support services; ED referral to treatment; and initiation of MAT in the ED.

项目摘要 罗得岛（RI）是美国阿片类药物过量死亡率最高的地区之一， 一直是减少阿片类药物过量死亡的创新战略的领导者。2017年3月，罗得岛（RI） 卫生部（RIDOH）和行为健康，发育障碍，和 医院（BHDDH）发布了医院和急诊科（艾德）成人护理治疗标准 阿片类药物使用障碍和阿片类药物过量患者：RI急诊科和 治疗过量和阿片类药物使用障碍的医院（护理水平）。这些标准规定了三个级别 用于阿片类药物使用障碍的医院和艾德治疗、过量预防、转诊治疗，以及 流行病学监测三个护理水平（LoC）中的每一个都要求ED处方纳洛酮，提供 同伴康复支持服务，并为经历过阿片类药物的患者提供转诊治疗 服药过量获得最高级别（1级）认证的设施提供更全面的治疗服务， 包括开始使用成瘾治疗药物（MAT）。已对接触线的各个组成部分进行了 但是，国家总体政策的有效性还没有得到评估。严格的政策评估 需要为正在进行的政策、实践和战略提供信息。 自从在全州范围内执行这项任务以来，据报告， 阿片类药物过量后接受治疗的患者，但接受艾德行为咨询、MAT启动和转诊 治疗没有显著增加（<50%的ED过量病例接受所有推荐的治疗）。 过量后护理的组成部分）。尽管有这些差距，RI的阿片类药物过量的比率在最近已经达到稳定水平。 多年来，尽管全国的发病率不断上升，试点数据表明，政策变化导致了 阿片类药物过量艾德访视后的治疗参与。鉴于阿片类药物的快速发展和高风险 我们将同时全面检视国际扶轮政策的执行与成效， 在整个RI的9个ED进行的动力III型实施有效性研究。这9个ED照顾 >95%的所有阿片类药物过量每年出现在RI ED中（n~1500），这创造了巨大的机会， 预防阿片类药物过量死亡，并评估RI的护理标准。 来自国际扶轮最大的卫生保健系统、布朗大学公共卫生学院和国际扶轮社的调查人员 正在合作进行一项混合实施效果研究，该研究将：（1）完善和测试 实施战略，旨在提高艾德过量后护理的保真度，因为它涉及到国家的 护理水平政策，以及（2）测试政策驱动的基于ED的过量后护理的有效性。我们将 具体针对4个艾德指标实施：出院时接受纳洛酮;接受同伴康复 支持服务;艾德转诊治疗;以及在ED启动MAT。