Integrating Addiction Research in Health Systems: The Addiction Research Network

 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的研究主要集中在少数正在寻求或已经从事专业SUD治疗的SUD患者身上。临床试验网络的成瘾研究网络（ARN）节点的总体目标是进行尖端研究，以改善在医疗环境中看到的所有SU/SUD患者的结局。ARN包括美国各地的15个大型卫生系统，这些系统使用HMO研究网络（HMORN）的虚拟数据仓库，提供地理和种族/民族多样性以及医疗和SU/SUD护理系统的变化。拟议的ARN节点有3个主要议程-1）评估在医疗环境中识别、参与和治疗SU或SUD患者的有效实践; 2）开发和测试有效、实用的方法，以持续的方式实施这些实践，作为常规医疗护理的一部分; 3）开发和传播SU和SUD的创新研究方法。三个PI将领导ARN节点，每个PI都具有对我们的研究议程至关重要的专业知识。Weisner博士在公共和私人医疗机构领导SUD研究方面拥有超过25年的经验，他将作为Kaiser Permanente的高级PI领导ARN。她在Kaiser Permanente与阿片类药物滥用研究以及以患者为中心的比较有效性研究专家坎贝尔博士以及Group Health高级PI布拉德利博士合作，布拉德利博士拥有20年的研究经验，针对非寻求治疗的患者在医疗环境中酗酒和SUD。ARN将有3个核心：1）行政核心将支持ARN节点的所有方面; 2）实施核心将支持以患者为中心的设计，即使用电子健康记录（EHR）在常规医疗环境中实施SUD护理的实用、可持续方法; 3）具有编程，使用EHR数据的生物统计学和经济学专业知识的分析核心将支持创新方法研究和研究设计。ARN的工作将利用HMORN 20年来使用EHR和全国虚拟数据仓库在卫生系统中进行务实的临床试验和比较有效性研究的经验。ARN节点将为基于人群的研究提供坚实的基础，包括实用的随机对照试验，比较有效性研究和实施研究，可以评估长期健康结果。此外，通过我们与15个学习医疗系统的连接，我们的研究将设计方法来提高现实世界医疗环境中SU和SUD的护理质量。通过这种方式，与其他CTN节点一起，ARN节点将帮助建立下一个成瘾健康服务研究时代所需的基础设施。

 DESCRIPTION: 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.