Optimizing HEALing in Ohio Communities (OHiO)

项目摘要 阿片类药物流行病在俄亥俄州已经根深蒂固，年龄调整后的阿片类药物相关过量死亡率 32.9/10万人（2017年），居全国第二位。农村和城市地区都未能幸免， 俄亥俄州的88个县中有38个县（43%）报告阿片类药物相关死亡人数超过25/100，000人。 自2012年以来，俄亥俄州开展了前所未有的努力，以减少阿片类药物使用障碍（OUD）的发病率， 通过在预防、治疗和康复工作方面的政策和投资，降低死亡率。但挑战 整合和部署跨部门循证干预措施（EBI）的固有缺陷限制了其 对受影响社区的影响。 在俄亥俄州社区（OHiO）优化愈合的目标是系统地计划，实施和评估 数据驱动的方法，将多方面的EBI整合到医疗保健、行为健康、司法系统 在19个受影响严重的县，3年内将阿片类药物过量死亡人数减少40%。俄亥俄州是 由三个NCATS资助的CTSA和NIDA资助的俄亥俄州山谷临床试验节点 建立网络并利用与社区联盟、州和县的广泛现有合作 政府、医疗保健、行为健康和刑事司法部门。俄亥俄州的方法基于 并与国家规定的社区健康评估和社区健康改善保持一致 计划，利用州和联邦资助的计划已经到位。总体目标将得到实现 完成三个目标。目标1）计划：我们将评估有关OUD的现行政策/计划， 阿片类药物滥用和阿片类药物相关死亡;使用探索、采用/准备、实施和 维持模式，与社区合作选择EBI以减少OUD和过量死亡;并确定 服务/服务协调方面的差距，可以采取干预措施。目标2）实施：通过 务实的社区为基础的临床试验，我们将提供EBI包使用集群阶梯楔形设计， 哪些协作社区根据接收选定干预措施的时间进行随机化。 目标3）评估：我们将使用覆盖范围、有效性、采用率， 实施和维护（RE-AIM）模型，以评估综合干预措施的影响， 实施结果，包括可接受性、采用性（包括对干预措施的忠实性）、可行性， 渗透率、增量成本和多管齐下的成本效益。我们还将建立 学习健康社区为社区利益相关者提供实时、可操作的信息。 最后，俄亥俄州将提供严格和可重复的证据，证明综合预防的有效性， 治疗和康复方案;一个可输出和可扩展的服务模式 评估、社区参与的决策;以及可以实施的集成的、数据驱动的EBI 受影响的社区在俄亥俄州，该地区，并在美国各地。

PROJECT SUMMARY The opioid epidemic has become entrenched in Ohio, with an age-adjusted opioid-related overdose death rate of 32.9/100,000 people (2017), ranking second nationally. Neither rural nor urban areas have been spared, with 38 of Ohio’s 88 counties (43%) reporting opioid-related deaths exceeding 25/100,000 people. Since 2012, Ohio has mounted an unprecedented effort to reduce opioid use disorder (OUD) morbidity and mortality through policies and investments in prevention, treatment, and recovery efforts. However, challenges inherent in integrating and deploying evidence-based interventions (EBI) across sectors has limited their impact in affected communities. The goal of Optimizing Healing in Ohio Communities (OHiO) is to systematically plan, implement, and evaluate data-driven approaches that integrate multi-pronged EBI within healthcare, behavioral health, justice systems, and communities to reduce opioid overdose deaths in 19 highly affected counties by 40% in 3 years. OHiO is anchored by three NCATS-funded CTSAs and the NIDA-funded Ohio Valley Node of the Clinical Trials Network and leverages extensive existing collaborations with community coalitions, state and county governments, and healthcare, behavioral health and criminal justice sectors. OHiO’s approach is based upon and aligned with the state-mandated Community Health Assessments and Community Health Improvement Plans, leveraging state and federally funded programs already in place. The overarching goal will be met through completion of three aims. Aim 1) Plan: We will assess current policies/programs regarding OUD, opioid misuse, and opioid-related fatalities; using the Exploration, Adoption/Preparation, Implementation and Sustainment model, work with communities to select EBI to reduce OUD and overdose deaths; and identify gaps in services/service coordination that are amenable to intervention. Aim 2) Implement: Through a pragmatic community-based clinical trial, we will deliver EBI packages using a cluster stepped-wedge design in which collaborating communities are randomized by the timing of which selected interventions are received. Aim 3) Evaluate: We will continuously collect and analyze data using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) model to assess the impact of the integrated interventions and implementation outcomes including acceptability, adoption (including fidelity to the intervention), feasibility, penetration, and incremental cost and cost-effectiveness of the multipronged approach. We will also establish Learning Health Communities to provide community stakeholders access to real-time, actionable information. Ultimately, OHiO will provide rigorous and reproducible evidence of the effectiveness of integrated prevention, treatment, and recovery programs in the community context; an exportable and scalable model of service assessment, community-engaged decision-making; and integrated, data-driven EBI that can be implemented by affected communities in Ohio, the region, and across the US.