CHASE: An Innovative County-Level Public Health Response to the Opioid Epidemic in New York State

项目总结 纽约州(NYS)在阿片类药物过量死亡的绝对数量上排名全国第二。从2015年开始- 2016年，纽约阿片类药物过量死亡人数增加了32%，其中与合成阿片类药物相关的死亡人数增加了88% 死亡。拟议的研究将开发和测试县系统中心和分支授权模型 (“大通”)在纽约15个地理和种族不同的县减少致命过量的发生率 2017年，平均每10万人中有28.2人死亡，符合UM1 RFA-DA-19-016标准。大通是一个 修改的中心和辐条模式，可适应任何特定县的独特需求，目的是 制定一个可以应用于全美各县的蓝图大通是一个协调的多系统， 多部门对阿片类药物流行的公共卫生反应，由县卫生专员指导，以及 由强大的社区参与和基于数据科学和系统科学的实时学习推动。 大通银行通过与未充分利用的县系统合作，解决减少阿片类药物死亡的结构性障碍 “Spokes”(例如，监狱、其他司法机构、急诊部以及其他卫生和社会服务 设置)将链接到“中心”，其中将包括联邦合格的医疗保健诊所、初级保健设置 和上瘾项目。大通银行将在以下方面瞄准阿片类药物预防和治疗级联中的差距(1) 增加阿片使用障碍(MOUD)提供者和成瘾专家的药物数量；(2) 使用循证筛查、短暂干预和 推荐工具，并使用同行导航将它们链接并保留在Moud中；(3)扩大过量教育 以及社区环境中的纳洛酮分配(OEND)；(4)改善监狱和急诊室获得Moud的机会，(5) 在学校、社交媒体和其他场所部署循证预防计划；以及(6)扩大 处方监测和处方回收计划。县领导将与县合作 主要利益相关者的社区咨询委员会，以定制和校准 蔡斯。此校准过程将由一个可促进数据驱动系统的交互式仪表板进行指导 建模以确定循证战略的组合，以最好地解决具体差距和阿片类药物 他们县的吸毒过量趋势。该控制面板还将提供有关如何改进和 优化落实力度。研究将采用混合方法严格识别多层次理论-- 阻碍或促进Chase在每个县的实施和可持续性的驱动因素。如果 有效，Chase可以扩大为对阿片类药物流行的全面公共卫生反应 这项研究将建立在多学科团队对大学的广泛研究基础上 和其他物质使用障碍，艾滋病毒，丙型肝炎和其他共病情况，阿片类药物过量预防， 药理学、数据和系统科学、实施科学和基于社区的参与性 研究和将包括来自纽约卫生部的政府调查人员。

PROJECT SUMMARY New York State (NYS) ranks second in the nation in absolute numbers of opioid overdose deaths. From 2015- 2016, opioid overdose deaths in NYS increased by 32%, including an 88% increase in synthetic opioid-related deaths. The proposed research will develop and test a County-system Hub and Spoke Empowerment model (“CHASE”) to reduce incidence of fatal overdoses in 15 geographically and racially diverse counties in NYS that averaged 28.2 deaths per 100,000 in 2017 and meet all the UM1 RFA-DA-19-016 criteria. CHASE is a modified Hub and Spoke model that is adaptable to the unique needs of any particular county with the aim of developing a blueprint that could be applied to counties across the U.S. CHASE is a coordinated multi-system, multi-sector public health response to the opioid epidemic, directed by County Health Commissioners, and driven by robust community engagement and real-time learning based on data science and systems science. CHASE addresses structural barriers to decreasing opioid deaths by engaging underutilized county systems “Spokes” (e.g., jails, other justice settings, emergency departments (EDs), and other health and social service settings ) will be linked to “hubs” which will include federally qualified health care clinics, primary care settings and addiction programs. CHASE will target gaps in the opioid prevention and treatment cascade by (1) expanding number of medications for opioid use disorder (MOUD) providers and addiction expertise; (2) identifying people at risk of opioid use disorder (OUD) using evidence-based screening, brief intervention and referral tools and linking and retaining them in MOUD using peer navigation; (3) scaling up overdose education and naloxone distribution (OEND) in community settings; (4) improving access to MOUD in jails and EDs, (5) deploying evidence-based prevention programs in schools, social media and other venues; and (6) scaling up prescription monitoring and prescription take-back programs. The county leadership will work with a county community advisory board of key stakeholders to customize and calibrate the intervention components of CHASE. This calibration process will be guided by an interactive dashboard that facilitates data-driven system modelling to identify the combination of evidence-based strategies to best address specific gaps and opioid overdose trends in their county. This dashboard will also provide real-time feedback on how to improve and optimize implementation efforts. The study will employ mixed methods to rigorously identify multi-level theory- driven factors that impede or facilitate the implementation and sustainability of CHASE in each county. If effective, CHASE can be scaled up as comprehensive public health response to the opioid epidemic in counties across the U.S. This study will build on the extensive research of the multidisciplinary team on OUD and other substance use disorders, HIV, HCV and other comorbid conditions, opioid overdose prevention, pharmacology, data and system science, implementation science, and community-based participatory research and will include government investigators from NYS Department of Health.