A systems science approach for improving continuity of service in substance use disorder treatment

提高药物滥用障碍治疗服务连续性的系统科学方法

• 批准号: 9982290
• 负责人: Suzanne Evelyn Spear
• 金额: $ 14.5万
• 依托单位: CALIFORNIA STATE UNIVERSITY NORTHRIDGE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9982290
• 关键词: Address; Administrator; Admission activity; Aftercare; Alcohol consumption; California; Caring; Characteristics; Computer Simulation; County; Data; Development; Drug Metabolic Detoxication; Ecology; Effectiveness; Ego; Evidence based treatment; Failure; Funding; Future; Goals; Grant; Health Services Accessibility; Heroin Dependence; Improve Access; Individual; Intervention; Interview; Link; Los Angeles; Measures; Methodology; Methods; Modality; Modeling; Morbidity - disease rate; Opiate Addiction; Overdose; Participant; Pathway Analysis; Patient Transfer; Patient risk; Patient-Focused Outcomes; Patients; Pattern; Pharmaceutical Preparations; Pilot Projects; Prevalence; Protocols documentation; Rehabilitation therapy; Reporting; Research; Research Project Grants; Resources; Science; Services; Social Network; Source; Structure; Substance Addiction; Substance Use Disorder; Substance abuse problem; Surveys; System; Testing; TimeLine; Training; United States; United States National Institutes of Health; Visualization; base; density; design; experience; high risk; improved; innovation; medication-assisted treatment; member; models and simulation; mortality; mortality risk; network models; opioid use; opioid use disorder; patient engagement; programs; public health priorities; referral services; relapse risk; service gap; service programs; skills; social networking website; sound; substance abuse prevention; theories; treatment program

Project Summary/Abstract Increasing access to substance use disorder (SUD) treatment is an important public health priority because substance abuse and dependence is associated with significant morbidity and mortality. While evidence-based treatments are available to care for people with SUDs, only 11% of individuals who need professional treatment receive it. One major service gap in the treatment of SUDs, particularly alcohol and opioid use disorders, is the engagement of patients in treatment or rehabilitation after an initial detoxification (detox). At the point of discharge from detox, patients are at high risk of relapse and therefore vulnerable to system failures. Detox alone increases patients' risk of mortality from overdose if they do not transition to rehabilitation after discharge. To date, research on the problem of continuity of service after detox has focused on patient characteristics and attributes of organizations with no consideration to the dynamic contexts within which SUD treatment occurs. What has not been explored to date is the impact of referral networks between service programs on entry into SUD treatment after detox. The goal of this pilot study is to determine the impact of systems-level predictors such as network structures on continuity of service in the SUD treatment system in Los Angeles County. The central hypothesis will be tested by pursuing three specific aims: 1) Describe the ecology of the publicly-funded SUD treatment system in Los Angeles County using social network analysis, 2) Determine the impact of network structure on continuity of service from detox to SUD treatment using computer simulation models, and 3) Design a protocol for a service implementation network intervention to increase continuity of service after detox. The unique strengths of the study are the experienced research team, theory-driven approach, and application of systems science methodologies such as social network analysis and agent-based modeling. Achieving the study aims will create greater understanding of the interdependency of programs within the treatment systems and demonstrate how partnerships and referral patterns at a system level can impact patient outcomes. The results of the study will be used to plan an R34 study to test the implementation and effectiveness of a service implementation network model for SUD treatment.

项目概要/摘要 增加药物使用障碍 (SUD) 治疗的可及性是一项重要的公共卫生事业 优先考虑，因为药物滥用和依赖与显着的发病率和 死亡。虽然基于证据的治疗可用于护理 SUD 患者，但只有 11% 需要专业治疗的个人接受它。治疗中的一大服务缺口 SUD（特别是酒精和阿片类药物使用障碍）的关键在于患者参与治疗 或初步戒毒（排毒）后的康复。排毒出院时， 患者复发的风险很高，因此容易受到系统故障的影响。独自排毒 如果患者在服药后不过渡到康复，则会增加患者因服药过量而死亡的风险 释放。迄今为止，关于戒毒后服务连续性问题的研究主要集中在 患者特征和组织属性，不考虑动态 SUD 治疗发生的背景。迄今为止尚未探讨的是 戒毒后进入 SUD 治疗的服务计划之间的转诊网络。目标 这项试点研究的目的是确定系统级预测因素（例如网络）的影响 洛杉矶县 SUD 处理系统服务连续性的结构。这 中心假设将通过追求三个具体目标来检验：1）描述生态系统 使用社交网络分析的洛杉矶县公共资助的 SUD 治疗系统，2) 确定网络结构对从戒毒到 SUD 治疗的服务连续性的影响 使用计算机模拟模型，以及 3) 设计服务实现的协议 网络干预以增加戒毒后服务的连续性。的独特优势 研究是经验丰富的研究团队、理论驱动的方法和系统的应用 科学方法，例如社交网络分析和基于代理的建模。实现 研究目标将加深对项目内项目相互依赖性的理解 治疗系统，并展示系统层面的伙伴关系和转诊模式如何能够 影响患者的治疗结果。研究结果将用于计划 R34 研究以测试 SUD 治疗服务实施网络模型的实施和有效性。