Health Systems Node of the NIDA Clinical Trials Network

NIDA 临床试验网络的卫生系统节点

• 批准号: 10644383
• 负责人: KATHARINE ANTHONY BRADLEY
• 金额: $ 3.42万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10644383
• 关键词: Address; Adolescent; Adult; Attention; Cannabis; Caring; Cellular Phone; Cessation of life; Chronic; Clinical Trials Network; Collaborations; Data; Drug Screening; Electronic Health Record; Evidence based treatment; Faculty; Faculty Recruitment; Family; Friends; HIV; Health; Health Care Visit; Health system; Healthcare; Healthcare Systems; Helping to End Addiction Long-term; Individual; Information Systems; Infrastructure; Leadership; Learning; Legal; Life; Mainstreaming; Measurement; Measures; Medical; Medicine; Methamphetamine use disorder; Methods; Monitor; Morbidity - disease rate; National Institute of Drug Abuse; Newly Diagnosed; Nurses; Opiate Addiction; Opioid; Outcome; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Persons; Population Heterogeneity; Population Research; Population Study; Positioning Attribute; Pregnant Women; Primary Health Care; Provider; Psychiatry; Public Health; Public Health Practice; Quality of Care; Randomized Controlled Trials; Research; Research Design; Research Institute; Research Personnel; Rural Community; Severities; Site; Speed; Stigmatization; Substance Use Disorder; Symptoms; System; Telephone; Testing; Translating; Treatment outcome; Underrepresented Minority; United States; United States National Institutes of Health; Vision; Work; Youth; addiction; base; clinical practice; collaborative care; comparative effectiveness study; disability; effective therapy; experience; illicit drug use; implementation research; implementation trial; improved; innovation; marijuana use; marijuana use disorder; medical specialties; methamphetamine use; mortality; multidisciplinary; neglect; novel; novel strategies; opioid epidemic; opioid misuse; opioid overdose; point of care; pragmatic implementation; pragmatic trial; public health relevance; screening; shared decision making; social stigma; substance use; substance use treatment; success; synthetic opioid; treatment response; young adult

This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction. Substance use (SU) and substance use disorders (SUD) cause extensive morbidity and mortality but have been neglected historically by mainstream health care. The Health Systems Node joined the National Institute on Drug Abuse’s Clinical Trials Network (CTN) in 2015, led by Drs. Campbell, Weisner and Bradley, addiction research leaders in innovative implementation research and pragmatic trials in medical settings. Our node includes 16 Learning Health Systems with national representation and rich population diversity, and represents over 26 million patients. Our faculty are researchers who are embedded in their health systems and committed to cutting-edge addiction research. They bring multidisciplinary expertise in conducting research using innovative methods in different medical settings (e.g. primary care, addiction medicine, OB/GYN, psychiatry, rural communities), and with diverse populations (e.g. under-represented minorities, adolescents, pregnant women, patients with HIV). The node had an outstanding track record in its first 5 years leading 6 multi-site studies, including the CTN’s first entirely electronic health record (EHR)-based pragmatic implementation trial as well as participating in several studies led by other nodes. This renewal application builds upon that success to address the CTN’s objectives over the next 5 years through 3 broad Research Agendas: 1) To test approaches to increasing identification of SU and SUD, and engagement in treatment. For example, we propose a multisite implementation trial to test an innovative approach to implementing cannabis and other drug screening and assessment for SUD; 2) To test new approaches to improve SUD outcomes in medical settings. For example, we propose a point-of-care pragmatic effectiveness trial of telephonic nurse collaborative care and an efficacious smartphone-based SUD treatment, in patients with newly diagnosed SUD; and 3) To develop novel measures and methods for SUD research using EHRs. For example, we propose to validate a 7-item SU severity measure developed by the NIH Roadmap initiative Patient Reported Outcome Measurement Information System (PROMIS) for use in measurement-based care of SUD. These agendas emphasize population-based studies, including pragmatic randomized controlled trials, comparative effectiveness studies, and implementation research, and leverage EHRs. Public Health and Clinical Practice Impact. Over 14.9 million patients with untreated SUD have health care visits annually in the US. If 10% of these patients were identified, engaged and successfully treated, it would translate to 1.5 million patients with resolved SUD each year who otherwise would have gone untreated. The Health Systems Node faculty and infrastructure, in collaboration with the CTN, are uniquely positioned to conduct and disseminate research that advances the integration of SUD treatment into routine medical care, and ultimately to improve patient outcomes and public health.

这项研究是 NIH 帮助消除成瘾长期 (HEAL) 计划的一部分，该计划旨在加快科学解决国家阿片类药物公共卫生危机的速度。 NIH HEAL Initiative 支持 NIH 的研究，以改善阿片类药物滥用和成瘾的治疗。物质使用（SU）和物质使用障碍（SUD）导致广泛的发病率和死亡率，但历史上一直被主流医疗保健所忽视。卫生系统节点于 2015 年加入国家药物滥用研究所的临床试验网络 (CTN)，由 Dr. 领导。坎贝尔、韦斯纳和布拉德利，成瘾 医疗环境中创新实施研究和实用试验的研究领导者。我们的节点包括 16 个具有全国代表性和丰富人口多样性的学习健康系统，代表超过 2600 万患者。我们的教职人员是深入卫生系统并致力于前沿成瘾研究的研究人员。他们带来了多学科的专业知识来进行研究 不同医疗环境（例如初级保健、成瘾医学、妇产科、精神病学、农村社区）和不同人群（例如代表性不足的少数民族、青少年、孕妇、艾滋病毒患者）的创新方法。该节点在前 5 年中取得了出色的业绩记录，领导了 6 项多站点研究，包括 CTN 的第一个完全基于电子健康记录 (EHR) 的务实实施试验 以及参与其他节点领导的多项研究。此次更新应用建立在这一成功的基础上，通过 3 个广泛的研究议程实现 CTN 未来 5 年的目标：1) 测试增加 SU 和 SUD 识别以及治疗参与度的方法。例如，我们提议进行多地点实施试验，以测试实施大麻和其他药物的创新方法 SUD药物筛选和评估； 2) 测试改善医疗环境中 SUD 结果的新方法。例如，我们建议对新诊断的 SUD 患者进行电话护士协作护理的护理点实用有效性试验和基于智能手机的有效 SUD 治疗； 3) 利用 EHR 开发 SUD 研究的新措施和方法。例如，我们建议验证 NIH 路线图倡议患者报告结果测量信息系统 (PROMIS) 开发的 7 项 SU 严重程度测量，用于基于测量的 SUD 护理。这些议程强调基于人群的研究，包括实用的随机对照试验、比较有效性研究和实施研究，并利用电子病历。公共卫生和临床实践的影响。在美国，每年有超过 1,490 万名未经治疗的 SUD 患者前往医疗机构就诊。如果这些患者中的 10% 得到识别、参与并成功治疗，那么每年将有 150 万 SUD 患者得到解决，否则他们将得不到治疗。卫生系统节点的教员和基础设施与 CTN 合作，具有独特的优势来开展和传播研究，推动将 SUD 治疗纳入常规医疗护理，并最终改善患者的治疗结果和公共卫生。