Health Systems Node of the NIDA Clinical Trials Network

这项研究是NIH帮助结束成瘾长期(Hear)倡议的一部分，该倡议旨在加快科学解决国家阿片类药物公共健康危机的速度。NIH Hear Initiative支持整个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，但历史上被主流卫生保健忽视。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Campbell、Weisner和Bradley博士领导 在创新实施研究和医疗环境中的务实试验方面的研究领导者。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，代表着2600多万名患者。我们的教职员工是嵌入他们的健康系统的研究人员，致力于前沿的成瘾研究。他们带来了进行研究的多学科专业知识 在不同的医疗环境(如初级保健、成瘾医学、妇产科/妇产科、精神病学、农村社区)和不同的人群(如代表性不足的少数群体、青少年、孕妇、艾滋病毒患者)中采用创新方法。该节点在其最初的5年中拥有出色的跟踪记录，领导了6项多站点研究，包括CTN第一个完全基于电子健康记录(EHR)的实用实施试验 以及参与由其他节点领导的几项研究。这项续签申请建立在这一成功的基础上，旨在通过三个广泛的研究议程来满足CTN在未来5年的目标：1)测试增加SU和SUD识别的方法，以及参与治疗。例如，我们提议进行一项多地点实施试验，以测试实施大麻和其他 SUD的药物筛选和评估；2)测试在医疗环境中改善SUD结果的新方法。例如，我们建议在新诊断的SUD患者中进行电话护士协作护理和有效的基于智能手机的SUD治疗的护理点实用有效性试验；以及3)利用EHR为SUD研究开发新的措施和方法。例如，我们建议验证由NIH路线图倡议的患者报告结果测量信息系统(PROIS)开发的7项SU严重程度测量，用于基于测量的SUD护理。这些议程强调以人群为基础的研究，包括务实的随机对照试验、比较有效性研究和实施研究，并利用电子健康记录。公共卫生和临床实践的影响。在美国，每年有超过1490万未经治疗的SUD患者接受医疗服务。如果这些患者中的10%被发现、参与并成功治疗，那么每年将有150万名SUD患者得到解决，否则他们将得不到治疗。卫生系统节点的教职员工和基础设施与CTN合作，处于独特的地位，可以进行和传播研究，促进将SUD治疗整合到常规医疗中，并最终改善患者的预后和公共健康。

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.