Improving transitions of care for hospitalized patients with opioid use disorder

项目摘要/摘要：K23指导的以患者为导向的研究生涯的目标 发展奖是支持申请者发展成为专家所必需的关键技能 增加在接触点获得阿片类药物使用障碍(OUD)循证治疗的机会 患有多发性硬化症的人可能会频繁出现。拟议的研究侧重于NIDA优先处理的领域 通过制定实施战略来改善治疗后的连续性，以应对现实世界的复杂性 OUD患者的住院治疗。与OUD及其并发症相关的住院人数有所增加 在过去的几十年里戏剧性地，导致了高发病率、死亡率和医疗成本。医院是 越来越多地被认为是让OUD患者参与治疗的关键接触点，并随机进行 对照试验支持在急性护理环境中启动OUD(Moud)药物治疗以提高疗效 出院后接受治疗。然而，如果患者不这样做，医院发起的治疗是不够的。 在社区继续关爱。尽管关于出院后护理过渡的文献很多，但 对于患有其他慢性病的患者，关于优化护理的最佳策略的证据有限 OUD患者入院后的参与度。我们需要有效的、可扩展的策略来连接患者 从急性护理到持续治疗，包括霉菌的持续治疗。这项研究的目的是 建议是开发和试行测试策略，以促进从 医院对社区的影响。具体目标是：(1)使用混合方法来确定决定因素 从急诊到门诊的有效护理过渡到患者、提供者、 和系统级别，(2)与医院和社区利益攸关方合作，并使用实施映射来 开发多组件、模块化的工具包，以促进从急性护理到社区的过渡，以解决多个 (3)对护理过渡工具包进行试点试验。主要结果将是治疗 在30天内参与，次要结果将包括Moud和物质使用、服务使用、可行性、 可接受性和患者满意度。导师团队汇集了卫生服务研究方面的专家， 实施科学，以及为OUD和医院的利益相关者顾问提供的护理提供干预 和社区设置。这一指导研究科学家发展奖建立在洛温斯坦博士的 作为临床医生和研究人员的经验，并通过五个关键培训目标扩展了这一经验：1)衡量 跨系统的与OUD相关的护理，2)高级定性调查，3)实施卫生系统变革，以及 5)稿件和赠款的撰写。成功完成此项目、培训活动和指导 来自一支经验丰富的研究团队，洛文斯坦博士将为领导一项独立研究做好充分准备 旨在改善OUD患者的护理和预后的议程。

PROJECT SUMMARY/ABSTRACT: The goal of this K23 Mentored Patient-Oriented Research Career Development Award is to support the applicant in developing the critical skills necessary to become an expert in increasing access to evidence-based treatment for opioid use disorder (OUD) at touchpoints for care that individuals with OUD are likely to frequent. The proposed research focuses on NIDA's priority area of addressing real-world complexities by developing implementation strategies to improve treatment continuity after hospitalization in patients with OUD. Hospitalizations related to OUD and its complications have increased dramatically over the last few decades, leading to high morbidity, mortality, and healthcare costs. Hospitals are increasingly recognized as critical touchpoints for engaging individuals with OUD in treatment, and randomized controlled trials support the efficacy of initiating medications for OUD (MOUD) in acute care settings to increase treatment engagement following discharge. However, hospital-initiated treatment is insufficient if patients do not continue care in the community. Despite the robust literature on care transitions after hospital discharge for patients with other chronic conditions, there is limited evidence about the best strategies to optimize care engagement for patients with OUD after hospitalization. We need effective, scalable strategies for linking patients with OUD from acute care to ongoing treatment, including continuation of MOUDs. The research objective of this proposal is to develop and pilot test strategies to facilitate transitions of care for patients with OUD from the hospital to the community. The specific aims are: (1) Use a mixed-methods approach to identify determinants of effective care transitions for patients with OUD from acute care to outpatient treatment at the patient, provider, and system level, (2) Partner with hospital and community stakeholders and use implementation mapping to develop a multicomponent, modular toolkit to facilitate transitions from acute care to community addressing multi- level barriers, and (3) Conduct a pilot trial of the care transition toolkit. The primary outcome will be treatment engagement at 30 days, and secondary outcomes will include MOUD and substance use, service use, feasibility, acceptability and patient satisfaction. The mentorship team brings together experts in health services research, implementation science, and care delivery interventions for OUD as well as stakeholder advisors from hospital and community settings. This Mentored Research Scientist Development Award builds on Dr. Lowenstein's experience as a clinician and researcher and extends it with five key training goals: 1) Measuring outcomes for OUD-related care across systems, 2) Advanced qualitative inquiry, 3) Implementing health systems change, and 5) Manuscript and grant writing. With successful completion of this project, training activities, and mentorship from a team of experienced investigators, Dr. Lowenstein will be well-prepared to lead an independent research agenda designed to improve care and outcomes for people with OUD.