C-DIAS RP 2: Implementing contingency management for stimulant use in specialty addiction treatment organizations

C-DIAS RP 2：在专业成瘾治疗组织中实施兴奋剂使用应急管理

• 批准号: 10668488
• 负责人: Sara J. Becker
• 金额: $ 39.55万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10668488
• 关键词: Abstinence; Address; Adoption; Advisory Committees; Cessation of life; Climate; Cocaine; Collaborations; Computerized Medical Record; Data; Data Collection; Dissemination and Implementation; Drops; Effectiveness; Ensure; Equity; Evaluation; Evidence based intervention; Evidence based treatment; Excision; Family; Feedback; Goals; HIV Infections; Human Resources; Incentives; Individual; Interview; Laboratories; Leadership; Legal; Maintenance; Measures; Mediator; Medical; Mentors; Methamphetamine; Methods; Modeling; New England; Opioid; Outcome; Overdose; Patient-Focused Outcomes; Patients; Perception; Performance; Persons; Pharmaceutical Preparations; Phase; Population; Provider; Public Health; Public Sector; Quality of Care; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Research Project Grants; Risk; Role; Science; Service provision; Services; Source; Specific qualifier value; Stimulant; Technology Transfer; Testing; Time; Training; United States Substance Abuse and Mental Health Services Administration; Vocation; addiction; cohort; contextual factors; contingency management; data harmonization; design; effective intervention; effectiveness testing; effectiveness/implementation trial; evidence base; experience; experimental study; follow up assessment; follow-up; high risk; implementation context; implementation determinants; implementation outcomes; implementation science; implementation strategy; implementation/effectiveness; improved; medical specialties; medication for opioid use disorder; opioid epidemic; opioid overdose; opioid treatment program; opioid use; opioid use disorder; overdose death; psychostimulant; recruit; research to practice; standardize measure; stimulant dependence; stimulant use; treatment duration; treatment organization; treatment response; treatment services; uptake

C-DIAS RESEARCH PROJECT 2: PROJECT SUMMARY/ABSTRACT This rigorous experiment addresses a critical public health problem--the rising stimulant/opioid epidemic. It advances implementation science through the evaluation of a multi-level implementation strategy and specifies of contextual determinants of outcomes. Stimulants constitute a new and deadly fourth wave of the opioid epidemic. Among persons with opioid use disorder, stimulant use has been associated with more persistent opioid use; higher risk of HIV infection; higher levels of family, medical, legal, and vocational problems; and higher risk of lethal overdose. Contingency management (CM) is the most effective intervention for stimulant use and is an evidence-based adjunct to medication for opioid use disorder (MOUD). Yet, uptake of CM in opioid treatment programs (OTPs) that provide MOUD remains low: in fact, access to CM is arguably one of the greatest research-to-practice gaps in the addiction treatment services field. The goal of C-DIAS Research Project 2 is to conduct a type III hybrid effectiveness-implementation trial to evaluate a multi-level implementation strategy, the Science to Service Laboratory (SSL), to install CM for stimulant use in OTPs. The SSL has three core components: didactic training; performance feedback; and external facilitation. The project employs common C-DIAS frameworks, measures, and methods to guide SSL evaluation. Utilizing a stepped wedge design, a regional cohort of 10 public sector OTPs will be randomized to receive SSL at five distinct time points. At six intervals, each of the 10 OTPs will provide data from all available patient charts on CM delivery and patient outcomes. Each OTP will also recruit 10 patients per wedge (n = 500 patients) to complete a baseline interview and 3-month follow-up. In addition, staff from each OTP will report on contextual determinants of implementation outcomes at three timepoints. This study will rigorously evaluate whether a multi-level implementation strategy developed by one of the longest-standing national intermediary purveyor organizations--the SAMHSA Technology Transfer Centers, will improve both implementation and patient outcomes. Implementation outcomes are guided by RE-AIM and include CM Reach, Adoption, Implementation and Sustainment, while patient outcomes include measures of CM Effectiveness such as stimulant abstinence and treatment retention. The study will advance the C-DIAS scientific aims by unpacking the black box of implementation strategies and exploring the mediational and moderating influence of context on implementation outcomes. Focused on the active IMPLEMENT phase, this Research Project leverages a bi- directional synergistic relationship with C-DIAS. Some but not all examples of this include: 1) standardized measures of implementation context, outcomes and procedural details of strategies; 2) PI (Becker)’s role on the C-DIAS Research Core; 3) a close network of collaboration and mentoring among the key project personnel and C-DIAS PI; and 4) harmonization of data that can be used for modeling by C-DIAS Research Core experts.

C-DIAS 研究项目 2：项目摘要/摘要 这项严格的实验解决了一个关键的公共卫生问题——兴奋剂/阿片类药物的流行。它 通过评估多层次实施战略来推进实施科学，并指定 结果的背景决定因素。兴奋剂构成了阿片类药物的新的致命第四波浪潮 流行性。在患有阿片类药物使用障碍的人中，兴奋剂的使用与更持久的相关 阿片类药物的使用；感染艾滋病毒的风险较高；更高层次的家庭、医疗、法律和职业问题；和 致命过量的风险更高。应急管理（CM）是最有效的刺激干预措施 使用，是阿片类药物使用障碍 (MOUD) 药物的循证辅助药物。然而，CM 的吸收 提供 MOUD 的阿片类药物治疗计划 (OTP) 仍然很低：事实上，获得 CM 可以说是其中之一 成瘾治疗服务领域最大的研究与实践差距。 C-DIAS研究的目标 项目2是进行III型混合有效性实施试验，以评估多层次的 实施战略，科学服务实验室（SSL），安装 CM 以在 OTP 中使用兴奋剂。这 SSL 具有三个核心组成部分：教学培训；绩效反馈；以及外部的便利。项目 采用通用的 C-DIAS 框架、措施和方法来指导 SSL 评估。利用阶梯式 楔形设计中，由 10 个公共部门 OTP 组成的区域队列将被随机分配，以在五个不同的地点接受 SSL 时间点。每隔 6 个时间间隔，10 个 OTP 中的每一个都将提供 CM 上所有可用患者图表的数据 分娩和患者结果。每个 OTP 还将招募每个楔子 10 名患者（n = 500 名患者）来完成 基线访谈和 3 个月的随访。此外，每个 OTP 的工作人员将报告相关情况 三个时间点实施结果的决定因素。这项研究将严格评估是否 由历史最悠久的国家中介供应商之一制定的多层次实施策略 组织——SAMHSA 技术转移中心，将改善实施和耐心 结果。实施结果以 RE-AIM 为指导，包括 CM 覆盖、采用、实施 和维持，而患者结果包括 CM 有效性的测量，例如兴奋剂戒断 和治疗保留。该研究将通过揭开 C-DIAS 的黑匣子来推进 C-DIAS 的科学目标 实施策略并探索环境的中介和调节影响 实施成果。该研究项目侧重于积极的实施阶段，利用了双 与C-DIAS的定向协同关系。一些但不是全部的例子包括：1）标准化 衡量战略的实施背景、结果和程序细节； 2）PI（Becker）的角色 C-DIAS 研究核心； 3）关键项目之间密切的合作和指导网络 人员和 C-DIAS PI； 4) 协调可用于 C-DIAS Research 建模的数据 核心专家。