C-DIAS RP3: Scaling-out app-based treatments: a multi-level strategy to promote equity across primary care patients with substance use

C-DIAS RP3：扩展基于应用程序的治疗：促进初级保健药物使用患者公平的多层次策略

• 批准号: 10668496
• 负责人: Joseph Edwin Glass
• 金额: $ 39.23万
• 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/10668496
• 关键词: Address; Adherence; Advisory Committees; African American; Asian Americans; Authorization documentation; Black American; Buprenorphine; Caring; Cellular Phone; Clinic; Collaborations; Communication; Community Health Systems; Data; Devices; Disparity; Disparity population; Dissemination and Implementation; Engineering; Ensure; Equity; Ethics; Ethnic Origin; Evidence based practice; Evidence based treatment; Failure; Feedback; Glass; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Hispanic; Home; Human Resources; Individual; Inequity; Intervention; Laboratories; Language; Latino; Leadership; Learning; Medicine; Mental Health Services; Mentors; Methodology; Modeling; Outcome; Ownership; Patient Care; Patient-Focused Outcomes; Patients; Perception; Performance; Persons; Phase; Population Heterogeneity; Primary Care; Privacy; Privatization; Problem Solving; Public Health; Race; Randomized; Research; Research Design; Research Personnel; Research Project Grants; Role; Service provision; Statistical Methods; Substance Use Disorder; System; Testing; Time; United States National Academy of Sciences; United States National Institutes of Health; Visit; Washington; World Health; addiction; authority; brief intervention; comorbidity; cost; data harmonization; design; digital; digital health; digital healthcare; digital treatment; disparity reduction; effectiveness/implementation hybrid; health disparity populations; health equity; high risk; implementation context; implementation cost; implementation evaluation; implementation outcomes; implementation science; implementation strategy; implementation study; improved; innovation; member; patient subsets; pragmatic trial; primary care clinic; primary care clinician; primary care patient; primary care team; primary care visit; social determinants; social stigma; standardize measure; stem; substance use; substance use treatment; success; web-based intervention

C-DIAS RESEARCH PROJECT 3: PROJECT SUMMARY/ABSTRACT At the SUSTAIN phase, C-DIAS Research Project 3 addresses a critical scientific and public health gap: How can we improve equity when offering digital treatments to patients with substance use disorders (SUDs) in primary care? A wide range of effective digital treatments —app or web-based interventions—for SUDs and comorbid conditions are available for use in primary care, and many have been evaluated in diverse populations. Digital treatments for SUDs could potentially reduce inequities, as they: 1) have the potential to reach more people by reducing access barriers; 2) can circumvent SUD stigma; and 3) allow patients to initiate interventions from the comfort and privacy of home. At the same time, digital treatments may also magnify inequities due to factors stemming from the “digital divide.” We will rigorously evaluate an implementation strategy to “scale-out” digital treatments to disadvantaged populations as an approach to potentially improve equity in digital care for people with SUDs, and as a model for how to ethically sustain digital treatments in real-world healthcare. Prior pragmatic trials found that evidence-based practices and other initiatives are hard to sustain without leadership and clinic buy-in, so our multi-level study design and analytic plan focuses on these issues. Our delivery system partners in Kaiser Permanente Washington are committed to collaborating with us to study multi-level strategies for scaling-out existing digital treatments in 32 primary care clinics in Washington State to address expected equity challenges. All clinics will receive a 3-part system-level set of implementation strategies that are suitable for primary care: 1) system-wide audit and feedback; 2) patient stories from members of disadvantaged populations; and, 3) engaging key stakeholders in problem solving to reduce barriers to the use of digital treatments among disadvantaged populations. To test a clinic-level implementation strategy, a subset of 12 clinics will be randomized to receive external facilitation or to a control condition (no facilitation) in a 1:1 parallel-groups design. Equity outcomes will be assessed by comparing reach across subgroups of patients defined by key social determinants (e.g., race/ethnicity). Specific Aims are to: 1) estimate the impact of a multi-level implementation strategy (system- and clinic-level) in increasing equity in the reach of digital treatments among patients with SUD in primary care clinics; and 2) describe the costs of and adherence to the implementation strategies, and examine how contextual determinants can impact equity in implementation and patient outcomes. Research Project 3 leverages a bi-directional relationship with C- DIAS, demonstrated in part by: 1) standardized measures of implementation context, outcomes and procedural details of strategies; 2) PI (Glass)’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; 4) harmonization of data that can be used for modeling by C-DIAS Research Core experts; 5) data on digital treatment implementation costs for decision- makers; and 6) expanded options for dissemination and impact of study findings through C-DIAS.

C-DIAS研究项目3：项目总结/摘要 在SUSTAIN阶段，C-DIAS研究项目3解决了一个关键的科学和公共卫生差距：如何 我们能否在为物质使用障碍（SUD）患者提供数字治疗时提高公平性？ 初级保健？针对SUD的各种有效数字治疗-应用程序或基于网络的干预， 共病条件可用于初级保健，许多已在不同的评估， 人口。SUD的数字化治疗可能会减少不平等，因为它们：1）有可能 通过减少准入障碍接触更多的人; 2）可以避免SUD的耻辱; 3）允许患者开始 从舒适和隐私的家庭干预。与此同时，数字治疗也可能放大 由于“数字鸿沟”造成的不平等。我们将严格评估一个实施 将数字治疗“扩展”到弱势群体的战略， 为SUD患者提供数字护理的公平性，并作为如何在道德上维持数字治疗的模式， 现实世界的医疗保健。之前的务实试验发现，循证实践和其他举措很难 在没有领导和诊所支持的情况下维持，因此我们的多层次研究设计和分析计划侧重于 这些问题我们在Kaiser Permanente华盛顿的交付系统合作伙伴致力于合作 与我们一起研究在32个初级保健诊所扩大现有数字治疗的多层次战略， 华盛顿州解决预期的公平挑战。所有诊所都将收到一套由三部分组成的系统级 适用于初级保健的实施策略：1）全系统审计和反馈; 2）患者 弱势群体成员的故事; 3）让关键利益攸关方参与解决问题， 减少弱势群体使用数字治疗的障碍。为了测试一个临床级的 实施策略，将随机选择12个诊所的子集接受外部促进或对照 在1：1平行组设计中的条件（无促进）。将通过比较覆盖范围来评估公平结果 在由关键社会决定因素定义的患者亚组中（例如，种族/民族）。具体目标是：1） 估计多层次实施战略（系统和诊所一级）在提高公平性方面的影响， 数字治疗在初级保健诊所SUD患者中的覆盖范围; 2）描述 和遵守执行战略，并审查背景决定因素如何影响公平 在实施和病人的结果。研究项目3利用与C的双向关系， DIAS，部分体现为：1）执行背景、结果和程序的标准化措施 战略细节; 2）PI（玻璃）在C-DIAS研究核心中的作用; 3）密切的合作网络， 在关键项目人员和C-DIAS PI之间进行指导; 4）协调可用于以下方面的数据： 由C-DIAS研究核心专家建模; 5）数字治疗实施成本的数据，用于决策- 制造商;和6）通过C-DIAS扩大研究结果的传播和影响的选择。