The STop UNhealthy Substance Use Now Trial (STUN II)

项目摘要/摘要 背景：物质使用障碍(SODS)，可涉及非法药物、处方药或酒精， 这种情况很常见，并导致相当大的发病率和死亡率。不健康的酒精和药物使用是其中之一 在美国，可预防死亡的主要原因正在增加，并且是导致 缩短了美国人的预期寿命。美国建议筛查使用不健康物质 预防服务工作队和其他国家团体，因为它可以改善健康结果， 然而，大多数初级保健实践都没有筛选和管理肥皂泡的系统。 目标：(1)确定实践便利化(PF)能否实现以患者为中心的快速实施 结果研究发现，以改善初级保健中SUDS的筛查和管理，以及(2) 比较学习协作(LC)、绩效激励(PI)或其组合是否可以 与初级保健相比，显著改善了初级保健中SUD筛查和管理的实施 仅用PF。 方法：立即停止不健康物质使用试验(STUN II)是一项多点2x2随机对照试验。 将纳入48家初级保健诊所的有效性试验。STUN II将对比较效果进行评估 实施以下战略，以实施对流行性出血热的筛查和循证干预 初级保健：PF、PF加LC、PF加PI和PF LC PI。评估将在12个月内进行- 在干预期间和干预后12个月的随访中，评估维持情况。此外，a 混合方法评估将评估实施效果和假设之间的关联 主持人(如组织变革准备情况)和调解人(如执行环境)。 潜在影响：这项研究将从根本上产生关于 PF、PF加LC、PF加PI和PF LC PI对循证筛查的影响 提供给初级保健机构时对SUD的干预。它还将产生关于以下方面的科学知识 背景因素如何影响各种方法在促进临床实践和 初级保健环境中的办公系统变化。这一结果将向卫生系统、政策制定者和 关于实施SUDS筛查和管理的最佳策略的初级保健做法 在初级保健方面。

Project Summary/Abstract Background: Substance use disorders (SUDs), which can involve illicit drugs, prescription drugs, or alcohol, are common and result in substantial morbidity and mortality. Unhealthy alcohol and substance use are among the leading causes of preventable deaths in the US, are increasing, and are among the top causes of the shortening life expectancy in the US. Screening for unhealthy substance use is recommended by the US Preventive Services Task Force and other national groups because it can lead to improved health outcomes, yet most primary care practices do not have a system to screen for and manage SUDs. Objectives: (1) to determine if practice facilitation (PF) can achieve rapid implementation of patient-centered outcomes research findings to improve screening for and management of SUDs in primary care and (2) to compare whether learning collaboratives (LC), performance incentives (PI), or their combination can significantly improve the implementation of screening for and management of SUDs in primary care compared with PF alone. Methods: The STop UNhealthy Substance Use Now trial (STUN II) is a multisite 2x2 randomized comparative effectiveness trial that will enroll 48 primary care practices. STUN II will evaluate the comparative effectiveness of the following strategies for the implementation of screening and evidence-based interventions for SUDs in primary care: PF, PF plus LC, PF plus PI, and PF+LC+PI. Assessments will be conducted throughout a 12- month intervention period and at a 12-month post-intervention follow up, to assess sustainment. In addition, a mixed methods evaluation will assess the association between implementation effectiveness and putative moderators (e.g., organizational readiness for change) and mediators (e.g., implementation climate). Potential Impact: The study will produce fundamentally important evidence about the comparative effectiveness of PF, PF plus LC, PF plus PI, and PF+LC+PI on uptake of evidence-based screening and interventions for SUD when delivered to primary care practices. It will also generate scientific knowledge about how contextual factors influence the effectiveness of the various approaches in promoting clinical practice and office systems changes in primary care settings. The results will inform health systems, policymakers, and primary care practices about optimal strategies for implementation of screening for and management of SUDs in primary care.