Systems analysis and improvement to optimize opioid use disorder care quality and continuity for patients exiting jail (SAIA-MOUD).

美国与阿片类药物有关的过量死亡人数正在飙升，包括在华盛顿州（WA）， 从2021年到2022年，过量死亡人数增加了37%。据估计，超过50%的阿片类药物使用障碍患者 (OUD)每年都要经过西澳大利亚州监狱监狱监禁导致过量风险急剧增加， 此外，还加剧了阻碍OUD管理的边缘化。有证据的治疗- 基于阿片类药物使用障碍（MOUD）的药物有效地管理OUD，降低患者过量用药的风险， 降低再犯率。西澳大利亚州将改善包括个人在内的MOUD的使用作为优先事项 被监禁在监狱中，但在从监狱向临床转诊地点移交护理方面存在系统性缺陷 很少注重制定促进服务业之间联系的战略。低成本、系统级 干预措施是改善连锁级联服务的有效和高效方法， 监狱和转诊临床服务之间的联系，改善通过MOUD级联的流量，解决障碍 全面的OUD护理，并最终减少未管理的OUD，累犯和死亡率。的系统分析 和改进方法（SAIA）是一种基于证据的捆绑系统实施策略 工程工具，旨在优化复杂的医疗保健提供系统，并改善 临床和社区提供者。SAIA-MOUD研究旨在加强MOUD的质量和连续性 在西澳金县的监狱和转诊诊所提供医疗保健和与社会服务的联系。落实好 SAIA为期三年，包括两年的强化阶段和一年的维持阶段， MOUD计划和两个转诊MOUD诊所。然后，我们将评估SAIA在改善 MOUD对在监狱中接受护理和离开转诊诊所的患者的质量和连续性进行级联，确定 释放后14天内对与护理联系的影响。保留的次要结果（那些返回 第二次MOUD拿起一个月内的初步联系）将被考虑。我们将描述并探索 通过对监狱的定性调查，采用、实施和维持SAIA-MOUD的决定因素， 诊所工作人员分析工作将遵循《执行情况研究综合框架》和 循证实施战略调整和修改报告框架（FRAME- IS）将用于记录实施战略的调整。我们会估算成本和费用- SAIA-MOUD的有效性，使用与MOUD转诊诊所相关的每增加一个客户的成本 以及从县政府、医疗保健部门和社会获得的质量调整生命年 视角使用微成本计算方法，我们将估计每增加一名患者的增量成本 穿过MOUD瀑布。这一实施研究的结果预计将开发 一个以系统为中心的干预措施如何应用于一个新的临床级联的证据基础，可以导致可衡量的 改善级联功能和患者水平的结果，以应对重大的国家公共卫生威胁。

Opioid-related overdose deaths in the United States are skyrocketing, including in Washington State (WA) where overdose deaths rose 37% from 2021-2022. Estimates suggest that over 50% of people with opioid use disorder (OUD) pass through WA jails each year. Jail incarceration causes a dramatic increase in overdose risk following release, in addition to compounding marginalization that hinders management of OUD. Treatment with evidence- based Medications for Opioid Use Disorder (MOUD) effectively manages OUD, reduces patients’ overdose risk, and reduces rates of recidivism. WA has prioritized improving access to MOUD, including for individuals incarcerated in jails, however systemic weaknesses exist in the handoff of care from jail to clinical referral sites and there is little focus on developing strategies that foster linkages between services. Low-cost, systems-level interventions are effective and efficient approaches to improve linked cascade services and may improve linkages between jails and referral clinical services, improve flow through the MOUD cascade, address barriers to holistic OUD care, and ultimately reduce unmanaged OUD, recidivism, and mortality. The Systems Analysis and Improvement Approach (SAIA) is an evidence-based implementation strategy of bundled systems engineering tools designed to optimize complex healthcare delivery systems and improve linkages between clinical and community providers. The SAIA-MOUD study aims to strengthen the quality and continuity of MOUD care, and linkages to social services, across jail and referral clinics in King County, WA. We will implement the SAIA for three years—including a two-year intensive phase and one year of sustainment—at one jail based MOUD program and two referral MOUD clinics. We will then evaluate the effectiveness of SAIA on improving MOUD cascade quality and continuity for patients receiving care in jail and exiting to referral clinics, determining the effect on linkage to care within 14 days of release. A secondary outcome of retention (those who return for a second MOUD pick up within a month of initial linkage) will be considered. We will describe—and explore determinants of—adoption, implementation, and sustainment of SAIA-MOUD via qualitative inquiry with jail and clinic staff. Analysis will be guided by the Consolidated Framework for Implementation Research (CFIR) and the Framework for Reporting Adaptations and Modification to Evidence-based Implementation Strategies (FRAME- IS) will be used to document implementation strategy adaptations. We will estimate the cost and cost- effectiveness of SAIA-MOUD using the cost per additional client linked to MOUD referral clinics upon release from jail as well as quality-adjusted life year gained from the county government, healthcare sector, and societal perspectives. Using a micro-costing approach, we will estimate the incremental costs per additional patient passing through the MOUD cascade. The results of this implementation research are expected to develop the evidence base on how a systems-focused intervention applied to a novel clinical cascade can lead to measurable improvements in cascade functioning and patient-level outcomes for a significant, national public health threat.