Systems analysis and improvement to optimize opioid use disorder care quality and continuity for patients exiting jail (SAIA-MOUD).
系统分析和改进,以优化出狱患者的阿片类药物使用障碍护理质量和连续性 (SAIA-MOUD)。
基本信息
- 批准号:10832930
- 负责人:
- 金额:$ 200.49万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-09-19 至 2026-06-30
- 项目状态:未结题
- 来源:
- 关键词:AccountabilityAddressAdoptionBiologicalCaringChronicClientClinicClinicalClinical ServicesCommunicationCommunitiesComplexConsensusConsolidated Framework for Implementation ResearchContinuity of Patient CareCountyCounty GovernmentDataDecision MakingDropsEconomicsEngineeringEnvironmentFamilyFocus GroupsFosteringGeneral PopulationGoalsHealth Care SectorHealth systemHomelessnessHousingImprisonmentImprove AccessIndividualInformation SystemsInterventionInterviewJailLegal systemLifeLinkMapsMeasurableMeasuresMedicaidMental HealthModificationMorbidity - disease rateOutcomeOverdoseOverdose reductionPathway interactionsPatient-Focused OutcomesPatientsPerformancePersonsPhasePopulationProcessProviderPublic HealthQuality of CareQuality-Adjusted Life YearsReportingServicesSiteSocial ConditionsSocial NetworkSocial WorkSocial supportSurveysSystemSystems AnalysisUnited StatesVisualizationWashingtonclinical carecommunity organizationscommunity partnershipcostcost effectivenesscost estimatedata hubdata integrationdesigneffective interventioneffectiveness evaluationeffectiveness studyevidence baseflexibilityhealth care deliveryhealth care service organizationhealthcare communityimplementation fidelityimplementation outcomesimplementation researchimplementation strategyimprovedincremental costinformantmarginalizationmedication for opioid use disordermicrocostingmortalitynovelopioid overdoseopioid use disorderorganizational readinessoverdose deathoverdose riskprogramsrecidivismsecondary outcomeservice deliverysocialsocial stigmasystem-level barrierssystems researchtool
项目摘要
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.
在美国,与阿片类药物有关的过量死亡人数正在飙升,包括华盛顿州
从2021年到2022年,服药过量死亡人数上升了37%。据估计,超过50%的阿片类药物使用障碍患者
(OUD)每年通过佤邦监狱。监狱监禁导致服药过量风险急剧增加
此外,还加剧了边缘化,阻碍了对儿童权利的管理。有证据的治疗-
阿片类药物使用障碍的基础药物(MOUD)有效地管理OUD,降低患者的过量用药风险,
并降低累犯率。佤邦优先改善对穆德的访问,包括个人
被监禁在监狱中,然而,在从监狱向临床转诊地点移交护理方面存在系统性弱点
而且,几乎没有把重点放在制定促进服务之间联系的战略上。低成本、系统级
干预措施是改善相互关联的级联服务的有效和高效的方法,并可能改善
监狱和转诊临床服务之间的联系,改善Moud级联的流动,解决障碍
整体护理,并最终减少无人管理的OUD、再犯罪率和死亡率。系统分析
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
在华盛顿州金县的监狱和转诊诊所,护理以及与社会服务的联系。我们会落实
三年的SAIA--包括两年的强化阶段和一年的维持--在一个监狱
穆德计划和两个转介穆德诊所。然后,我们将评估SAIA在改进方面的有效性
在监狱接受护理的患者和离开转诊诊所的患者的MOD级联质量和连续性,决定
对出院后14天内护理的影响。留存的次要结果(那些返回的人
将考虑在初始联系后一个月内第二次拾取Moud)。我们将描述-并探索
决定因素-采用、实施和维持SAIA-Moud,通过对监狱和
诊所工作人员。分析将以执行研究综合框架和
报告对循证执行战略的调整和修改框架(框架--
将用于记录实施战略的调整。我们将估算成本和成本-
SAIA-Moud在出院时使用与Moud转诊诊所相关联的每个额外客户的成本的效果
从监狱以及从县政府、医疗保健部门和社会获得的质量调整的生活年
透视。使用微观成本计算方法,我们将估算每个新增患者的增量成本
穿过穆德瀑布。这项实施研究的结果预计将制定
以系统为中心的干预应用于新的临床级联如何导致可测量的证据
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。
项目成果
期刊论文数量(0)
专著数量(0)
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会议论文数量(0)
专利数量(0)
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Sarah Odell Gimbel其他文献
Sarah Odell Gimbel的其他文献
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{{ truncateString('Sarah Odell Gimbel', 18)}}的其他基金
Towards Cervical cancer elimination: Implementation and scale-up of a single-visit, screen-and-treat approach with thermal ablation for sustainable cervical cancer prevention services in Kenya
消除宫颈癌:在肯尼亚实施和扩大单次就诊、筛查和治疗的热消融方法,以提供可持续的宫颈癌预防服务
- 批准号:
10843625 - 财政年份:2021
- 资助金额:
$ 200.49万 - 项目类别:
Towards Cervical cancer elimination: Implementation and scale-up of a single-visit, screen-and-treat approach with thermal ablation for sustainable cervical cancer prevention services in Kenya
消除宫颈癌:在肯尼亚实施和扩大单次就诊、筛查和治疗的热消融方法,以提供可持续的宫颈癌预防服务
- 批准号:
10180713 - 财政年份:2021
- 资助金额:
$ 200.49万 - 项目类别:
Towards Cervical cancer elimination: Implementation and scale-up of a single-visit, screen-and-treat approach with thermal ablation for sustainable cervical cancer prevention services in Kenya
消除宫颈癌:在肯尼亚实施和扩大单次就诊、筛查和治疗的热消融方法,以提供可持续的宫颈癌预防服务
- 批准号:
10491699 - 财政年份:2021
- 资助金额:
$ 200.49万 - 项目类别:
Towards Cervical cancer elimination: Implementation and scale-up of a single-visit, screen-and-treat approach with thermal ablation for sustainable cervical cancer prevention services in Kenya
消除宫颈癌:在肯尼亚实施和扩大单次就诊、筛查和治疗的热消融方法,以提供可持续的宫颈癌预防服务
- 批准号:
10693340 - 财政年份:2021
- 资助金额:
$ 200.49万 - 项目类别:
Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN)
优化 HIV 感染者高血压诊断和护理级联的系统分析和改进方法 (SAIA-HTN)
- 批准号:
10392907 - 财政年份:2019
- 资助金额:
$ 200.49万 - 项目类别:
Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN)
优化 HIV 感染者高血压诊断和护理级联的系统分析和改进方法 (SAIA-HTN)
- 批准号:
10617293 - 财政年份:2019
- 资助金额:
$ 200.49万 - 项目类别:
Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN)
优化 HIV 感染者高血压诊断和护理级联的系统分析和改进方法 (SAIA-HTN)
- 批准号:
10153876 - 财政年份:2019
- 资助金额:
$ 200.49万 - 项目类别:
Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN)
优化 HIV 感染者高血压诊断和护理级联的系统分析和改进方法 (SAIA-HTN)
- 批准号:
9924633 - 财政年份:2019
- 资助金额:
$ 200.49万 - 项目类别:
Usability and Feasibility of a Phone-based Decision Support Tool for Option B+
选项 B 的基于电话的决策支持工具的可用性和可行性
- 批准号:
9116602 - 财政年份:2016
- 资助金额:
$ 200.49万 - 项目类别:
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