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)。

• 批准号: 10832930
• 负责人: Sarah Odell Gimbel
• 金额: $ 200.49万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 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: https://reporter.nih.gov/project-details/10832930
• 关键词: Accountability; Address; Adoption; Biological; Caring; Chronic; Client; Clinic; Clinical; Clinical Services; Communication; Communities; Complex; Consensus; Consolidated Framework for Implementation Research; Continuity of Patient Care; County; County Government; Data; Decision Making; Drops; Economics; Engineering; Environment; Family; Focus Groups; Fostering; General Population; Goals; Health Care Sector; Health system; Homelessness; Housing; Imprisonment; Improve Access; Individual; Information Systems; Intervention; Interview; Jail; Legal system; Life; Link; Maps; Measurable; Measures; Medicaid; Mental Health; Modification; Morbidity - disease rate; Outcome; Overdose; Overdose reduction; Pathway interactions; Patient-Focused Outcomes; Patients; Performance; Persons; Phase; Population; Process; Provider; Public Health; Quality of Care; Quality-Adjusted Life Years; Reporting; Services; Site; Social Conditions; Social Network; Social Work; Social support; Surveys; System; Systems Analysis; United States; Visualization; Washington; clinical care; community organizations; community partnership; cost; cost effectiveness; cost estimate; data hub; data integration; design; effective intervention; effectiveness evaluation; effectiveness study; evidence base; flexibility; health care delivery; health care service organization; healthcare community; implementation fidelity; implementation outcomes; implementation research; implementation strategy; improved; incremental cost; informant; marginalization; medication for opioid use disorder; microcosting; mortality; novel; opioid overdose; opioid use disorder; organizational readiness; overdose death; overdose risk; programs; recidivism; secondary outcome; service delivery; social; social stigma; system-level barriers; systems research; tool

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飞涨，包括在华盛顿州（WA） 从2021 - 2022年起，过量死亡人数增长了37％。估计表明，超过50％的阿片类药物使用障碍患者 （OUD）每年通过西澳监狱。监狱增加导致过量风险急剧增加 释放，除了加剧边缘化外，还阻碍了OUD的管理。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，降低了患者的过量风险， 并降低了累犯的速度。西澳大利亚已经优先提高对MOUD的访问，包括个人 在监狱中被监禁，但是从监狱到临床推荐地点的护理交接中存在系统的弱点 几乎没有关注开发促进服务之间联系的策略。低成本，系统级 干预措施是改善链接的级联服务的有效和有效的方法，并可能改善 监狱与推荐临床服务之间的联系，改善通过MOUD级联的流动，地址障碍 整体护理，并最终减少未管理的Oud，累犯和死亡率。系统分析 改进方法（SAIA）是捆绑系统的基于证据的实施策略 工程工具旨在优化复杂的医疗保健提供系统并改善之间的联系 临床和社区提供者。 Saia-Moud研究旨在增强MOUD的质量和连续性 护理以及与社会服务的联系，华盛顿州金县的监狱和推荐诊所。我们将实施 SAIA三年，包括一个两年的密集阶段和一年的维持 - 在一个监狱 MOUD计划和两个推荐MOUD诊所。然后，我们将评估SAIA对改进的有效性 MOUD级联质量和连续性，用于在监狱中接受护理并退出推荐诊所的患者，确定 释放后14天内对链接的影响。保留的次要结果（那些返回的人 将考虑在初始链接的一个月内进行第二次穆德接送）。我们将描述并探索 通过定性调查和监狱的定性调查和 诊所工作人员。分析将以合并实施研究框架（CFIR）和 报告改编和修改基于证据的实施策略的框架（框架 - IS）将用于记录实施策略改编。我们将估算成本和成本 - Saia-Moud使用链接到MOUD推荐诊所的每个客户的成本 从监狱以及从县政府，医疗保健部门和社会中获得的质量调整的生活年份 观点。使用微观成本的方法，我们将估计每位患者的增量成本 穿过Moud Cascade。这项实施研究的结果有望发展 基于以系统为中心的干预措施应用于新型临床级联的证据可以导致可测量的 级联功能和患者级别的成果的改善，构成了重大的国家公共卫生威胁。