HEALing Communities Study Health Equity Research

项目总结/摘要 阿片类药物过量危机在美国持续存在，造成了沉重的发病率和死亡率负担。 有一个强大的证据基础，减少阿片类药物过量，包括过量教育和纳洛酮 分销（OEND）、阿片类药物使用障碍（MOUD）药物以及更安全的阿片类药物处方和处置。 然而，社区一级采用这些循证实践（EBP）在医疗保健，行为 卫生和刑事法律的系统是次优的。 愈合社区研究（HCS）设计了社区愈合（CTH）干预，以帮助 增加EBP的采用，并最终减少美国四个州67个社区的阿片类药物过量死亡 肯塔基州、马萨诸塞州、纽约和俄亥俄州。CTH是一个由联盟领导和数据驱动的干预措施 包括三个组成部分：（1）社区参与;（2）阿片类药物过量减少连续 护理方法（ORCCA），这是一个EBP菜单;（3）一套沟通活动，以减少 污名化并推动对EBP的需求。 在HCS的过程中，美国面临着明显的种族，民族和社会经济差异， COVID-19的结果以及乔治弗洛伊德在警察拘留期间被杀的可怕的8分钟视频。 这些事件使人们注意到我国制度中普遍存在的不平等现象。作为回应，HCS研究人员 完善了对等待名单上的社区的社区卫生保健干预措施，以更加明确地关注卫生公平。 作为数据协调中心（DCC），RTI将与研究中心合作，探索实施 CTH干预的公平相关增强成果。根据这项补充，我们将 进行新的分析，以评估联盟成员对成员多样性的满意程度（目标1）; 联盟成员认为需要培训，资源和针对种族和民族的定制战略 少数群体和其他得不到充分服务的群体（目标2）;联盟讨论的频率和重点 种族平等（目标3）;所实施的开放式教育和发展战略及发展模式战略的范围在多大程度上反映了 第二波社区的社会人口特征（目标4）;以及社区一级 衡量耻辱和健康的社会决定因素，通过OEND和MOUD战略， 向特殊人群提供服务，EBP向第二波社区提供服务（目标5）。 DCC有能力与HCS研究中心合作，以实现这些目标。多重主体 调查人员伊曼纽尔·奥加博士、拉肖恩·格拉斯哥博士和加里·扎金博士都是经验丰富的多地点领导人。 在药物滥用，社区参与，实施科学和健康方面具有专业知识的研究 股权更广泛的团队包括分析师和一名协调员，他们支持de novo的开发 建议分析的数据来源，分析人员具有进行其他实施的相关经验- 在母HCS下进行定向分析。实现以公平为重点的新目标， 调查结果将有助于为社区参与的方法建立基于实践的证据， 阿片类药物过量危机

Project Summary/Abstract The opioid overdose crisis persists in the United States, exacting a heavy burden of morbidity and mortality. There is a robust evidence base for reducing opioid overdose, including overdose education and naloxone distribution (OEND), medication for opioid use disorder (MOUD), and safer opioid prescribing and disposal. However, community-level adoption of these evidence-based practices (EBPs) in healthcare, behavioral health, and criminal legal systems is suboptimal. The HEALing Communities Study (HCS) designed the Communities That HEAL (CTH) intervention to help increase adoption of EBPs and ultimately reduce opioid overdose deaths in 67 communities across four U.S. states: Kentucky, Massachusetts, New York, and Ohio. The CTH is a coalition-led and data-driven intervention that includes three components: (1) community engagement; (2) the Opioid-overdose Reduction Continuum of Care Approach (ORCCA), which is a menu of EBPs; and (3) a set of communication campaigns to reduce stigma and drive demand for EBPs. Over the course of the HCS, the United States faced stark racial, ethnic, and socioeconomic differences in COVID-19 outcomes alongside the horrific eight-minute video of George Floyd’s killing in police custody. These events called attention to pervasive inequities in our nation’s systems. In response, HCS researchers refined the CTH intervention for wait-listed communities to include a more explicit focus on health equity. As the Data Coordination Center (DCC), RTI will work with research sites to explore implementation outcomes for equity-related enhancements to the CTH intervention. Under this supplement, we will conduct new analyses to assess coalition members’ level of satisfaction with the diversity of membership (Aim 1); coalition members’ perceived need for training, resources, and tailored strategies for racial and ethnic minoritized and other underserved groups (Aim 2); the frequency and focus of coalitions’ discussions about racial equity (Aim 3); the extent to which the reach of implemented OEND and MOUD strategies reflect the sociodemographic characteristics of Wave 2 communities (Aim 4); and associations among community-level measures of stigma and social determinants of health, the adoption of OEND and MOUD strategies intended to reach special populations, and EBP reach in Wave 2 communities (Aim 5). The DCC is equipped to collaborate with HCS research sites to achieve these aims. Multiple Principal Investigators, Drs. Emmanuel Oga, LaShawn Glasgow, and Gary Zarkin, are experienced leaders of multisite studies with expertise in substance abuse, community engagement, implementation science, and health equity. The broader team includes analysts and a coordinator who have supported the development of de novo data sources for proposed analyses, and analysts have relevant experience conducting other implementation- oriented analyses under the parent HCS. Achievement of the new equity-focused aims and dissemination of findings will help build practice-based evidence for community-engaged approaches to equitably addressing the opioid overdose crisis.