HEALing Measurement Center: Enhancing Opioid Use Disorder Recovery through Measurement Based Care

摘要 阿片类药物使用障碍（OUD）仍然是宾夕法尼亚州的一个严重公共卫生危机。宾夕法尼亚中心 卓越被指控提供阿片类药物治疗，包括阿片类药物使用障碍的药物 （MOUD），以提高治疗的可及性，促进康复，并减少整个致命过量的影响 该州尽管努力改善对OUD的循证治疗，如药物治疗， 综合行为健康服务，国家OUD和阿片类药物过量死亡率仍然存在 惊人的高。目前主要针对减少OUD症状的MOUD干预措施具有显著的 辍学率（20-50%），并导致约36%的个体OUD缓解。合并症患者- 发生物质使用和精神健康障碍的风险更大，往往是因为他们 具有更复杂的治疗需求，难以在真实的时间内识别、跟踪和响应。以潜在地 改善OUD干预结果，这是密歇根大学健康措施中心的首要目标。 匹兹堡将加强社区阿片类药物治疗中提供的护理的测量，质量和公平性 通过持续实施基于测量的护理（MBC）来实施OTP计划。具体而言是 三个拟议项目旨在解决我们的合作伙伴所表达的紧迫关切 同时填补关键的研究空白。研究计划1将制定MBC 实施蓝图，包括技术援助、学习网络和减少文书工作 战略布局研究计划2将展示实施增强型MBC的真实性和有效性 实施（MBC+）与通过阶梯楔型混合II型常规测量（MAU） 有效性试验。研究计划3将证明MBC+的临床有效性 相对于MAU，OUD和精神健康诊断同时发生的患者。拟定的研究将 提供关键的初步证据，说明利用MBC在OUD中的作用和意义 干预措施，加强实施可持续、公平和有效的《巴塞尔公约》干预措施， 与利益相关者（决策者、付款人和OTP）共同设计的实施战略，以及 潜在增强OUD的治疗相关结局和治疗保留的替代途径 对下游社会、心理和公共卫生有益的干预措施。

Abstract Opioid use disorder (OUD) remains a critical public health crisis in Pennsylvania. The Pennsylvania Centers of Excellence have been charged with providing opioid treatment, including medication for opioid use disorder (MOUD), to enhance treatment access, promote recovery, and reduce the impact of fatal overdose throughout the state. Despite efforts to improve access to evidence-based treatments for OUD such as medications and integrated behavioral health services, national OUD and opioid involved overdose death rates remain alarmingly high. Current MOUD interventions primarily targeting reduction in OUD symptoms have significant dropout rates (20-50%) and result in remission of OUD for ~36 percent of individuals. The patients with co- occurring substance use and mental health disorders are at greater risk for poor outcomes, often because they have more complex treatment needs that are hard to identify, track, and respond to in real time. To potentially improve OUD intervention outcomes, the overarching goal of the HEALing Measures Center at University of Pittsburgh is to enhance the measurement, quality, and equity of care delivered in community opioid treatment programs (OTPs) through sustained implementation of measurement-based care (MBC). Specifically, the three proposed projects were designed to address the immediate concerns expressed by our partners while simultaneously meeting critical research gaps. Research Plan 1 will develop an MBC Implementation Blueprint including technical assistance, learning networks, and paperwork reduction strategies. Research Plan 2 will demonstrate the fidelity and effectiveness of implementing enhanced MBC implementation (MBC+) versus measurement as usual (MAU) via a stepped-wedge, hybrid type II effectiveness-implementation trial. Research Plan 3 will demonstrate the clinical effectiveness of MBC+ relative to MAU for patients with co-occurring OUD and mental health diagnoses. The proposed study will provide critical preliminary evidence regarding the role and significance of capitalizing on MBC in OUD interventions, enhanced implementation of a sustainable, equitable, and effective MBC intervention via implementation strategies that are co-designed with stakeholders (policymaker, payer, and OTP), and alternative avenues to potentially enhance symptom-related outcomes and treatment retention of OUD interventions with downstream societal, psychological, and public health benefits.