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Identifying High Utilizing Patients with Opioid Use Disorder to Engage in Primary Care

识别患有阿片类药物使用障碍的高利用率患者以参与初级保健

基本信息

批准号：
10369935
负责人：
Brian Chan
金额：
$ 17.33万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10369935
关键词：
Address Area Caring Case Study Chronic Clinical Clinical Oncology Supplement (K12)Clinical Trials Design Communities Community Health Systems Complex Consolidated Framework for Implementation Research Data Diagnosis Discipline of Nursing Disease Enrollment Ensure Evidence based treatment Federally Qualified Health Center Future Goals Health Health Services Health Services Research Health system Heroin Intensive Care Internist Intervention Intervention Trial K-Series Research Career Programs Low income Measures Medical Medicine Mentored Patient-Oriented Research Career Development Award Mentors Methods Modeling National Institute of Drug Abuse Outcome Patient Care Patients Persons Pharmaceutical Preparations Pharmacy facility Physicians Population Primary Health Care Provider Quality of Care Randomized Research Research Methodology Research Personnel Resources SECTM1 gene Scientist Signal Transduction Site Strategic Planning Substance Use Disorder Testing Training Trust Work acceptability and feasibility addiction base care coordination care fragmentation career development cost effective intervention evidence base experience faculty mentor health care service utilization health service use high risk high risk population hospital utilization implementation determinants implementation science implementation strategy improved improved outcome interest medical complication mortality multidisciplinary novel opioid use disorder outreach patient engagement pilot test pilot trial pragmatic efficacy trial prescription pain reliever preventive intervention primary care setting psychosocial randomized trial risk stratification safety net social social determinants social health determinants social stigma substance use success therapy design treatment choice

项目摘要

PROJECT SUMMARY/ABSTRACT Brian Chan MD MPH is an internist and health services researcher passionate about improving health outcomes for vulnerable patients with opioid use disorder (OUD). This career development award will establish Dr. Chan as a clinician-investigator focused on implementing and disseminating novel primary care interventions that target high-risk patients with OUD in safety-net settings. The K23 award provides mentored training to develop expertise in 3 areas: 1) conduct of mixed-methods research to develop deployment-focused interventions; 2) clinical trial design and implementation science; and 3) addiction medicine treatment in federally qualified health center (FQHC) settings. To achieve these goals, Dr. Chan has assembled a multidisciplinary mentoring team with expertise in health services research, addiction medicine, intervention design and implementation science, and FQHC health systems, with success in mentoring faculty to research independence. In 2018, 2.1 million people had an opioid use disorder (OUD) related to heroin or prescription pain relievers. While the recognition of OUD is increasing, few patients receive evidence-based treatment. This is particularly true for medically complex patients with OUD in safety-net settings. OUD complicates management of other chronic medical conditions and is associated with high utilization of healthcare resources. Health systems are interested in risk stratifying complex patients to improve targeting of interventions, like ambulatory intensive care teams (A-ICU); these could be adapted for complex patients with OUD, but scalability limit dissemination. Informed by his clinical experience as an internist and data from his K12 award evaluating an A- ICU for medically complex high-utilizers in an FQHC, Dr. Chan will complete the following 3 aims: 1) Adapt an existing A-ICU intervention to address high complexity patients with OUD using community stakeholder engaged methods; 2) Refine the intervention through an iterative implementation case study, and identify measures of acceptability, feasibility, and implementation strategy; 3) Evaluate and pilot a randomized trial of the intervention to assess feasibility, acceptability, and preliminary efficacy of the refined intervention to improve clinical outcomes, and retention in OUD treatment at a FQHC using implementation and mixed- methods. The results provide preliminary data for a future R01 proposal pragmatic efficacy trial of the refined intervention at multiple FQHC sites. This proposal directly aligns with the priorities of the National Institute on Drug Abuse’s strategic planning workgroup on the “complexity of substance use disorders” and its priority to “develop and test strategies for effectively and sustainably implementing evidence-based treatments.” Completion of these studies will pave the way for implementing scalable primary care interventions to narrow OUD treatment gaps and improve care for high-risk populations.

项目总结/文摘