CHASE: An Innovative County-Level Public Health Response to the Opioid Epidemic in New York State

CHASE：针对纽约州阿片类药物流行病的创新县级公共卫生应对措施

• 批准号: 10391484
• 负责人: Nabila El-Bassel
• 金额: $ 868万
• 依托单位: COLUMBIA UNIV NEW YORK MORNINGSIDE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-17 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10391484
• 关键词: Accident and Emergency department; Address; Adoption; Affect; Alcohol abuse; Attention; Back; Biological Models; Buprenorphine; Calibration; Cessation of life; Clinic; Cluster randomized trial; Collaborations; Communities; Consolidated Framework for Implementation Research; Continuity of Patient Care; County; Custom; Data; Data Coordinating Center; Data Science; Death Rate; Drug Prescriptions; Effectiveness; Evidence based intervention; Failure; Feedback; Future; Geography; Goals; Government; HIV; Harm Reduction; Health; Health Services; Health Status; Healthcare; Hepatitis C virus; Hot Spot; Improve Access; Incidence; Individual; Information Systems; Interdisciplinary Study; Intervention; Jail; Justice; Leadership; Learning; Level of Evidence; Link; Maintenance; Methadone; Methods; Modeling; Monitor; Naloxone; Naltrexone; New York; Opioid; Outcome; Overdose; Overdose reduction; Persons; Pharmaceutical Preparations; Pharmacology; Prevention; Prevention program; Prevention strategy; Primary Health Care; Process; Provider; Public Health; Public Sector; Recovery; Research; Research Personnel; Risk; Rural; Schools; Science; Service setting; Services; Social Work; Substance Use Disorder; Substance abuse problem; System; Testing; Time; Training; Vermont; Work; Youth; addiction; base; behavioral health; community based participatory research; community engagement; community setting; comorbidity; cost; cost effectiveness; cost-effectiveness evaluation; dashboard; effective therapy; effectiveness evaluation; empowerment; evidence base; experience; implementation barriers; implementation efforts; implementation evaluation; implementation facilitation; implementation fidelity; implementation research; implementation science; improved; innovation; multidisciplinary; opioid epidemic; opioid mortality; opioid overdose; opioid use; opioid use disorder; opioid user; overdose death; overdose education; overdose prevention; peer; prescription opioid; prevention service; primary care setting; primary outcome; programs; racial diversity; response; scale up; screening and brief intervention; secondary outcome; social media; social stigma; synthetic opioid; theories; tool; treatment services; treatment strategy; trend; trial design; uptake

PROJECT SUMMARY New York State (NYS) ranks second in the nation in absolute numbers of opioid overdose deaths. From 2015- 2016, opioid overdose deaths in NYS increased by 32%, including an 88% increase in synthetic opioid-related deaths. The proposed research will develop and test a County-system Hub and Spoke Empowerment model (“CHASE”) to reduce incidence of fatal overdoses in 15 geographically and racially diverse counties in NYS that averaged 28.2 deaths per 100,000 in 2017 and meet all the UM1 RFA-DA-19-016 criteria. CHASE is a modified Hub and Spoke model that is adaptable to the unique needs of any particular county with the aim of developing a blueprint that could be applied to counties across the U.S. CHASE is a coordinated multi-system, multi-sector public health response to the opioid epidemic, directed by County Health Commissioners, and driven by robust community engagement and real-time learning based on data science and systems science. CHASE addresses structural barriers to decreasing opioid deaths by engaging underutilized county systems “Spokes” (e.g., jails, other justice settings, emergency departments (EDs), and other health and social service settings ) will be linked to “hubs” which will include federally qualified health care clinics, primary care settings and addiction programs. CHASE will target gaps in the opioid prevention and treatment cascade by (1) expanding number of medications for opioid use disorder (MOUD) providers and addiction expertise; (2) identifying people at risk of opioid use disorder (OUD) using evidence-based screening, brief intervention and referral tools and linking and retaining them in MOUD using peer navigation; (3) scaling up overdose education and naloxone distribution (OEND) in community settings; (4) improving access to MOUD in jails and EDs, (5) deploying evidence-based prevention programs in schools, social media and other venues; and (6) scaling up prescription monitoring and prescription take-back programs. The county leadership will work with a county community advisory board of key stakeholders to customize and calibrate the intervention components of CHASE. This calibration process will be guided by an interactive dashboard that facilitates data-driven system modelling to identify the combination of evidence-based strategies to best address specific gaps and opioid overdose trends in their county. This dashboard will also provide real-time feedback on how to improve and optimize implementation efforts. The study will employ mixed methods to rigorously identify multi-level theory- driven factors that impede or facilitate the implementation and sustainability of CHASE in each county. If effective, CHASE can be scaled up as comprehensive public health response to the opioid epidemic in counties across the U.S. This study will build on the extensive research of the multidisciplinary team on OUD and other substance use disorders, HIV, HCV and other comorbid conditions, opioid overdose prevention, pharmacology, data and system science, implementation science, and community-based participatory research and will include government investigators from NYS Department of Health.

项目摘要 纽约州（纽约州）以绝对数量的阿片类药物过量死亡排名全国第二。从2015年开始 2016年，纽约州阿片类药物过量死亡增加了32％，包括合成阿片类药物相关的88％ 死亡人数。拟议的研究将开发和测试一个县系统中心并进行授权模型 （“追逐”）减少15个地理和大致多样化县的致命过量发生率 2017年平均每100,000人死亡28.2人死亡，并符合所有UM1 RFA-DA-19-016标准。追逐是一个 修改的枢纽和讲话模型可适应任何特定县的独特需求，目的 开发一个可以应用于美国追逐县的蓝图是一个协调的多系统， 由县卫生专员指导的多部门公共卫生对阿片类药物流行的反应， 基于数据科学和系统科学的强大社区参与和实时学习的驱动。 Chase通过涉及未充分利用的县系统来解决减少阿片类药物死亡的结构障碍 “辐条”（例如，监狱，其他司法机构，急诊科（EDS）以及其他健康和社会服务 设置）将链接到“枢纽”，其中包括联邦合格的医疗保健诊所，初级保健环境 和成瘾计划。 Chase将通过（1）靶向预防阿片类药物的差距和治疗级联 不断扩大阿片类药物使用障碍（MOUD）提供者和成瘾专业知识的药物数量； （2） 使用基于证据的筛查，简短的干预和 转介工具，并使用同行导航将其链接并保留在MOUD中； （3）扩大过量教育 和社区环境中的纳洛酮分布（OEND）； （4）改善监狱和急诊室中穆德的访问，（5） 在学校，社交媒体和其他场所中部署基于证据的预防计划； （6）扩展 处方监控和处方收款程序。县领导将与一个县合作 关键利益相关者的社区顾问委员会自定义和校准的干预组件 追赶。此校准过程将由互动仪表板指导，该仪表板有助于数据驱动系统 建模以确定基于证据的策略的组合，以解决特定差距和OOID 他们县的过量趋势。该仪表板还将提供有关如何改进和 优化实施工作。该研究将采用混合方法来严格识别多层次理论 - 驱动因素阻碍或支持每个县的追逐的实施和可持续性。如果 有效的追逐可以扩大为对阿片类药物流行的全面公共卫生反应 美国各国这项研究将基于Oud多学科团队的广泛研究 以及其他药物使用障碍，艾滋病毒，HCV和其他合并症，阿片类药物预防，预防疾病， 药理学，数据和系统科学，实施科学以及基于社区的参与 研究，将包括来自纽约州卫生部的政府调查员。