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

项目摘要 纽约州（NYS）在阿片类药物过量死亡的绝对数量方面排名全国第二。从2015年起- 2016年，纽约州阿片类药物过量死亡增加了32%，其中合成阿片类药物相关死亡增加了88%。 死亡拟议的研究将开发和测试一个县系统的中心和辐射授权模型 （“追逐”），以减少纽约州15个地理和种族多样化县的致命过量发生率 2017年平均每10万人中有28.2人死亡，符合所有UM 1 RFA-DA-19-016标准。大通是一家 改进的中心辐射模型，可适应任何特定县的独特需求，目的是 制定一个可以应用于美国各县的蓝图。CHASE是一个协调的多系统， 多部门公共卫生应对阿片类药物流行，由县卫生专员指导， 由强大的社区参与和基于数据科学和系统科学的实时学习驱动。 CHASE通过参与未充分利用的县系统来解决减少阿片类药物死亡的结构性障碍 “轮辐”（例如，监狱、其他司法机构、急诊室以及其他卫生和社会服务机构 设置）将连接到“枢纽”，其中将包括联邦合格的医疗保健诊所，初级保健设置， 和戒毒项目CHASE将通过以下方式瞄准阿片类药物预防和治疗级联中的差距：（1） 扩大阿片类药物使用障碍（MOUD）提供者和成瘾专家的药物数量;（2） 使用循证筛查、简短干预和 推荐工具，并使用同行导航将其链接并保留在MOUD中;（3）扩大过量教育 和纳洛酮分布（OEND）在社区设置;（4）改善获得MOUD在监狱和ED，（5） 在学校、社交媒体和其他场所部署循证预防计划;以及（6）扩大规模 处方监测和处方收回计划。县领导将与一个县 关键利益攸关方社区咨询委员会，以定制和校准 追这一校准过程将由一个交互式仪表板指导，该仪表板有助于数据驱动系统 建模，以确定最佳处理具体差距和类阿片 他们县的吸毒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- 阻碍或促进CHASE在每个县的实施和可持续性的驱动因素。如果 有效，CHASE可以扩大规模，作为对阿片类药物流行病的全面公共卫生应对措施， 这项研究将建立在OUD多学科团队的广泛研究基础上 和其他物质使用障碍，艾滋病毒，丙型肝炎病毒和其他共病条件，阿片类药物过量预防， 药理学、数据和系统科学、实施科学和社区参与 研究，并将包括来自纽约州卫生部的政府调查人员。

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.