Improving transitions of care for hospitalized patients with opioid use disorder

项目总结/摘要：K23指导的以患者为导向的研究生涯的目标 发展奖旨在支持申请人发展成为以下领域专家所需的关键技能： 在接触点增加对阿片类药物使用障碍的循证治疗， 患有OUD的人可能会经常出现。拟议的研究重点是NIDA的优先领域， 通过制定实施策略来改善治疗的连续性， OUD患者的住院治疗。与OUD及其并发症相关的住院治疗有所增加 在过去的几十年中，这种疾病急剧增加，导致高发病率、死亡率和医疗保健成本。医院 越来越多地被认为是让OUD患者参与治疗的关键接触点， 对照试验支持在急性护理环境中启动OUD（MOUD）药物治疗的有效性， 出院后接受治疗。然而，如果患者不愿意， 继续在社区中照顾。尽管有大量关于出院后护理过渡的文献， 对于其他慢性病患者，关于优化护理的最佳策略的证据有限 为住院后的OUD患者提供服务。我们需要有效的、可扩展的策略， 从急性护理到持续治疗，包括继续MOUD。本研究的目的是 建议是制定和试点测试策略，以促进从OUD患者的护理过渡到 医院到社区具体目标是：（1）使用混合方法确定 OUD患者从急性护理到门诊治疗的有效护理过渡， （2）与医院和社区利益相关者合作，并使用实施映射， 开发一个多组件的模块化工具包，以促进从急性护理到社区的过渡， （3）开展护理过渡工具包的试点试验。主要结果将是治疗 参与30天，次要结果将包括MOUD和物质使用，服务使用，可行性， 可接受性和患者满意度。导师团队汇集了医疗服务研究领域的专家， 实施科学和OUD的护理提供干预以及医院的利益相关者顾问 和社区设置。这个指导研究科学家发展奖建立在博士。 作为临床医生和研究人员的经验，并将其扩展为五个关键培训目标：1）测量结果， OUD相关的跨系统护理，2）高级定性调查，3）实施卫生系统变革，以及 5)授权书和授权书。成功完成本项目、培训活动和指导 从一个经验丰富的研究团队，洛温斯坦博士将做好充分准备，领导一个独立的研究， 旨在改善OUD患者的护理和结果的议程。

PROJECT SUMMARY/ABSTRACT: The goal of this K23 Mentored Patient-Oriented Research Career Development Award is to support the applicant in developing the critical skills necessary to become an expert in increasing access to evidence-based treatment for opioid use disorder (OUD) at touchpoints for care that individuals with OUD are likely to frequent. The proposed research focuses on NIDA's priority area of addressing real-world complexities by developing implementation strategies to improve treatment continuity after hospitalization in patients with OUD. Hospitalizations related to OUD and its complications have increased dramatically over the last few decades, leading to high morbidity, mortality, and healthcare costs. Hospitals are increasingly recognized as critical touchpoints for engaging individuals with OUD in treatment, and randomized controlled trials support the efficacy of initiating medications for OUD (MOUD) in acute care settings to increase treatment engagement following discharge. However, hospital-initiated treatment is insufficient if patients do not continue care in the community. Despite the robust literature on care transitions after hospital discharge for patients with other chronic conditions, there is limited evidence about the best strategies to optimize care engagement for patients with OUD after hospitalization. We need effective, scalable strategies for linking patients with OUD from acute care to ongoing treatment, including continuation of MOUDs. The research objective of this proposal is to develop and pilot test strategies to facilitate transitions of care for patients with OUD from the hospital to the community. The specific aims are: (1) Use a mixed-methods approach to identify determinants of effective care transitions for patients with OUD from acute care to outpatient treatment at the patient, provider, and system level, (2) Partner with hospital and community stakeholders and use implementation mapping to develop a multicomponent, modular toolkit to facilitate transitions from acute care to community addressing multi- level barriers, and (3) Conduct a pilot trial of the care transition toolkit. The primary outcome will be treatment engagement at 30 days, and secondary outcomes will include MOUD and substance use, service use, feasibility, acceptability and patient satisfaction. The mentorship team brings together experts in health services research, implementation science, and care delivery interventions for OUD as well as stakeholder advisors from hospital and community settings. This Mentored Research Scientist Development Award builds on Dr. Lowenstein's experience as a clinician and researcher and extends it with five key training goals: 1) Measuring outcomes for OUD-related care across systems, 2) Advanced qualitative inquiry, 3) Implementing health systems change, and 5) Manuscript and grant writing. With successful completion of this project, training activities, and mentorship from a team of experienced investigators, Dr. Lowenstein will be well-prepared to lead an independent research agenda designed to improve care and outcomes for people with OUD.