Health Systems Node of the NIDA Clinical Trials Network

摘要 物质使用(SU)和物质使用障碍(SUD)导致广泛的发病率和死亡率，但 在历史上一直被主流医疗保健忽视。卫生系统节点加入了国家研究院 以Campbell、Weisner和Bradley博士为首的2015年药物滥用临床试验网络(CTN) 在创新实施研究和医疗环境中的务实试验方面的研究领导者。我们的节点 包括16个具有全国代表性和丰富人口多样性的学习卫生系统，并代表 超过2600万名患者。我们的教职员工是研究人员，他们扎根于他们的健康系统，致力于 到尖端的成瘾研究。他们带来了进行研究的多学科专业知识 不同医疗环境下的创新方法(如初级保健、成瘾医学、妇产科、精神病学、 农村社区)，人口多样化(例如，代表性不足的少数族裔、青少年、孕妇 妇女、艾滋病毒感染者)。该节点在其最初5年中有出色的业绩记录，领先于6个多站点 研究，包括CTN第一个完全基于电子健康记录(EHR)的实用实施试验 以及参与由其他节点领导的几项研究。此续订申请建立在这一成功的基础上 要通过3个广泛的研究议程解决CTN在未来5年的目标：1)测试 提高对SU和SUD的认同度和参与治疗的途径。例如，我们 提议进行一项多地点实施试验，以测试实施大麻和其他 SUD的药物筛选和评估；2)测试新的方法，以改善SUD的医疗结局 设置。例如，我们提出了一项电话护士的护理点实用有效性试验 新诊断患者的协作式护理和有效的基于智能手机的SUD治疗 以及3)开发利用EHR进行SUD研究的新手段和新方法。例如，我们 建议验证由NIH路线图倡议患者报告开发的7项SU严重程度测量 结果测量信息系统(PROIS)用于以测量为基础的SUD护理。这些 议程强调以人群为基础的研究，包括务实的随机对照试验、比较 有效性研究和实施研究，并利用企业人力资源。公共卫生与临床 练习的影响。在美国，每年有超过1490万未经治疗的SUD患者接受医疗服务。如果 其中10%的患者得到了确认、参与并成功治疗，这将转化为150万人 每年都有SUD消退的患者，否则他们就不会得到治疗。医疗保健系统节点 与CTN合作，教职员工和基础设施处于独特的地位，可以进行和传播 推动将SUD治疗与常规医疗护理相结合，并最终改善 患者结局和公共卫生。

ABSTRACT Substance use (SU) and substance use disorders (SUD) cause extensive morbidity and mortality but have been neglected historically by mainstream health care. The Health Systems Node joined the National Institute on Drug Abuse’s Clinical Trials Network (CTN) in 2015, led by Drs. Campbell, Weisner and Bradley, addiction research leaders in innovative implementation research and pragmatic trials in medical settings. Our node includes 16 Learning Health Systems with national representation and rich population diversity, and represents over 26 million patients. Our faculty are researchers who are embedded in their health systems and committed to cutting-edge addiction research. They bring multidisciplinary expertise in conducting research using innovative methods in different medical settings (e.g. primary care, addiction medicine, OB/GYN, psychiatry, rural communities), and with diverse populations (e.g. under-represented minorities, adolescents, pregnant women, patients with HIV). The node had an outstanding track record in its first 5 years leading 6 multi-site studies, including the CTN’s first entirely electronic health record (EHR)-based pragmatic implementation trial as well as participating in several studies led by other nodes. This renewal application builds upon that success to address the CTN’s objectives over the next 5 years through 3 broad Research Agendas: 1) To test approaches to increasing identification of SU and SUD, and engagement in treatment. For example, we propose a multisite implementation trial to test an innovative approach to implementing cannabis and other drug screening and assessment for SUD; 2) To test new approaches to improve SUD outcomes in medical settings. For example, we propose a point-of-care pragmatic effectiveness trial of telephonic nurse collaborative care and an efficacious smartphone-based SUD treatment, in patients with newly diagnosed SUD; and 3) To develop novel measures and methods for SUD research using EHRs. For example, we propose to validate a 7-item SU severity measure developed by the NIH Roadmap initiative Patient Reported Outcome Measurement Information System (PROMIS) for use in measurement-based care of SUD. These agendas emphasize population-based studies, including pragmatic randomized controlled trials, comparative effectiveness studies, and implementation research, and leverage EHRs. Public Health and Clinical Practice Impact. Over 14.9 million patients with untreated SUD have health care visits annually in the US. If 10% of these patients were identified, engaged and successfully treated, it would translate to 1.5 million patients with resolved SUD each year who otherwise would have gone untreated. The Health Systems Node faculty and infrastructure, in collaboration with the CTN, are uniquely positioned to conduct and disseminate research that advances the integration of SUD treatment into routine medical care, and ultimately to improve patient outcomes and public health.