Health Systems Node of the NIDA Clinical Trials Network

摘要 物质使用（SU）和物质使用障碍（SUD）引起广泛的发病率和死亡率，但 在历史上被主流医疗忽视。卫生系统节点加入了国家研究所 2015年，在坎贝尔、韦斯纳和布拉德利博士的领导下， 在医疗环境中创新实施研究和务实试验的研究领导者。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， 超过2600万患者。我们的教师都是研究人员谁是嵌入在他们的卫生系统和承诺 最前沿的成瘾研究他们带来了多学科的专业知识，在进行研究， 不同医疗环境中的创新方法（例如初级保健，成瘾医学，OB/GYN，精神病学， 农村社区），以及不同的人口（例如，代表性不足的少数民族、青少年、孕妇 艾滋病患者）。该节点在其第一个5年有一个出色的跟踪记录领先6多站点 研究，包括CTN的第一个完全基于电子健康记录（EHR）的实用实施试验 以及参与其他节点领导的几项研究。这一更新申请建立在这一成功的基础上 在未来5年内，通过3个广泛的研究领域来实现CTN的目标：1）测试 增加SU和SUD识别的方法，以及参与治疗的方法。比如我们 建议进行多地点执行试验，以测试执行大麻和其他 SUD的药物筛选和评估; 2）测试新的方法来改善SUD的医疗结果 设置.例如，我们提出了一个护理点的务实有效性试验电话护士 协作护理和有效的基于智能手机的SUD治疗， 3）利用EHR为SUD研究开发新的措施和方法。比如我们 建议确认由NIH路线图倡议患者报告制定的7项SU严重程度测量 结果测量信息系统（PROMIS）用于SUD的基于测量的护理。这些 议程强调以人群为基础的研究，包括实用的随机对照试验， 有效性研究和实施研究，并利用EHR。公共卫生和临床 实践影响。在美国，每年有超过1490万未经治疗的SUD患者接受医疗保健访问。如果 这些患者中有10%被识别，参与并成功治疗，这将转化为150万 每年都有SUD消退的患者，否则他们将无法接受治疗。卫生系统节点 教师和基础设施，与CTN合作，具有独特的地位，进行和传播 推进SUD治疗融入常规医疗护理的研究，并最终改善 病人的结果和公共卫生。

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.