Developing Implementation Strategies to Improve Access to Transitional Opioid Programs in Safety Net Hospitals

制定实施策略以改善安全网医院过渡性阿片类药物计划的可及性

• 批准号: 10671082
• 负责人: Ji E Chang
• 金额: $ 23.46万
• 依托单位: OHIO UNIVERSITY ATHENS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10671082
• 关键词: Acute; Address; Adopted; Adoption; Budgets; Buprenorphine; Caring; Catalogs; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic; Collaborations; Communicable Diseases; Communities; Community Hospitals; Data; Decision Making; Disparity; Economic Burden; Economics; Endocarditis; Ensure; Evidence based program; Extramural Activities; Face; Funding; Future; Goals; HIV/HCV; Harm Reduction; Health; Health Services; Health Services Accessibility; Healthcare Systems; Hospitalization; Hospitals; Improve Access; Institution; Interdisciplinary Health Team; Intervention; Interview; Investments; Knowledge; Link; Logistic Regressions; Medicaid; Methods; Morbidity - disease rate; Opioid; Outcome; Outpatients; Overdose; Patients; Pattern; Persons; Play; Provider; Public Health; Publications; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Resources; Role; Sampling; Schedule; Service provision; Services; Site; Skin Tissue; Soft Tissue Infections; Stress; Testing; Time; Typology; Underinsured; Uninsured; United States; addiction; beneficiary; community barrier; community based service; community partnership; disease transmission; effectiveness testing; evidence base; follow-up; implementation barriers; implementation science; implementation strategy; improved; longitudinal database; medication for opioid use disorder; mortality; opioid misuse; opioid overdose; opioid use; opioid use disorder; patient engagement; programs; rural setting; safety net; secondary infection; social; social stigma; trend; underserved community; uptake; urban setting

Project Summary/Abstract: Opioid use disorder (OUD) is a pressing public health problem nationwide but is increasing rapidly in underserved communities where there is currently a shortage of services, particularly evidence-based transitional opioid programs (TOPs) which link patients in hospitals to harm reduction and treatment resources. Hospitals are ideal sites to address OUD and engage patients given the relationship between opioid use and misuse and a number of acute health conditions, including overdose and infectious disease. Evidence suggests that hospitals are highly motivated to participate in offering new interventions due to the economic and social toll of untreated OUD. Safety net hospitals, however, face considerable barriers to adopting TOPs and have been significantly less likely to offer OUD services in their communities. To engage safety-net hospitals effectively and help them implement opioid programs such as TOPs, more information is needed on implementation barriers to tailor implementation strategies that will be most effective given the local constraints faced by safety-net providers. Using a combination of the latest publicly available community benefits reports and Internal Revenue Service Schedule H data, we will catalog hospitals’ OUD services, including TOPs, and assess the relationship between the adoption of TOP and various community and hospital characteristics, including safety-net status, and examine trends in the availability of OUD services across time (Aim 1). We will then interview hospital decision makers and community partners at five diverse safety net hospitals to better understand barriers and facilitators to adopting and implementing TOPs. (Aim 2). Finally, we will convene an expert panel to identify high-yield and tailored implementation strategies to increase the availability of transitional opioid programs and other evidence-based opioid services in underserved communities (Aim 3). As an interdisciplinary team of health services researchers, we have a strong record of collaborative publication and extramural funding related to hospital-community partnerships and opioid services. The implementation strategies developed in this study will lead to a future cluster randomized controlled trial to test the effectiveness of tailoring implementation strategies to safety net settings. The long term outcome is to increase the availability of TOPs in communities where significant disparities currently exist.

项目摘要/摘要： 阿片类药物使用障碍 (OUD) 是全国范围内一个紧迫的公共卫生问题，但在 服务不足的社区，目前缺乏服务，特别是基于证据的服务 过渡性阿片类药物计划 (TOP) 将医院患者与减少伤害和治疗资源联系起来。 考虑到阿片类药物使用与患者之间的关系，医院是解决 OUD 问题并吸引患者参与的理想场所。 滥用和一些急性健康问题，包括用药过量和传染病。证据 表明由于经济的原因，医院非常积极地参与提供新的干预措施 以及未经处理的 OUD 造成的社会损失。然而，安全网医院在采用 TOP 方面面临相当大的障碍 并且在其社区提供 OUD 服务的可能性明显较小。建立安全网 医院有效地帮助他们实施阿片类药物计划，例如 TOP，需要更多信息 实施障碍 考虑到当地的限制，制定最有效的实施战略 安全网提供商面临的问题。 结合使用最新公开的社区福利报告和国内收入 Service Schedule H数据，我们将对医院的OUD服务进行分类，包括TOP，并评估关系 TOP 的采用与各种社区和医院特征（包括安全网状况）之间的关系， 并检查 OUD 服务可用性随时间变化的趋势（目标 1）。然后我们会采访医院 五家不同安全网医院的决策者和社区合作伙伴更好地了解障碍和 采用和实施 TOP 的促进者。 （目标 2）。最后，我们将召集专家小组来确定 高收益和量身定制的实施战略，以增加过渡性阿片类药物计划的可用性 在服务不足的社区提供其他循证阿片类药物服务（目标 3）。作为一支跨学科团队 卫生服务研究人员，我们在合作出版和外部资助方面拥有良好的记录 与医院-社区伙伴关系和阿片类药物服务有关。制定的实施策略 这项研究将导致未来进行整群随机对照试验，以测试定制的有效性 安全网设置的实施策略。长期结果是增加 TOP 的可用性 在目前存在显着差异的社区中。