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

项目摘要/摘要： 阿片使用障碍(OUD)在全国范围内是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(TOPS)，将医院中的患者与减少危害和治疗资源联系起来。 考虑到阿片类药物的使用和使用之间的关系，医院是解决和吸引患者的理想场所 滥用和一些急性健康状况，包括服药过量和传染病。证据 表明医院非常有动力参与提供新的干预措施，因为经济 以及未经治疗的OUD的社会代价。然而，安全网医院在采用TOPS方面面临着相当大的障碍 也不太可能在他们的社区提供OUD服务。使用安全网 医院有效，并帮助他们实施阿片类药物计划，如TOPS，需要更多信息 在考虑到当地限制的情况下，制定最有效的实施战略的实施障碍 面临着安全网提供商的挑战。 使用最新的可公开获得的社区福利报告和国内收入的组合 服务时间表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 在采用TOP和各种社区和医院特征之间，包括安全网状况， 并审查可利用的服务随时间变化的趋势(目标1)。然后我们将采访医院 五家不同的安全网医院的决策者和社区合作伙伴，以更好地了解障碍和 促进者采用和实施TOPS。(目标2)。最后，我们将召集一个专家小组来确定 高产出和量身定制的实施战略，以增加过渡类阿片方案的可得性和 服务不足社区的其他基于证据的阿片类药物服务(目标3)。作为一个跨学科的团队， 卫生服务研究人员，我们在合作出版和外部资助方面有很好的记录 与医院-社区伙伴关系和阿片类药物服务有关。年制定的实施战略 这项研究将导致未来的整群随机对照试验，以测试裁剪的有效性 安全网设置的实施策略。长期的结果是增加TOP的可用性 在目前存在显著差异的社区。

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.