Implementing a patient navigation intervention across a health system to address treatment entry inequities

在整个卫生系统中实施患者导航干预，以解决治疗进入不平等问题

• 批准号: 10812628
• 负责人: Karen Alexander
• 金额: $ 94.68万
• 依托单位: FRIENDS RESEARCH INSTITUTE, INC.
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812628
• 关键词: Address; Adoption; Agreement; Awareness; Buprenorphine; COVID-19 pandemic; Clinical; Clinical Trials; Communities; Complex; Consult; Continuity of Patient Care; Data; Dedications; Effectiveness; Emergency department visit; Ensure; Epidemic; Ethnic Origin; Evidence based intervention; Feedback; Goals; Health Services Accessibility; Health system; Hospitalization; Hospitals; Human Resources; Hybrids; Inequity; Inpatients; Institution; Intervention; Manuals; Maps; Methadone; Minority Groups; Morbidity - disease rate; Outcome; Overdose; Overdose reduction; Participant; Patient-Focused Outcomes; Patients; Performance; Persons; Phase; Philadelphia; Population; Preparation; Probability; Process; Proctor framework; Protocols documentation; Public Health; Quality of life; Race; Randomized; Research; Resources; Scoring Method; Services; Site; Social support; System; Testing; Training; Translations; acceptability and feasibility; access disparities; addiction; care systems; community based treatment; cost effective; data sharing; design; effectiveness evaluation; effectiveness trial; effectiveness/implementation study; effectiveness/implementation trial; evidence base; follow-up; geographic disparity; high risk; hospital readmission; hospital utilization; implementation barriers; implementation facilitation; implementation intervention; implementation process; implementation strategy; implementation study; improved; innovation; mortality; navigator intervention; novel; operation; opioid agonist therapy; opioid epidemic; opioid overdose; opioid use disorder; patient navigation; patient navigator; pilot test; pilot trial; poor health outcome; post implementation; prevent; randomized trial; research to practice; scale up; socioeconomic disparity; substance use; success; theories; treatment as usual

Project Summary/Abstract Opioid agonist treatment (OAT) is protective against overdose, yet less than 20% of people with opioid use disorder (OUD) engage in such treatment. Hospital utilization is high among people with OUD and can be a ‘reachable moment’ to initiate OAT. However, most hospitals lack the capacity to follow up with patients after discharge. Theory-based, empirically supported patient navigator (PN) interventions following hospital discharge reduce inequities in accessing community-based OAT by helping patients navigate complex systems of care. However, challenges persist in implementing PN interventions on a wide scale, as they require coordination across institutions, data sharing, dedicated personnel, and community resources. This is especially true in settings that reach diverse, resource-challenged communities. To bring these interventions to scale, strategies are needed to assess factors that influence PN implementation in hospitals to increase feasibility, reach, and sustainability. Testing innovative implementation strategies for PN interventions has the potential for significant impact, as it will demonstrate implementation success of an intervention that can address the opioid epidemic in real-world settings and close the research-to-practice translation gap. The proposed study is a type II hybrid implementation-effectiveness trial of Navigation Services To Avoid Rehospitalization (NavSTAR). Our research team showed in a single-site randomized trial with 400 participants that NavSTAR significantly increased OAT entry, reduced readmissions, and was highly cost- effective compared to treatment as usual. The present study will test an Implementation Facilitation (IF) strategy following Proctor’s conceptual model using an external facilitator and an internal local clinical champion to provide training, resources, and performance feedback to implement NavSTAR in four hospitals. We hypothesize that engaging stakeholders (including patients, clinicians, and community leaders) in an IF strategy will create and test an implementation process that is feasible, acceptable, and effective in expanding access to OAT post-discharge. The R61 phase will conduct process mapping to identify existing hospital workflow and then refine an IF strategy through sequential pilot trials at 4 hospital sites in preparation for the R33 phase. The team’s NavSTAR operations manual will be adapted to the sites to train the existing staff. R61 milestones include the creation of an implementation toolkit and data sharing agreements. During the R33 phase, we will conduct a type II hybrid-implementation-effectiveness trial (N=720) of NavSTAR using a randomized stepped-wedge design with augmented inverse probability weighting to compare outcomes pre- and post-implementation. This study will develop an effective IF strategy to increase the reach and sustainability of NavSTAR and provide a path to scale-up this intervention to address the opioid epidemic.

项目总结/摘要 阿片类激动剂治疗（OAT）可防止过量使用，但使用阿片类药物的人不到20% 疾病（OUD）参与这样的治疗。OUD患者的医院利用率很高， 启动OAT的“可到达时刻”。然而，大多数医院缺乏对患者进行随访的能力， 放电基于理论、经验支持的患者导航（PN）干预 出院通过帮助患者驾驭复杂的系统， 照顾。然而，在广泛实施PN干预措施方面仍然存在挑战，因为它们需要 跨机构协调、数据共享、专职人员和社区资源。这是 尤其是在涉及多样化、资源紧张的社区的环境中。把这些干预措施带到 规模，战略需要评估的因素，影响PN在医院的实施，以增加 可行性、覆盖范围和可持续性。测试PN干预措施的创新实施策略， 潜在的重大影响，因为它将证明一项干预措施的实施成功， 解决现实世界中的阿片类药物流行问题，缩小研究与实践之间的差距。的 拟议的研究是一个II型混合实施效果试验导航服务，以避免 再住院（NavSTAR）。我们的研究小组在一项单中心随机试验中显示， 参与者认为，NavSTAR显著增加了OAT入组，减少了再入院，并且成本很高- 与常规治疗相比，效果更好。本研究将测试一个执行便利化机制， 遵循普罗克特概念模型的策略，使用外部促进者和内部本地临床 冠军提供培训，资源和绩效反馈，以在四家医院实施NavSTAR。 我们假设，参与利益相关者（包括患者，临床医生和社区领导人）在IF 战略将创建和测试一个可行、可接受和有效的实施过程， 出院后领取燕麦片。R61阶段将进行流程映射，以确定现有医院 工作流程，然后通过在4家医院进行的连续试点试验来完善IF策略， R33阶段。该小组的NavSTAR操作手册将根据现场情况进行调整，以培训现有工作人员。R61 里程碑包括创建一个执行工具包和数据共享协议。在R33 在第二阶段，我们将进行NavSTAR的II型混合实施有效性试验（N=720）， 采用增强逆概率加权的随机化逐步楔形设计， 和实施后。这项研究将制定一项有效的综合框架战略， 这将有助于提高NavSTAR的可持续性，并提供一条扩大这种干预措施的途径，以解决阿片类药物的流行问题。