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Navigation Services to Avoid Rehospitalization (NavSTAR) among substance abusers

为药物滥用者提供避免再住院的导航服务 (NavSTAR)

基本信息

批准号：
9220776
负责人：
Jan Gryczynski
金额：
$ 62.02万
依托单位：
FRIENDS RESEARCH INSTITUTE, INC.
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-04-01 至 2019-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9220776
关键词：
Address Adherence Admission activity Adoption Adult Affordable Care Act Alcohol or Other Drugs use Alcohols Ambulatory Care Area Caring Cocaine Communities Comorbidity Congestive Heart Failure Consultations Cost Control Costs and Benefits Diagnostic Discharge Plannings Disease Effectiveness Ensure Expenditure Explosion Goals HIV risk Health Health Care Costs Health Insurance Health Services Healthcare Hospital Design Hospitalization Hospitals Individual Intervention Length of Stay Measures Medical Medicare Morbidity - disease rate Motivation Operative Surgical Procedures Opiates Outcome Outpatient Health Services Outpatients Participant Patient risk Patients Performance Pharmaceutical Preparations Policies Population Procedures Provider Public Health Randomized Randomized Controlled Trials Recommendation Research Research Design Risk Risk Behaviors Services Substance Use Disorder Substance abuse problem Testing Theoretical model Time Transportation Urban Hospitals Urine Work arm care systems compare effectiveness cost cost effective cost effectiveness economic evaluation economic outcome effective intervention evidence base follow-up health care service utilization health related quality of life health service use high risk high risk population hospital readmission improved incremental cost-effectiveness innovation interest meetings motivational intervention patient oriented prevent primary outcome public health relevance randomized trial reduced substance use secondary outcome service utilization substance abuse treatment substance abuser tool treatment as usual

项目摘要

DESCRIPTION (provided by applicant): In recent years, the problem of rehospitalization has come under intense focus as a major contributor to preventable morbidity and escalating healthcare costs. Substance use disorders are strongly associated with poor health outcomes and highly inefficient use of healthcare services, including repeat hospitalizations. Interventions that increase adherence to recommendations for outpatient medical care and substance abuse treatment could potentially help recently-hospitalized individuals with substance use disorders to avoid unnecessary rehospitalization, associated morbidity, and medical expenses. The current study is a randomized controlled trial comparing the effectiveness of Navigation Services to Avoid Rehospitalization (NavSTAR) vs. Treatment-as-Usual (TAU) for hospital patients with co-occurring medical problems and substance use disorders. Applying Andersen's theoretical model of health service utilization, NavSTAR will employ the promising strategies of Patient Navigation and motivational interventions to facilitate engagement in outpatient medical and substance abuse treatment, thereby lowering the likelihood of rehospitalization. Patient Navigators embedded within the substance abuse consultation liaison service at a large urban hospital will deliver patient- centered, proactive navigation and motivational services initiated during the hospital stay and continued for 3 months post-discharge. Participants randomized to TAU will receive usual care from the hospital and the substance abuse consultation liaison service, which includes referral to substance abuse treatment but no continued contact post-hospital discharge. Participants will be assessed at study entry and again at 3-, 6-, and 12-months follow-up on various measures of healthcare utilization, substance use, and functioning. The primary outcome of interest is time-to-rehospitalization through 12 months. In addition, a range of secondary outcomes spanning the medical and substance abuse service areas will be assessed. The study will include an economic evaluation of the cost, incremental cost-effectiveness, and cost-benefits of NavSTAR from the service provider perspective. This study addresses a problem of national significance. The extent of avoidable rehospitalizations in the U.S., and among individuals with substance use disorders specifically, is indicative of public health risks and constitutes a key driver of healthcare expenditures. This study is innovative in its application of Patient Navigation and motivational intervention strategies with the specific purpose of avoiding rehospitalization among individuals with co-occurring medical problems and substance use disorders. If NavSTAR proves to be effective and cost-effective in reducing rehospitalizations in this high risk patient group, it would have important implications for designing hospital discharge planning services, informing national cost containment initiatives, and improving public health.

描述（由申请人提供）：近年来，再住院问题作为导致可预防的发病率和医疗费用不断上升的主要因素而受到密切关注。药物使用障碍与不良健康结果和医疗服务使用效率极低（包括重复住院）密切相关。干预措施提高对门诊医疗护理和药物滥用治疗建议的遵守程度可能会帮助最近住院的药物滥用障碍患者避免不必要的再住院、相关发病率和医疗费用。目前的研究是一项随机对照试验，比较避免再住院导航服务 (NavSTAR) 与常规治疗 (TAU) 对于同时出现医疗问题和药物滥用障碍的医院患者的有效性。 NavSTAR 应用安德森的卫生服务利用理论模型，将采用患者导航和激励干预等有前景的策略，以促进患者参与门诊医疗和药物滥用治疗，从而降低再住院的可能性。大型城市医院的药物滥用咨询联络服务中嵌入的患者导航器将提供以患者为中心的、主动的导航和激励服务，该服务在住院期间启动，并持续出院后 3 个月。随机分配到 TAU 的参与者将接受医院的常规护理和药物滥用咨询联络服务，其中包括转介药物滥用治疗，但出院后不再继续接触。参与者将在研究开始时接受评估，并在 3、6 和 12 个月的随访中再次评估医疗保健利用率、物质使用和功能的各种指标。主要关注结果是 12 个月内的再住院时间。此外，还将评估医疗和药物滥用服务领域的一系列次要结果。该研究将包括从服务提供商的角度对 NavSTAR 的成本、增量成本效益和成本效益进行经济评估。这项研究解决了一个具有全国意义的问题。在美国，特别是在患有药物滥用障碍的个体中，可避免的再住院程度表明了公共卫生风险，并构成了医疗保健支出的关键驱动因素。这项研究在患者导航和动机干预策略的应用方面具有创新性，其具体目的是避免同时出现医疗问题和药物滥用障碍的个体再次住院。如果事实证明 NavSTAR 在减少这一高风险患者群体的再住院方面是有效且具有成本效益的，那么它将对设计出院计划服务、为国家成本控制举措提供信息和改善公共卫生产生重要影响。