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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(申请人提供)：近年来，作为可预防的发病率和不断上升的医疗费用的主要贡献者，再次住院的问题已经成为人们关注的焦点。物质使用障碍与不良的健康结果和高度低效的医疗服务使用密切相关，包括重复住院。干预措施增加对门诊医疗和药物滥用治疗建议的遵守可能会帮助最近住院的药物使用障碍患者避免不必要的再次住院、相关的发病率和医疗费用。目前的研究是一项随机对照试验，比较了导航服务避免再次住院(Navstar)与常规治疗(TAU)对同时存在医疗问题和药物使用障碍的住院患者的有效性。应用安徒生的医疗服务利用理论模型，Navstar将采用患者导航和激励性干预等前景看好的战略，以促进参与门诊医疗和药物滥用治疗，从而降低再次住院的可能性。一家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导航和激励服务，这些服务在住院期间启动，并在出院后持续3个月。被随机分配到TAU的参与者将得到医院和药物滥用咨询联络服务的常规护理，包括转介到药物滥用治疗，但不会在出院后继续接触。参与者将在研究开始时进行评估，并在3个月、6个月和12个月的随访中对医疗保健利用、物质使用和功能的各种指标进行评估。令人感兴趣的主要结果是12个月内再住院的时间。此外，还将评估医疗和药物滥用服务领域的一系列次要成果。这项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国家意义的问题。在美国，尤其是在有药物使用障碍的个人中，可避免的再次住院的程度表明了公共健康风险，并构成了医疗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，具体目的是避免同时存在医疗问题和药物使用障碍的个人再次住院。如果Navstar被证明在减少这一高危患者群体的再住院方面是有效和具有成本效益的，它将对设计医院出院计划服务、为国家成本控制倡议提供信息以及改善公共健康具有重要意义。