Identifying High Utilizing Patients with Opioid Use Disorder to Engage in Primary Care

项目总结/摘要 布赖恩陈医学博士公共卫生硕士是一个内科医生和卫生服务研究人员热衷于改善健康 阿片类药物使用障碍（OUD）的脆弱患者的结局。这个职业发展奖将建立 博士Chan作为一名临床研究员，专注于实施和传播新型初级保健 在安全网环境中针对OUD高危患者的干预措施。K23奖提供指导 培训，以发展3个领域的专门知识：1）进行混合方法研究，以发展以部署为重点的 干预措施; 2）临床试验设计和实施科学; 3）成瘾药物治疗 联邦合格的健康中心（WHC）。为达致这些目标，陈博士 多学科指导团队，具有卫生服务研究、成瘾医学、干预等方面的专业知识 设计和实施科学，以及卫生系统，成功地指导教师进行研究 独立 2018年，210万人患有与海洛因或处方疼痛有关的阿片类药物使用障碍（OUD） 中继投手虽然对OUD的认识正在增加，但很少有患者接受循证治疗。这是 特别是对于在安全网环境中患有OUD的医学复杂患者。OUD使管理复杂化 与其他慢性疾病有关，并与医疗资源的高利用率有关。健康 系统感兴趣的是对复杂患者进行风险分层，以提高干预的针对性，如门诊 重症监护团队（A-ICU）;这些可以适用于患有OUD的复杂患者，但可扩展性有限 传播。根据他作为内科医生的临床经验和他的K12奖评估A- 在一个医疗复杂的高利用率的ICU在一个CIMHC，陈医生将完成以下3个目标：1）适应一个 现有的A-ICU干预措施，利用社区利益相关者解决高复杂性OUD患者 2）通过迭代实施案例研究完善干预措施，并确定 可接受性，可行性和实施策略的措施; 3）评估和试点的随机试验， 评估改进干预措施的可行性、可接受性和初步疗效的干预措施， 改善临床结果，并保留在OUD治疗在一个CMEHC使用实施和混合- 方法.研究结果为今后R 01提案的实用功效试验提供了初步数据 在多个联合国艾滋病毒/艾滋病中心进行干预。这一建议与国家研究所的优先事项直接一致， 药物滥用战略规划以“药物使用障碍的复杂性”为基础， “制定和测试有效和可持续实施循证治疗的策略。” 完成这些研究将为实施可扩展的初级保健干预措施铺平道路， OUD治疗差距和改善高风险人群的护理。

PROJECT SUMMARY/ABSTRACT Brian Chan MD MPH is an internist and health services researcher passionate about improving health outcomes for vulnerable patients with opioid use disorder (OUD). This career development award will establish Dr. Chan as a clinician-investigator focused on implementing and disseminating novel primary care interventions that target high-risk patients with OUD in safety-net settings. The K23 award provides mentored training to develop expertise in 3 areas: 1) conduct of mixed-methods research to develop deployment-focused interventions; 2) clinical trial design and implementation science; and 3) addiction medicine treatment in federally qualified health center (FQHC) settings. To achieve these goals, Dr. Chan has assembled a multidisciplinary mentoring team with expertise in health services research, addiction medicine, intervention design and implementation science, and FQHC health systems, with success in mentoring faculty to research independence. In 2018, 2.1 million people had an opioid use disorder (OUD) related to heroin or prescription pain relievers. While the recognition of OUD is increasing, few patients receive evidence-based treatment. This is particularly true for medically complex patients with OUD in safety-net settings. OUD complicates management of other chronic medical conditions and is associated with high utilization of healthcare resources. Health systems are interested in risk stratifying complex patients to improve targeting of interventions, like ambulatory intensive care teams (A-ICU); these could be adapted for complex patients with OUD, but scalability limit dissemination. Informed by his clinical experience as an internist and data from his K12 award evaluating an A- ICU for medically complex high-utilizers in an FQHC, Dr. Chan will complete the following 3 aims: 1) Adapt an existing A-ICU intervention to address high complexity patients with OUD using community stakeholder engaged methods; 2) Refine the intervention through an iterative implementation case study, and identify measures of acceptability, feasibility, and implementation strategy; 3) Evaluate and pilot a randomized trial of the intervention to assess feasibility, acceptability, and preliminary efficacy of the refined intervention to improve clinical outcomes, and retention in OUD treatment at a FQHC using implementation and mixed- methods. The results provide preliminary data for a future R01 proposal pragmatic efficacy trial of the refined intervention at multiple FQHC sites. This proposal directly aligns with the priorities of the National Institute on Drug Abuse’s strategic planning workgroup on the “complexity of substance use disorders” and its priority to “develop and test strategies for effectively and sustainably implementing evidence-based treatments.” Completion of these studies will pave the way for implementing scalable primary care interventions to narrow OUD treatment gaps and improve care for high-risk populations.