Fatal Overdose Review Teams - Research to Enhance Surveillance Systems (FORTRESS)

这项研究是NIH帮助结束长期成瘾（HEAL）计划的一部分，旨在加速科学解决国家阿片类药物公共卫生危机。NIH HEAL倡议支持整个NIH的研究，以改善阿片类药物滥用和成瘾的治疗，并制定能够为阿片类药物危机提供快速和持久解决方案的具体战略。 该项目旨在通过与过量死亡审查（OFR）团队合作来解决过量流行病。目前，难民署的做法依赖于案件审查模式，以提出政策和方案建议。然而，过量服用率的持续上升和可预防的过量服用死亡的绝对数量表明， 需要将OFR团队从病例审查转向使用及时的人口水平数据，以更好地为他们的建议和行动提供信息。我们提议的项目“致命药物过量审查小组-加强监测系统研究”（FORTRESS）的目标是通过为OFR配备以下设备来改进标准OFR实践 建立在实时汇总数据基础上的数据仪表板，与多个来源的记录相关联，并以有助于确定和可视化常见“过量接触点”的方式呈现，或提供减少危害服务或使有过量风险的个人参与循证治疗的机会。与联合国千年发展目标保持一致 HEAL Data 2Action计划，Fortress研究团队将利用现有资源和专业知识帮助OFR将数据转化为行动。在R61阶段，研究团队将加强与两个州机构（印第安纳州卫生部和印第安纳州管理部门）建立的跨部门合作关系 性能中心（MPH），提供必要的全州范围的数据基础设施，以记录链接来自多个来源的人口级别的管理数据。MPH还成功开发了可公开访问的数据仪表板。Fortress团队将以MPH的早期成功为基础，确保更及时地收集过量事件数据，并设计“过量接触点仪表板”（目标1）。我们的团队将对OFR团队成员进行数据驱动决策（DDDM）培训，以有效使用仪表板。Fortress团队还包括参与制定CDC OFR最佳实践指南的个人，以及OFR遵守这些指南的试点研究，这将为我们团队开发“OFR保真度工具”（Aim 2）提供信息。该工具将是同类工具中的第一个。对于R33阶段，我们将进行一项随机分组的阶梯楔形试验，比较我们的干预（仪表板+ DDDM培训）与标准OFR实践对实施（目标3）和有效性结局（目标4）的影响。实施成果包括实施 过程保真度（实施完成阶段）、工作人员对危害降低理念的接受程度（定性访谈）、OFR对CDC最佳实践的保真度（Fortress OFR保真度工具）和过量接触点仪表板的可用性（系统可用性量表）。一个全州范围的OFR数据库作为一个丰富的 有效性结果的数据来源，包括OFR团队建议的质量和当地为实施建议的过量预防策略而采取的行动。我们还将调查OFR团队成员，以评估他们对基于证据的过量预防策略的态度变化。总而言之，Fortress团队是唯一有资格帮助OFR使用更全面，可用的数据来提供高质量，以行动为导向的建议，以减少过量。

This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction and to develop concrete strategies capable of providing rapid and durable solutions to the opioid crisis. This project seeks to address the overdose epidemic by working with overdose fatality review (OFR) teams. Current OFR practices rely on the case review model to make policy and programmatic recommendations. However, the continued rise in overdose rates and sheer number of preventable overdose deaths suggest a need to shift OFR teams away from case review and toward using timely population-level data to better inform their recommendations and actions. The goal of our proposed project, Fatal Overdose Review Teams – Research to Enhance Surveillance Systems (FORTRESS), is to improve standard OFR practices by equipping OFRs with a data dashboard built on real-time aggregate data, record-linked across multiple sources and presented in a way that helps identify and visualize common “overdose touchpoints,” or opportunities to deliver harm-reduction services or engage individuals at risk for overdose in evidence-based treatment. Aligning with the goals of the HEAL Data2Action Program, the FORTRESS research team will leverage available resources and expertise to help OFRs translate data to action. During the R61 Phase, the research team will strengthen established cross-sector partnerships with two state agencies, the Indiana Department of Health and the Indiana Management Performance Hub (MPH), which provide the necessary statewide data infrastructure to record-link population-level administrative data from multiple sources. MPH has also successfully developed publicly accessible data dashboards. The FORTRESS team will build on the early successes of MPH to ensure more timely collection of overdose event data and design the “Overdose Touchpoints Dashboard” (Aim 1). Our team will train OFR team members in Data-Driven Decision Making (DDDM) to effectively use the dashboard. The FORTRESS team also includes individuals involved in developing the CDC’s OFR best practice guidelines and a pilot study of OFR adherence to these guidelines, which will inform our team’s development of an “OFR Fidelity Tool” (Aim 2). This tool will be the first of its kind. For the R33 phase, we will conduct a cluster-randomized stepped-wedge trial comparing the impact of our intervention (dashboard + DDDM training) versus standard OFR practices on both implementation (Aim 3) and effectiveness outcomes (Aim 4). Implementation outcomes include implementation process fidelity (Stages of Implementation Completion), staff acceptance of harm reduction philosophies (qualitative interviews), OFR fidelity to CDC best practices (FORTRESS OFR Fidelity Tool), and usability of the Overdose Touchpoint Dashboard, (Systems Usability Scale). A statewide OFR data repository serves as a rich source of data on effectiveness outcomes, including OFR team recommendation quality and local actions to implement recommended overdose prevention strategies. We will also survey OFR team members to assess changes in their attitudes toward evidence-based overdose prevention strategies. In sum, the FORTRESS team is uniquely qualified to help OFRs use more comprehensive, available data to inform quality, action-oriented recommendations to reduce overdose.