Emergency department community health worker-peer recovery navigation for linkage to recovery: A mixed methods evaluation

项目摘要 急诊科(ED)在药物过量流行的第一线，治疗的人数越来越多 有物质使用障碍(SUD)的人。在与药物使用有关的急诊室就诊后的一年内，死亡风险 是其他患者的六倍，对于阿片类药物过量治疗的人来说，超过二十分之一 病人会死的。每一次与药物使用相关的急诊都是将患者与 恢复服务，但在提供服务方面存在很大差距，只有不到三分之一的人收到 行为咨询和只有五分之一的人与成瘾治疗有关。改善与恢复和恢复的联系 来自教育署的戒毒服务，我们推出了一个多学科、多专业的教育署社区健康工作者--同龄人 恢复专家计划(PCHW)，物质滥用援助响应小组(SMART)，在一个大的， 学术，城市医疗中心，在罗德岛州照顾大多数肥皂泡患者。绘图 从现有的同伴康复专家、CHW和健康促进倡导者计划的模式来看，SMART是一种 新颖的基于ED的方案，为人们提供与物质使用相关的ED访问个性化支持， 短期病例管理、社会服务导航、减少伤害、康复和成瘾治疗 进出教育署的服务。SMART有别于其他类型的急诊患者导航和/或 同伴恢复专家计划，通过在教育部门内外工作，并专注于 恢复。近年来，ED同伴康复计划激增，但人们对此知之甚少 他们的效率。我们将对已建立的ED PCHW计划进行务实、混合的方法研究，以 评估计划交付、与循证康复服务的联系以及短期和长期患者 结果。本研究的目的是1)了解学员使用智能PCHW的体验，以及 确定成功恢复链接的可能机制；2)评估患者的SMART有效性- 以成果为中心，建立恢复资本和恢复联系；3)评估智能实施和 随着时间的推移，对患者结局的有效性。参与者面谈将考察参与者的体验 智能、恢复服务参与，并确定潜在有效的参与战略。A RE-AIM 框架将用于评估计划执行情况(过程结果)和有效性(患者 结果)。将使用调查和与医院和州行政数据库的数据链接来衡量 恢复资金、社会网络、接受社会服务、与减少伤害的联系、恢复、 和成瘾治疗服务，以及在接受治疗的人中急性护理利用和死亡率的变化 聪明。这项研究的结果将提供有关ED同伴恢复专家计划过程的可靠数据 以及患者水平的结果，这是后续多层次综合研究所需的，以确定和测试 ED同伴康复计划组成部分的有效性及实施策略 增强、传播和可持续发展。

Project Summary The emergency department (ED) is on the front lines of the overdose epidemic, treating an increasing number of people with substance use disorders (SUD). In the year after a substance use-related ED visit, risk of death is six time higher than other patients, and for people treated after an opioid overdose, more than one in twenty patients will die. Each substance use-related ED visit represents a crucial opportunity to link patients to recovery services, however there are significant gaps in service provision with less than one in three receiving behavioral counseling and only one in five linked to addiction treatment. To improve linkage to recovery and addiction treatment services from the ED, we launched a multidisciplinary, ED community health worker-peer recovery specialist program (PCHW), the Substance Misuse Assistance Response Team (SMART), at a large, academic, urban medical center which cares for the majority of patients with SUDs in Rhode Island. Drawing from models of existing peer recovery specialist, CHW, and health promotion advocate programs, SMART is a novel ED-based program that provides people with a substance-use related ED visit individualized support, short term case management, navigation to social services, harm reduction, recovery, and addiction treatment services in and out of the ED. SMART distinguishes itself from other models of ED patient navigation and/or peer recovery specialist programs by working in and out of the ED and focusing on social determinants of recovery. In recent years there has been a proliferation of ED peer recovery programs, but little is known about their effectiveness. We will conduct a pragmatic, mixed methods study of an established ED PCHW program to evaluate program delivery, linkage to evidence-based recovery services, and short- and long-term patient outcomes. Aims of this study are to 1) understand participant experiences working with a SMART PCHW and identify possible mechanisms for successful recovery linkage; 2) Evaluate SMART effectiveness on patient- centered outcomes, building recovery capital, and recovery linkage; 3) Evaluate SMART implementation and effectiveness on patient outcomes over time. Participant interviews will examine participant experiences with SMART, recovery services engagement, and identify potentially effective engagement strategies. A RE-AIM framework will be used to evaluate program implementation (process outcomes) and effectiveness (patient outcomes). Surveys and data linkage to hospital and state administrative databases will be used to measure changes in recovery capital, social networks, receipt of social services, linkage to harm reduction, recovery, and addiction treatment services, and changes in acute care utilization and mortality among people receiving SMART. Results from this study will provide robust data about ED peer recovery specialist program process and patient-level outcomes needed for a subsequent multilevel, comprehensive study to identify and test effectiveness of ED peer recovery program components and implementation strategies for program enhancement, dissemination, and sustainability.