Assessing the Population-level and Equity Impact of the Emergency Medical Services Overdose Prevention Project (EMS-OPP) Using Critical Race Theory

使用批判种族理论评估紧急医疗服务过量预防项目 (EMS-OPP) 的人口水平和公平影响

• 批准号: 10738918
• 负责人: Jenna van Draanen
• 金额: $ 71.56万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738918
• 关键词: Address; Adopted; Affect; Alaska Native; American Indians; Black Populations; Black race; Caring; Cessation of life; Communities; County; Critical Race Theory; Data; Data Linkages; Data Management Resources; Death Rate; Disadvantaged; Discrimination; Disparity; Drug usage; Drug user; Emergency medical service; Equity; Evaluation; Evidence based intervention; Fentanyl; Funding; Future; Health; Health Services Accessibility; Hispanic; Hispanic Populations; Information Systems; Institution; Interruption; Intervention; Interview; Investigation; Jail; Latinx; Leadership; Link; Medical; Medical emergency; Methods; Naloxone; National Institute of Drug Abuse; Native-Born; Natural experiment; Opioid; Outcome; Overdose; Overdose reversal; Patient-Focused Outcomes; Patients; Persons; Policies; Population; Prospective cohort; Provider; Public Health; Race; Records; Research; Research Design; Research Personnel; Scientist; Series; Services; State Government; Stigmatization; Structural Racism; Structure; Survivors; System; Time; Training; Translations; Trauma; Work; access disparities; buprenorphine treatment; care providers; cohort; combat; design; effectiveness evaluation; effectiveness/implementation study; evidence base; experience; fentanyl test; follow-up; improved; journal article; opioid epidemic; opioid mortality; outcome disparities; overdose death; overdose prevention; peer; people of color; perceived discrimination; posters; prescription monitoring program; prevent; programs; racial disparity; racial health disparity; racial identity; racial population; recruit; response; routine provider; social stigma; stem; substance use; substance use treatment; symposium; test strip; training project

The public health crisis of overdose continues unabated in King County, WA, with over 500 deaths in 2020, 700 in 2021, and rates continuing to rise with vast disparities in those affected. Emergency Medical System providers (EMS) are first to arrive at the scene of an overdose and are critical partners in care for people who use drugs. We partnered with people who use drugs, EMS leadership, and community partners to collect pilot data and then co-design EMS-delivered interventions tailored to reduce stigma and increase access to care for people who use drugs. These interventions are being rolled out as the EMS Overdose Prevention Project (EMS-OPP), and hold great potential to reduce racial disparities in access to evidence-based medical services and to improve long-term outcomes. EMS-OPP includes training for all EMS providers on stigma reduction and trauma-informed care, an EMS naloxone leave-behind program, and warm hand-off to a follow-up team for connecting to care. King County EMS teams will adopt these programs iteratively, and plan to have 90% of teams participating by 2026. Although this provides an excellent opportunity to assess the effectiveness of EMS-OPP, currently no investigation of patient-level, population-level, or equity impacts is planned. Thus, we will capitalize on the natural experimental conditions using a concurrent triangulation mixed methods design to examine the impact of EMS- OPP on racial disparities in health outcomes. Specifically, guided by Public Health Critical Race Praxis, we will partner with people who use drugs and Public Health Seattle & King County to: 1) evaluate the effect of EMS- OPP on racial disparities in patient-level experiences (e.g., discrimination in EMS interactions) and outcomes (e.g., linkage to buprenorphine treatment) (Aim 1); 2) further evaluate EMS-OPP from the perspectives of Black, Hispanic/Latinx, and American Indian/Alaska Native non-fatal overdose survivors using in-depth interviews (Aim 2); and 3) examine the impact of the EMS-OPP on racial disparities in population-level outcomes (e.g., connections to follow-up care) (Aim 3). Aims 1 involves the creation of a cohort of non-fatal overdose survivors with recent EMS interactions, linking multiple data systems. Aim 2 uses a qualitative study design involving semi- structured interviews with Black, Hispanic/Latinx, and American Indian/Alaska Native survivors from Aim 1. Aim 3 uses data from the EMS Records Management System data using an interrupted time series design comparing disparities in overdose outcomes for patients treated EMS-OPP-trained teams vs. not. In response to the escalating overdose crisis, and racial disparities in outcomes, state governments have expanded EMS funding, training, and scope of practice. Our proposed study capitalizes on this key moment in the opioid crisis to assess the population-level and equity impact of a structural community-level intervention with real-world complexities that has the potential for spread and scale. Findings will be shared in community venues (e.g. posters, community zine), policy briefs, conference presentations, and academic journal articles. 1

在华盛顿州金县，过量的公共卫生危机持续不断，2020年死亡500多人，700 在2021年，在受影响者的差距上，利率持续上升。紧急医疗系统提供者 （EMS）首先到达过量的现场，并且是对使用毒品的人的关键伙伴。 我们与使用毒品，EMS领导力和社区合作伙伴收集飞行员数据的人合作 量身定制的共同设计EMS提供的干预措施，以减少污名和增加对那些人的护理机会 使用药物。当EMS预防项目（EMS-OPP）和 在减少获得循证医疗服务的种族差异并改善的种族差异方面发挥了巨大潜力 长期结局。 EMS-OPP包括所有EMS提供商的培训，以减少污名和创伤信息 Care是EMS Naloxone休假计划，并热情地交出了一支随访团队，以连接护理。 金县EMS团队将迭代采用这些计划，并计划让90％的团队参与 2026年。尽管这为评估EMS-OPP的有效性提供了绝佳的机会，但目前没有 计划对患者级，人口级或股权影响进行调查。因此，我们将利用自然 实验条件使用并发三角剖分混合方法设计，以检查EMS-的影响 OPP关于健康成果的种族差异。具体而言，在公共卫生关键竞赛实践的指导下，我们将 与使用毒品和公共卫生西雅图和金县的人合作：1）评估EMS的影响 OPP患者级经验中的种族差异（例如，EMS互动中的歧视）和结果 （例如，与丁丙诺啡治疗的联系）（AIM 1）； 2）从黑色的角度进一步评估EMS-OPP， 西班牙裔/拉丁裔和美洲印第安人/阿拉斯加本地非致命过量幸存者使用深入的访谈（AIM 2）; 3）检查EMS-OPP对种族差异对种群级别结果的影响（例如， 与后续护理的联系）（目标3）。目标1涉及创建非致命过量幸存者的队列 随着最近的EMS交互，链接了多个数据系统。 AIM 2使用定性研究设计，涉及半 AIM 1的黑色，西班牙裔/拉丁裔和美洲印第安人/阿拉斯加本地幸存者的结构化访谈。 3使用EMS记录管理系统数据中的数据使用中断的时间序列设计比较 治疗EMS-OPP训练的小组的患者与不相比的患者的过量结果差异。回应 州政府不断升级过量危机以及成果的种族差异，扩大了EMS资金， 培训和实践范围。我们拟议的研究利用了阿片类药物危机中的这一关键时刻来评估 结构性社区级别干预具有现实世界复杂性的人口级别和公平影响 这有可能扩展和扩展。调查结果将在社区场所共享（例如海报，社区 杂志），政策摘要，会议演讲和学术期刊文章。 1