Beyond Treatment Initiation: Enhancing Opioid Use Disorder Care Transitions Across Health System Touchpoints

7.项目总结/摘要 阿片类药物流行病继续肆虐，对美国的发病率和死亡率造成了巨大损失。 努力扩大阿片类药物使用障碍（MOUD）的救生药物的可用性，这是一个重大的差距， 在这些治疗的获取和连续性方面的主要问题。鉴于急诊护理的高频率 阿片类药物使用障碍（OUD）患者、急诊室和医院的情况越来越多， 被视为促进MOUD治疗启动的“接触点”。越来越多的证据表明， 在医院启动MOUD并将人们与社区治疗联系起来， 医院干预。然而，很少有人知道的性质或成功的战略，用于过渡- 将患者从医院环境转移到基于社区的MOUD治疗。了解哪些转型战略 在改善住院后MOUD治疗的参与方面最有效， 通过“OUD级联护理”，减少过量用药风险，改善健康状况。 这个K 01奖的目标是解决这些差距，同时推进候选人的职业目标，成为 一个独立的调查员谁在干预和实施研究的接口工作，epide- 和政策，以促进对改善获得、吸收和可持续发展的战略的了解， 为阿片类药物和其他物质使用障碍提供基于牙科的服务。通过课程作业，科学讨论- 经验，体验式学习，以及来自成瘾，健康服务研究和 定性和定量方法在纽约大学格罗斯曼医学院和合作机构，博士。 Krawczyk将发展提供成瘾服务和急性护理干预的能力;混合 收集和分析有关医疗保健实践及其实施的数据的方法; 从不同的数据集水平的医疗保健数据;和专业技能的赠款写作和研究伙伴关系。 拟议的研究将采用定量和定性方法，研究 用于将OUD患者从医院联系到社区中正在进行的MOUD参与的过渡策略 使用纽约市11家公立医院的案例研究。研究的目的是（1）建立一个分类系统， 通过文献回顾和专家意见，对医院OUD护理过渡策略进行了一项近期调查 德尔菲小组;（2）就主要障碍与提供者和患者利益相关者进行深入访谈 和促进有效的过渡，和（3）探索患者特征之间的多层次关联， 医院过渡策略和出院后MOUD参与结果。这项工作符合 NIDA的目标是进行研究，解决现实世界的复杂性，探索可持续的实施 药物使用治疗的循证实践，并研究治疗服务的整合， 不同的医疗保健机构。通过提供工资支持，培训和正式的导师结构， 该奖项将促进Krawczyk博士过渡到成瘾健康服务研究的独立职业生涯。

7. PROJECT SUMMARY/ABSTRACT The opioid epidemic continues to rage, taking a vast toll on morbidity and mortality across the U.S. Despite efforts to expand availability of life-saving medications for opioid use disorder (MOUD), a significant gap re- mains in access to and continuity in these treatments. Given the high frequency of encounters with acute-care settings among patients with opioid use disorder (OUD), emergency departments and hospitals are increas- ingly seen as ‘touchpoints’ to promote initiation of MOUD treatment. Growing evidence around the efficacy of initiating MOUD in the hospital and linking people to community treatment has led to a rapid growth of such hospital-based interventions. However, little is known about the nature or success of strategies used to transi- tion patients from hospital settings to community-based MOUD treatment. Knowing which transition strategies are most effective in improving engagement in MOUD treatment post-hospitalization is critical to supporting patients through the ‘OUD Cascade of Care’ towards reduced overdose risk and improved health. The goal of this K01 Award is to address these gaps while advancing the candidate’s career goal of becom- ing an independent investigator who works at the interface of intervention and implementation research, epide- miology, and policy to advance knowledge on strategies to improve access to, uptake and sustainability of evi- dence-based services for opioid and other substance use disorders. Through coursework, scientific confer- ences, experiential learning, and close mentorship from experts in addiction, health services research and qualitative and quantitative methods at the NYU Grossman School of Medicine and partner institutions, Dr. Krawczyk will develop competency in the delivery of addiction services and acute care interventions; mixed methods for collecting and analyzing data on healthcare practices and their implementation; analysis of multi- level healthcare data from diverse datasets; and professional skills for grant writing and research partnerships. The proposed research will employ quantitative and qualitative methods to study the nature and role of transition strategies used to link OUD patients from hospitals to ongoing MOUD engagement in the community using a case study of 11 public hospitals in NYC. Research aims are to (1) Develop a taxonomy and subse- quent survey of hospital OUD care transition strategies via review of the literature and input from an expert Delphi panel; (2) Conduct in-depth interviews with provider and patient stakeholders regarding primary barriers and facilitators to effective transitions, and; (3) Explore multi-level associations between patient characteristics, hospital transition strategies, and post-discharge MOUD engagement outcomes. This work is in line with NIDA’s goals to conduct research that addresses real-world complexities, explores sustainable implementation of evidence-based practices for substance use treatment, and studies the integration of treatment services in diverse health care settings. By providing salary support, training, and a formal mentorship structure, this award will facilitate Dr. Krawczyk’s transition to an independent career in addiction health services research.