A longitudinal collaborative care model for patients with prescription opioid misuse utilizing the Emergency Department for care

 描述（由申请人提供）： 摘要劳伦·K. Whiteside医学博士是一名经过奖学金培训的执业急诊医学医师，其长期职业目标是成为一名独立的联邦资助的研究者，能够为处方阿片类药物滥用（POM）和相关药物滥用、精神健康和医疗合并症患者开发和实施急诊科（艾德）的创新护理系统。POM患者的合并症发生率很高，K23提案将告知，完善和试点从慢性病管理框架建立的协作护理模式，以降低POM的发生率，同时解决卫生服务需求和合并症。有物质使用问题的患者比没有这些需求的患者更多地利用艾德进行护理，因此，艾德是为这些患者启动协作护理模式的关键和创新位置。为了实现这一长远目标，D. Whiteside召集了一群多学科的导师和贡献者，并制定了一个结构化的，量身定制的教育计划，以学习特定的技能，过渡到她职业生涯的下一个阶段。这个K23指导的以病人为导向的职业发展奖的短期培训目标是：1）通过获得卫生系统和混合方法研究的正式培训，为POM提供协作护理模式; 2）通过了解POM和相关物质使用问题，医疗/精神科合并症和卫生服务利用的模式，获得在艾德实施协作护理系统所需的技能; 3）学习如何进行随机临床试验，并了解如何将创新的适应性设计和务实的试验考虑应用于这个高度可变的人群。鉴于已知的医疗，精神和物质使用与POM患者的合并症，医疗保健系统的方法是必要的，以解决这个问题的复杂性。因此，本提案的具体研究目的是：1）通过与目标患者群体及其护理提供者进行半结构化访谈，告知协作护理模式（RxCC）的内容，以减少POM和相关并发症; 2：通过招募参与者和进行半在一个月内进行结构化访谈，以探讨协作护理框架内医疗保健利用的障碍和促进因素;以及 3)在艾德的POM患者中，使用适应性随机化程序进行了一项随机对照试验，将RxCC与常规治疗进行比较，为期6个月，以评估其可行性和可接受性。RCT没有足够的把握度来检测显著的治疗效果，因此探索性分析将比较6个月时医疗保健利用率以及处方阿片类药物滥用（POM）的差异。这K23指导以病人为导向的职业发展奖提案直接解决NIDA的战略计划概述了2010年通过解决治疗POM和相关的合并症，并提供了一个创新的卫生系统的方法，这一复杂的问题。

 DESCRIPTION (provided by applicant): ABSTRACT Lauren K. Whiteside M.D. is a fellowship-trained, practicing emergency medicine physician with a long term career goal to become an independent, federally funded investigator capable of developing and implementing innovative systems of care from the Emergency Department (ED) for patients with prescription opioid misuse (POM) and related substance abuse, mental health and medical comorbidities. Patients with POM have high rates of comorbidity, and this K23 proposal will inform, refine and pilot a collaborative care model built from the chronic disease management framework to decrease rates of POM while addressing health services needs and comorbidity. Patients with substance use problems utilize the ED for care more than patients without these needs and thus, the ED is a critical and innovative location to initiate a collaborative care model for these patients. To reach this long-term goal, D. Whiteside has assembled a group of multidisciplinary mentors and contributors and put together a structured, tailored educational plan to learn specific skills to transition to the next stage ofher career. The short term training goals for this K23 Mentored Patient-Oriented Career Development Award are to 1) inform a collaborative care model for POM by getting formal training in health systems and mixed methods research; 2) Acquire the skills necessary to implement a collaborative care system in the ED by understanding patterns of POM and associated substance use problems, medical/psychiatric comorbidity and health service utilization; 3) Learn how to conduct randomized clinical trials and understand how to apply innovative adaptive design and pragmatic trial considerations to this highly variable population. Given the known medical, psychiatric and substance use comorbidities associated with patients with POM, a health care system approach is required to address the complexity associated with this problem. Therefore specific research aims of this proposal are to: 1) Inform content for a collaborative care model (RxCC) to decrease POM and related comorbidity by conducting semi- structured interviews with the target patient population and their care providers; 2: Refine RxCC by enrolling participants and conducting semi-structured interviews at one month to explore barriers and facilitators of healthcare utilization within the framework of collaborative care; and 3) Pilot a randomized control trial of RxCC delivered over six months compared to usual care using adaptive randomization procedures for patients in the ED with POM for feasibility and acceptability. The RCT will not be adequately powered to detect significant treatment effects, thus exploratory analyses will compare differences in health care utilization at six months as well as prescription opioid misuse (POM). This K23 Mentored Patient-Oriented Career Development Award proposal directly addresses NIDA's strategic plan outlined in 2010 by addressing treatment for POM and associated comorbidities and provides an innovative health systems approach for this complex problem.