Studying the PhilAdelphia Resilience Project as a Response to Overdose (SPARRow)

阿片类药物危机对费城的打击尤其严重，每10万居民中有超过46人过量死亡， 2017年，是全国平均水平的两倍。作为回应，费城市制定了一项全面的预防措施， 战略，复原力项目，其中包括针对阿片类药物使用者的服务， 邻里环境干预，解决大多数过量发生的恶劣条件。 本提案的目的是，研究费城的复原力项目，作为对 过量（SPARROw），是为了评估两个复原力项目的有效性和实施情况 减少阿片类药物过量的计划：（1）替代反应单位（ARU），伴随 救护车对过量用药作出反应，旨在减少伤害并与人们建立护理联系 谁拒绝医院运输，和（2）枯萎病修复废弃的建筑物和土地。这 应用程序利用弹性项目实施中的自然实验来评估其影响 过量用药的结果我们假设针对阿片类药物过量的时间和地点的干预措施- 包括ARU和枯萎病补救-将更有效地防止过量相比，标准 紧急医疗服务（EMS）护理或缺乏环境改造。我们将：1）确定 恢复力项目ARU对阿片类药物过量患者的有效性 吸毒过量后被转移使用准实验设计，我们将比较近端过量 结局（治疗联系的发生率和时间）和远端过量结局（致死性和非致死性过量） 对于接受ARU参与的患者，与那些由于时间或地点限制， 接受传统的EMS护理。2)评估恢复力项目枯萎病补救措施的影响 关于致命和非致命阿片类药物过量的活动。我们将使用差异中的差异设计来比较 在任何特定补救措施之前和之后的60天内， 同一时间段，附近两个地点没有得到补救，但有可比的枯萎前 补救过量率。3)评估复原力项目的执行情况，方法是： 肯辛顿ARU干预的保真度，B）测量调节ARU保真度的因素，包括 c）评估ARU实施的障碍和促进因素，以及d）确定 ARU和枯萎病补救措施。我们将描述完成的ARU组件 每个患者遇到（带回家纳洛酮，快速治疗转诊，运输到治疗，获得 电话号码和/或电话随访）。我们还将衡量潜在的调节因素，包括ARU 在ARU交战地点使用经验证的照片进行真实的实时团队组成和附近的枯萎病 方法.我们将通过对ARU供应商的访谈来描述实施的障碍和促进因素。最后， 我们将确定ARU和枯萎病修复的成本，以告知可持续性和传播工作。

The opioid crisis has hit Philadelphia particularly hard, with over 46 overdose deaths per 100,000 residents in 2017, twice the national average. In response, the City of Philadelphia developed an overarching prevention strategy, the Resilience Project, which includes both services targeted toward people who use opioids and neighborhood environment interventions that address the blighted conditions where most overdoses occur. The objective of this proposal, Studying the PhilAdelphia Resilience Project as a Response to Overdose (SPARROw), is to evaluate the effectiveness and implementation of two Resilience Project programs to reduce opioid overdose: (1) the Alternative Response Unit (ARU) that accompanies ambulances responding to overdoses and aims to deliver harm reduction and care linkage to people who refuse hospital transport, and (2) blight remediation of abandoned buildings and land. This application leverages a natural experiment within the Resilience Project implementation to evaluate its impact on overdose outcomes. We hypothesize that interventions targeted at the time and place of opioid overdose – including the ARU and blight remediation – will be more effective at preventing overdose compared to standard Emergency Medical Services (EMS) care or absence of environmental modifications. We will: 1) Determine the effectiveness of the Resilience Project ARU on opioid overdose outcomes for patients who refuse transport after overdose. Using a quasi-experimental design, we will compare the proximal overdose outcomes (rates and timing of treatment linkage) and distal overdose outcomes (fatal and non-fatal overdoses) for patients who receive ARU engagement compared to those who, due to timing or location restrictions, receive traditional EMS care alone. 2) Evaluate the impact of Resilience Project blight remediation activities on fatal and non-fatal opioid overdose. We will use a difference-in-difference design to compare fatal and non-fatal overdoses in the 60 days before and after any given remediation effort compared to the same time period in two nearby locations that did not get remediated but had comparable pre-blight remediation overdose rates. 3) Evaluate implementation of the Resilience Project by a) characterizing the fidelity of ARU intervention in Kensington, b) measuring factors that moderate ARU fidelity, including blight, c) assessing barriers and facilitators to ARU implementation, and d) determining the costs for ARU and blight remediation interventions. We will characterize which ARU components are completed for each patient encounter (take home naloxone, rapid treatment referral, transportation to treatment, obtain phone number, and/or phone follow-up). We will also measure potential moderating factors including ARU team composition and nearby blight in real time at ARU engagement locations using validated photographic methods. We will characterize barriers and facilitators to implementation with ARU provider interviews. Last, we will determine the costs for ARU and blight remediation to inform sustainability and dissemination efforts.