Collaborative Care Management for Complex, Recurrent Substance Use Disorders

描述（由申请人提供）： 项目背景：物质使用障碍（SUD）是最常见和最昂贵的医疗条件，并与显着的发病率和死亡率。SUD通常通过限时干预进行管理，但越来越多的证据表明，对于一部分接受治疗的患者，药物使用问题在严重的精神病学和高医疗保健利用率情况下反复发生。尽管人们一致认为，这些复杂SUD患者需要新的模型，但很少有研究评估这种方法的可接受性或使用。本研究的目的是评估患者对协同护理管理模式（CCMM）的接受程度和使用情况。该模式是从慢性病护理模式，但适应于复杂的SUD和高利用率的资源密集型服务的患者。项目目标：本项目的具体目的包括：1）估计基于登记的合格患者的比例以及在研究的最初6个月内通过4种途径寻求VA服务的患者中的招募率，2）描述患者在入组的最初6个月内使用CCMM服务和每月监测的依从性，从患者和提供者的角度确定患者参与CCMM服务的障碍和促进因素，并检查患者对服务的满意度。该项目的第二个目标是评估药物使用、心理困扰和与健康有关的生活质量结果的前后变化。这些数据将提供信息来完善模型，并支持CCMM与SUD常规专科护理的比较成本和临床结局的大型评价试验。项目方法：在12个月内，拟议的研究将招募20名患有复杂SUD和高医疗保健利用的患者。CCMM旨在提供以患者为中心的护理，同时减少资源密集型服务的重复使用，并由跨学科团队提供，提供物质使用，心理健康和基本医疗服务的访问和协调。将通过有计划、按需和主动的办公室和电话联系方式协调各项服务。将在入组研究后3个月和6个月评估护理措施、临床结局和耐心体验以及对服务的满意度。将每月收集一次治疗反应指标。描述性分析将估计基于登记的合格患者寻求VA服务、初始招募和在最初6个月内联系> 6次的招募患者的比率。壁垒和 将报告参与CCMM服务的促进者，以及临床结局、患者使用、体验和对服务的满意度。预期影响：新的护理模式，解决患者的需要经常性和复杂的物质使用问题，如共病的心理健康问题和无家可归，可以提高他们的医疗保健，住房稳定性，护理质量和临床结果的有效利用。

DESCRIPTION (provided by applicant): Project Background: Substance use disorders (SUDs) are among the most common and costly of medical conditions and are associated with significant morbidity and mortality. SUDs have been typically managed with time-limited interventions, but there is growing evidence that for a subset of treated patients substance-use problems are recurrent with severe symptomatology and high healthcare utilization. Although there is agreement that new models are needed for these patients with complex SUDs, little research has evaluated the acceptability or use of such approaches. This pilot study proposes to evaluate patients' acceptance and use of a Collaborative Care Management Model (CCMM). The model is informed from chronic care models, but adapted for patients with complex SUDs and high utilization of resource intensive services. Project Objectives: Specific aims of this project include to 1) estimate rates of registr-based eligible patients and rates of recruitment among those seeking VA services via 4 pathways during initial 6 months of study, 2) describe patients' use of CCMM services and compliance with monthly monitoring during the initial 6 months of enrollment, and 3) identify the barriers and facilitators to patient engagement with CCMM services from patient and provider perspectives and examine patients' satisfaction with services. A secondary aim of the project will evaluate pre-post change on substance use, psychological distress and health-related quality of life outcomes. These data will provide information to refine the model and support larger evaluation trials of the comparative costs and clinical outcomes of CCMM versus SUD specialty-care as-usual. Project Methods: Over 12 months, the proposed study will enroll 20 patients with complex SUDs and high healthcare utilization. CCMM are designed to provide patient centered care while reducing recurrent utilization of resource intensive services, and delivered by an interdisciplinary team that provides access to and coordination of substance use, mental health and basic medical services. Services will be coordinated using planned, on-demand and proactive office- and telephone-based contacts. Process of care measures, clinical outcomes and patience experience and satisfaction with services will be assessed at 3 and 6 months after enrollment in the study. A treatment response measure will be collected monthly. Descriptive analyses will estimate rates of registry-based eligible patients seeking VA services, initial enrollment, and enrolled patients contacted > 6 times during initial 6 months. Barriers and facilitators to engagement in CCMM services, as well as clinical outcomes, patients' use, experience and satisfaction with services will be reported. Anticipated Impacts: New models of care that address the needs of patients with recurrent and complex substance use problems such as comorbid mental health problems and homelessness could improve efficient utilization of their healthcare, housing stability, quality of care and clinical outcomes.