Hub and Spoke Model to Improve Pharmacotherapy Use for Opioid Addiction and Promote Recovery

联邦政府，通过SAMHSA的阿片类药物国家有针对性的反应（阿片类药物STR）赠款， 向每个州提供资金，以扩大应对范围，希望扭转正在进行的阿片类药物 危机治疗阿片类药物使用障碍（OUD）的药物治疗是一种循证实践，尽管它是 显然未得到充分利用，尤其是初级保健提供者。华盛顿州正在实施一个“中心辐射” （H&S）综合护理模式，以扩大获得药物治疗服务（也称为药物辅助） 治疗或MAT），并减少OUD患者的未满足需求，无论客户如何或在何处 进入治疗系统。这项拟议的R21/R33研究将采取混合有效性-实施 这是一种以执行评价和有效性为主要目标的方法。必须了解 如何实施H&S模型，以了解它是否、如何以及为什么是治疗OUD的有效方法。 拟议研究的具体目标如下。R21阶段-早期实施和 可行性：（1）确认从枢纽、辐条和比较中收集客户端和程序数据的可行性 收集基线数据;确认与其他关键数据库的数据链接;（2）最后确定要素 R33有效性研究所需，包括比较组、因变量和关键分析 （3）评估H&S模式的早期实施情况。R33阶段-有效性：（1）测试 H&S模型是否有效地解决OUD;（2）确定OUD患者是否在 如果他们接受药物治疗+咨询，H&S模型的结果更好， 药物治疗. (3)测试H&S模型是否对亚组（例如，年龄，性别， OUD类型，精神障碍，农村）;（4）使用混合方法，检查H&S模式的实施情况， 每个轴辐式网络之间和内部的具体方面如何与整体效率相关。 本研究将主要关注华盛顿参加医疗补助计划的OUD成人（18岁以上）， 华盛顿约90%的OUD患者正在接受治疗。有效性措施包括一系列 客户和系统各级的结构、成果和程序措施，包括吸毒、过量、获得 药物治疗，逮捕，监禁和就业。华盛顿在戒毒治疗方面处于领先地位 服务和详细的数据系统。将使用统计方法来确保严格的准实验性 设计这项研究的结果将使我们能够了解 最有效治疗OUD的H&S模式，以及如何将更多的初级保健提供者带到 成瘾药物治疗实践。它将作为其他国家和系统的模式，提供灵活的 该方法解决了OUD患者使用药物治疗的许多现有障碍， 没有错误的门进入治疗，OUD患者接受最好的治疗 成功促进复苏。

The federal government, through SAMHSA’s Opioid State Targeted Response (Opioid-STR) grants, has provided funding to each state to ramp up the range of responses in hopes of reversing the ongoing opioid crisis. Pharmacotherapy to address opioid use disorders (OUDs) is an evidence-based practice although it is clearly underutilized, especially by primary care providers. Washington State is implementing a “Hub & Spoke” (H&S) integrated care model to expand access to pharmacotherapy services (also known as medicationassisted treatment or MAT) and reduce unmet need for people with OUDs regardless of how or where clients enter the treatment system. This proposed R21/R33 study will take a hybrid effectiveness-implementation approach, with both implementation evaluation and effectiveness as primary goals. It is essential to understand how the H&S model is implemented to understand if, how, and why it is an effective approach to treat OUDs. The specific aims for the proposed study are as follows. R21 PHASE – Early Implementation and Feasibility: (1) Confirm the feasibility of collecting client and program data from hubs, spokes and comparison groups; collect baseline data; and confirm data linkages with other key databases; (2) Finalize elements needed for R33 effectiveness study, including comparison groups, dependent variables, and key analytic subgroups; (3) Assess the early implementation of the H&S model. R33 PHASE – Effectiveness: (1) Test whether the H&S model is effective for addressing OUDs; (2) Determine whether people with OUDs treated in the H&S model have better outcomes if they receive pharmacotherapy + counseling versus only pharmacotherapy. (3) Test whether the H&S model is differentially effective for subgroups (e.g., age, gender, OUD type, mental disorder, rural); (4) Examine, using mixed methods, implementation of the H&S model and how specific aspects across and within each hub-spoke network relate to the overall effectiveness. This study will focus primarily on adults (18+) with OUDs in Washington who are enrolled in Medicaid, about 90% of people with OUDs in treatment in Washington. Effectiveness measure include a range of structure, outcome and process measures at client- and system-levels, including drug use, overdose, access to pharmacotherapy, and arrests, incarceration and employment. Washington is a leader in addiction treatment services and detailed, linkable data systems. Statistical methods will be used to ensure a rigorous quasiexperimental design. The findings from this study will enable us to understand the essential elements of the H&S model for the most effective treatment for OUDs, and how to bring more primary care providers to the addiction pharmacotherapy practice. It will serve as a model for other states and systems, offering a flexible approach that addresses many existing barriers to the use of pharmacotherapy for people with OUDs, ensuring that there is no wrong door to enter treatment and that people with OUDs receive the treatment with the best success for promoting recovery.