Integrating Addiction Research in Health Systems: The Addiction Research Network

摘要 超过2000万美国成年人和青少年患有物质使用障碍(SODS)和物质使用障碍(SU) 相关问题。然而，大多数肥皂水患者从未接受过肥皂水治疗。从历史上看，对 SUDS的重点是正在寻求或已经参与的一小部分肥皂症患者， 特制的硫磺疗法。拟议成瘾研究网络(ARN)节点的总体目标 临床试验网络将进行尖端研究，以改善所有患有 在医疗环境中看到的SU/SUD患者。ARN包括全美15个大型卫生系统，它们使用 HMO研究网络(HMORN‘s)的虚拟数据仓库，提供地理和种族/民族 医疗和SU/SUD护理系统的多样性和多样性。所提出的ARN节点具有3个宽泛 议程-1)评估识别、接触和治疗SU或SU患者的有效做法 医疗环境中的SODS；2)开发和测试实施这些实践的有效、实用的方法 以可持续的方式作为常规医疗保健的一部分；以及3)开发和传播创新 苏打和苏打的研究方法。三名PI将领导ARN节点，每个PI都具有对我们的 研究议程。Weisner博士，他有超过25年的经验，领导公共和 私人医疗机构，将作为Kaiser Permanente的高级PI领导ARN。她是凯撒律师事务所的合伙人 Permanente与Campbell博士，阿片类药物滥用研究专家，以患者为中心和比较 有效性研究，以及拥有20年研究经验的团体健康高级PI布拉德利博士 以未寻求治疗的患者为目标，在医疗环境中滥用酒精和肥皂水。ARN将拥有 3个核心：1)管理核心将支持ARN节点的所有方面；2)实施核心将 支持以患者为中心设计实用、可持续的方法，在常规情况下实施SUD护理 使用电子健康记录(EHR)的医疗环境；以及3)具有以下专业知识的分析核心 编程、使用电子病历数据的生物统计和经济学，将支持创新方法研究和 研究设计。ARN的工作将利用HMORN 20年来进行务实临床试验和 使用电子病历和全国虚拟数据进行卫生系统间的有效性比较研究 仓库。ARN节点将为基于人口的研究提供坚实的基础--包括实用主义 随机对照试验、比较有效性研究和实施研究--可以 评估长期的健康结果。此外，通过我们与15个学习医疗系统的连接，我们的 研究将设计方法来改善现实世界医疗环境中SU和SUDS的护理质量。 通过这种方式-与其他CTN节点-ARN节点将帮助构建下一步所需的基础设施 成瘾时代的健康服务研究。

ABSTRACT Over 20 million US adults and youth suffer from substance use disorders (SUDs) and substance use (SU) related problems. However, most people with SUDs never receive SUD treatment. Historically, research on SUDs has focused on the small minority of patients with SUDs who are seeking, or already engaged in, specialty SUD treatment. The overall goal of the proposed Addictions Research Network (ARN) node of the Clinical Trials Network will be to conduct cutting edge research to improve outcomes in all patients with SU/SUD who are seen in medical settings. The ARN includes 15 large health systems across the US that use the HMO Research Network’s (HMORN’s) Virtual Data Warehouse, providing geographic and racial/ethnic diversity as well as variation in systems of medical and SU/SUD care. The proposed ARN node has 3 broad agendas—1) to evaluate effective practices for identifying, engaging and treating patients with SU or SUDs in medical settings; 2) to develop and test effective, practical ways to implement these practices in a sustained manner as part of routine medical care; and 3) to develop and disseminate innovative research methods on SU and SUDs. Three PIs will lead the ARN node, each with expertise critical to our research agenda. Dr. Weisner, who has more than 25 years of experience leading SUD research in public and private medical settings, will lead the ARN as Senior PI at Kaiser Permanente. She partners at Kaiser Permanente with Dr. Campbell, an expert in research on opioid misuse and patient-centered and comparative effectiveness research, and Dr. Bradley, Senior PI at Group Health, who has 20 years of research experience targeting non-treatment-seeking patients with alcohol misuse and SUDs in medical settings. The ARN will have 3 Cores: 1) an Administrative Core will support all aspects of the ARN node; 2) an Implementation Core will support patient-centered design of practical, sustainable approaches to implementing SUD care in routine medical settings using electronic health records (EHRs), and; 3) an Analytics Core with expertise in programming, biostatistics using EHR data, and economics, will support innovative methods research and study design. ARN work will leverage the HMORN’s 20 years of conducting pragmatic clinical trials and comparative effectiveness research across health systems using EHRs and the nationwide Virtual Data Warehouse. The ARN node will provide a robust foundation for population-based studies—including pragmatic randomized controlled trials, comparative effectiveness studies, and implementation research—that can evaluate long-term health outcomes. Moreover, through our connection to 15 learning healthcare systems, our research will design approaches to improve the quality of care for SU and SUDs in real-world medical settings. In this way—with the other CTN nodes—the ARN node will help build the infrastructure required for the next era of addictions health services research.