The Whole Health Study: Collaborative Care for OUD and Mental Health Conditions

项目总结 此应用程序请求资金来完善和严格测试阿片类药物患者的协作护理模式 在小学使用精神障碍(OUD)和严重抑郁、创伤后应激障碍或焦虑障碍 关心。我们还将检查与成功实施相关的临床医生和实践特征 以及不同护理模式的成本效益。这项建议的主要目标是：(1)迅速 制作并测试我们协作护理模式的每个元素，以优化其实施；(2)执行 一项对三种协作性护理条件的随机研究，包括39种做法，以确定哪种情况最多 有效改善有精神障碍和精神健康状况的人的结局：(A)加强日常护理： 免除PCP处方丁丙诺啡和精神卫生保健经理，(B)合作护理：豁免 PCP；精神卫生保健经理接受OUD培训；执业接受电话精神咨询， 或(C)协作护理+社会工作者，以解决健康的社会决定因素；(3)衡量临床医生和 与每个组成部分的实施有关的组织一级因素，目标是制定 增加成功实施的战略；(4)对每项协作护理进行成本评估 模式；以及(5)与较小和较农村的做法合作，以制定和测试有效的战略来管理 奥德。这项拟议研究的成功完成将为大多数 整合协作护理所需的简约要素集，以最大限度地提高个人结果 有精神障碍和精神障碍。由于研究设计，我们对实施因素的检查， 而我们的社区合作伙伴关系，成果也将有很高的被采纳和实施的概率。

PROJECT SUMMARY This application requests funds to refine and rigorously test a collaborative care model for patients with opioid use disorder (OUD) and major depression, post-traumatic stress disorder, or an anxiety disorder in primary care. We also will examine clinician and practice characteristics associated with successful implementation and the cost effectiveness of different care models. The primary aims of this proposal are: (1) Rapidly prototype and test each element of our collaborative care models to optimize it for implementation; (2) Conduct a randomized study of three collaborative care conditions with 39 practices to determine which is most effective in improving outcomes for people with OUD and mental health conditions: (a) Augmented Usual Care: PCP waivered to prescribe buprenorphine and mental health care manager, (b) Collaborative Care: Waiver PCP; mental health care manager receives OUD training; practice receives telephonic psychiatric consultation, or (c) Collaborative Care + Social Worker to address social determinants of health; (3) Measure clinician and organizational-level factors associated with implementation of each component, with the goal of developing strategies to increase successful implementation; (4) Conduct a cost evaluation of each collaborative care model; and (5) Work with smaller and more rural practices to develop and test effective strategies to manage OUD. Successful completion of the proposed study will provide definitive evidence regarding the most parsimonious set of elements of integrated collaborative care required to maximize outcomes for individuals with OUD and psychiatric disorders. Because of the study design, our examination of implementation factors, and our community partnerships, the results also will have high probability of adoption and implementation.