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，#年每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，费城市政府制定了一项总体预防措施 战略，复原力项目，其中包括针对阿片类药物使用者的服务和 社区环境干预措施，解决大多数过量发生的恶劣条件。 这项提案的目标是研究费城复原力项目以应对 过量(麻雀)，是评价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方案：(1)随行的替代反应单位(ARU) 应对过量用药的救护车，旨在为人们提供减少伤害和护理联系 拒绝医院运输的人，以及(2)废弃建筑和土地的枯萎病修复。这 应用程序利用Resilience Project实施中的自然实验来评估其影响 关于服药过量的后果。我们假设干预针对阿片类药物过量的时间和地点- 包括ARU和枯萎病补救措施-与标准相比，将更有效地防止过量使用 紧急医疗服务(EMS)护理或未进行环境修改。我们将：1)确定 复原力项目ARU对拒绝阿片类药物过量患者结局的影响 服药过量后的运输。使用准实验设计，我们将比较近端过量用药 结果(治疗联系的比率和时间)和远端过量结果(致命性和非致命性过量) 对于接受ARU参与的患者与那些由于时间或地点限制， 单独接受传统的EMS护理。2)评估Resilience项目枯萎病修复的影响 致命性和非致命性阿片类药物过量的活动。我们将使用差异设计来比较 在任何给定补救措施之前和之后的60天内致命性和非致命性过量与 附近两个地点的相同时间段，没有得到补救，但有类似的枯萎病前 补救过量服药率。3)评估复原力项目的实施情况，a)说明 肯辛顿ARU干预的保真度，b)衡量适度ARU保真度的因素，包括 枯萎病，c)评估执行ARU的障碍和促进者，以及d)确定 ARU和疫病补救干预措施。我们将确定为哪些ARU组件完成 每次患者遇到(带回家纳洛酮、快速治疗转诊、接送治疗、获得 电话号码和/或电话跟进)。我们还将测量潜在的缓和因素，包括ARU 使用经过验证的照片实时显示ARU交战地点的团队组成和附近的枯萎病 方法：研究方法。我们将通过与ARU提供商的访谈来描述实施的障碍和促进者。最后的, 我们将确定ARU和疫病补救的费用，以便为可持续性和传播努力提供信息。

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.