MassHEAL - Reducing overdose deaths by 40% (2019-2023)

项目总结/摘要 过去十年，美国阿片类药物过量（OD）死亡率急剧上升;马萨诸塞州 (MA)是受影响最严重的州之一，在年龄调整后的OD死亡率中排名第七。临床护理创新 导致了有效的干预;不幸的是，这些创新在许多千年生态系统评估中并没有成为标准 社区.使用社区关怀（CTC）模型，MassHEAL专家和社区 利益攸关方将利用数据驱动的方法来确定和缩小服务差距， 一系列计划，在3年内将MA的OD死亡率降低40%。关键组成部分将包括确定 阿片类药物使用障碍（OUD）患者;降低OD风险;加速获得低门槛 在住院、监禁期间，对高危人群启动OUD（MOUD）药物治疗， 阿片类药物解毒在整个千年评估中确定了16个受到高度影响的社区。Massheal将 采用整群随机平行组设计，社区以1：1的比例随机分配至干预组 （基于办公室的成瘾治疗[OBAT]加上社区的外部便利， 方案和策略，n=8）与对照组（仅0 BAT，n=8）。公共卫生数据（PHD） Warehouse是一种独特的资源，它将来自十几个国家机构的个人级别数据链接起来 只有在千年生态系统评估中才能得到，以便对社区和个人层面的结果进行务实的评估。的 MassHEAL团队具备必要的多学科专业知识和协作经验， 成功完成这项研究。它包括专门从事更安全的阿片类药物处方和治疗的临床医生。 OUD并开发了许多提议的方案。这支临床团队与健康 服务研究人员，公共卫生专业人员，生物统计学家，社区参与专家， 实施科学家和卫生经济学家，以全面评估干预措施。使用 基于社区参与式研究（CBPR）的原则，MassHEAL建立了一个社区 咨询委员会，将支持有效的社区学术伙伴关系。具体目标是：（1）就业 社区参与原则，以制定和实施量身定制的临床，预防和沟通 在MassHEAL干预社区的战略; 2）确定MassHEAL干预的影响， 阿片类药物过量死亡和其他结果; 3）衡量外部促进对社区成功的影响 实施OUD预防和治疗干预;以及4）估计MassHEAL的价值 社区干预相对于护理标准。MassHEAL将实施和评估一个菜单， 以证据为基础的计划，以减少整个MA高度受影响社区的阿片类药物OD死亡。结果 这项研究将为创新医疗和公共卫生的广泛传播和实施提供信息。 战略，以实现整个美国的健康社区倡议的目标。

PROJECT SUMMARY/ABSTRACT Rates of opioid overdose (OD) deaths have risen drastically in the US over the last decade; Massachusetts (MA) is one of the hardest hit states, ranking 7th in age-adjusted OD death rate. Clinical care innovations have led to effective interventions; unfortunately, these innovations have not become standard in many MA communities. Using the Communities That Care (CTC) model, MassHEAL experts and community stakeholders will utilize a data-driven approach to identify and narrow service gaps to tailor and implement a suite of programs to reduce OD deaths in MA by 40% in 3 years. Key components will include identifying people with opioid use disorder (OUD); providing OD risk reduction; and accelerating access to low-threshold initiation of medications for OUD (MOUD) for high-risk individuals during hospitalization, incarceration, and opioid detoxification. Sixteen highly impacted communities have been identified across MA. MassHEAL will use a cluster-randomized parallel group design with communities randomized 1:1 to the intervention arm (office-based addiction treatment [OBAT] PLUS external facilitation for communities to select from a menu of programs and strategies, n=8) vs. a control arm (OBAT only, n=8). The MA Public Health Data (PHD) Warehouse, which links individual-level data from more than a dozen state agencies, is a unique resource available only in MA permitting pragmatic assessment of community- and individual-level outcomes. The MassHEAL team exemplifies the multi-disciplinary expertise and collaborative experience necessary to execute this study successfully. It includes clinicians who specialize in safer opioid prescribing and treatment of OUD and have developed many of the programs proposed. This clinical team is complemented with health services researchers, public health professionals, biostatisticians, community engagement specialists, implementation scientists, and health economists in order to evaluate the intervention comprehensively. Using principles of community-based participatory research (CBPR), MassHEAL has established a Community Advisory Board that will support effective community–academic partnerships. The Specific Aims are: 1) employ community engagement principles to develop and implement tailored clinical, prevention, and communication strategies in MassHEAL intervention communities; 2) determine the impact of the MassHEAL intervention on opioid OD deaths and other outcomes; 3) measure the impact of external facilitation on communities' success implementing an OUD prevention and treatment intervention; and 4) estimate the value of the MassHEAL community intervention relative to standard of care. MassHEAL will implement and assess a menu of evidence-based programs to reduce opioid OD deaths in highly impacted communities across MA. Results of this study will inform the broad dissemination and implementation of innovative medical and public health strategies to achieve the aims of the HEALing Communities initiative across the US.