A systems science approach for improving continuity of service in substance use disorder treatment

项目摘要/摘要 增加获得物质使用障碍(SUD)治疗的机会是一项重要的公共卫生 优先考虑，因为药物滥用和依赖与严重的发病率和 死亡率。虽然有基于证据的治疗方法可用于肥皂泡患者的护理，但只有11%的人 需要专业治疗的人都会接受治疗。治疗中的一个主要服务差距 肥皂泡，特别是酒精和阿片类药物使用障碍，是患者参与治疗的原因 或在最初戒毒(戒毒)后康复。在排毒出院的时候， 患者复发的风险很高，因此很容易受到系统故障的影响。单独戒毒 如果患者在服药后没有过渡到康复，则会增加患者因服药过量而死亡的风险 出院。到目前为止，对戒毒后服务连续性问题的研究主要集中在 不考虑动态的组织的患者特征和属性 发生SUD处理的上下文。到目前为止，还没有探讨的是 戒毒后进入SUD治疗的服务项目之间的转介网络。目标是 这项试点研究的目的是确定网络等系统级预测因素的影响 关于洛杉矶县SUD治疗系统服务连续性的结构。这个 中心假说将通过追求三个具体目标来检验：1)描述 使用社会网络分析的洛杉矶县公共资助的SUD治疗系统，2) 确定网络结构对从戒毒到SUD治疗的服务连续性的影响 使用计算机模拟模型，以及3)设计用于服务实现的协议 网络干预，以增加戒毒后服务的连续性。它的独特优势在于 学习是经验丰富的研究团队、理论驱动的方法和系统的应用 社会网络分析和基于代理的建模等科学方法。实现 研究目标将使我们更好地理解 并展示系统一级的伙伴关系和转诊模式如何 影响患者的预后。这项研究的结果将用于计划一项R34研究，以测试 用于sud治疗的服务实施网络模型的实施和有效性。

Project Summary/Abstract Increasing access to substance use disorder (SUD) treatment is an important public health priority because substance abuse and dependence is associated with significant morbidity and mortality. While evidence-based treatments are available to care for people with SUDs, only 11% of individuals who need professional treatment receive it. One major service gap in the treatment of SUDs, particularly alcohol and opioid use disorders, is the engagement of patients in treatment or rehabilitation after an initial detoxification (detox). At the point of discharge from detox, patients are at high risk of relapse and therefore vulnerable to system failures. Detox alone increases patients' risk of mortality from overdose if they do not transition to rehabilitation after discharge. To date, research on the problem of continuity of service after detox has focused on patient characteristics and attributes of organizations with no consideration to the dynamic contexts within which SUD treatment occurs. What has not been explored to date is the impact of referral networks between service programs on entry into SUD treatment after detox. The goal of this pilot study is to determine the impact of systems-level predictors such as network structures on continuity of service in the SUD treatment system in Los Angeles County. The central hypothesis will be tested by pursuing three specific aims: 1) Describe the ecology of the publicly-funded SUD treatment system in Los Angeles County using social network analysis, 2) Determine the impact of network structure on continuity of service from detox to SUD treatment using computer simulation models, and 3) Design a protocol for a service implementation network intervention to increase continuity of service after detox. The unique strengths of the study are the experienced research team, theory-driven approach, and application of systems science methodologies such as social network analysis and agent-based modeling. Achieving the study aims will create greater understanding of the interdependency of programs within the treatment systems and demonstrate how partnerships and referral patterns at a system level can impact patient outcomes. The results of the study will be used to plan an R34 study to test the implementation and effectiveness of a service implementation network model for SUD treatment.