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

项目摘要/摘要 马萨诸塞州阿片类药物过量(OD)死亡率在过去十年中在美国急剧上升 马萨诸塞州是受影响最严重的州之一，经年龄调整后的OD死亡率排名第7。临床护理创新已经 导致了有效的干预；不幸的是，这些创新并没有成为许多并购的标准 社区。使用关爱的社区(CTC)模式、MassHEAL专家和社区 利益相关方将利用数据驱动的方法来识别和缩小服务差距，以定制和实施 一系列计划，可在3年内将马萨诸塞州的服药过量死亡人数减少40%。关键组件将包括识别 阿片类药物使用障碍(OUD)患者；提供服药过量风险降低；以及加速获得低阈值 在住院、监禁期间为高危个人启动OUD(Moud)药物治疗， 阿片类药物戒毒。马萨诸塞州已经确定了16个高度受影响的社区。马斯黑尔将会 采用整群随机平行分组设计，社区与干预臂1：1随机化 (基于办公室的成瘾治疗[obat]加上外部便利，供社区从以下菜单中选择 程序和策略，n=8)与控制臂(仅限obat，n=8)。硕士公共卫生数据(PHD) 仓库是一种独特的资源，它连接着十几个州机构的个别级数据 仅在MA中可用，允许对社区和个人层面的结果进行务实评估。这个 MassHEAL团队体现了多学科的专业知识和协作经验， 成功地执行这项研究。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 并开发了许多拟议的方案。这个临床团队有健康方面的补充 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、 实施科学家和健康经济学家，以便全面评估干预措施。vbl.使用 基于社区的参与性研究原则(CBPR)，MassHEAL建立了一个社区 将支持有效的社区-学术伙伴关系的咨询委员会。具体目标是：1)聘用 开发和实施量身定制的临床、预防和沟通的社区参与原则 MassHEAL干预社区的策略；2)确定MassHEAL干预对 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 实施预防和治疗干预措施；4)评估MassHEAL的价值 相对于护理标准的社区干预。MassHEAL将实施和评估一项菜单 在马萨诸塞州受高度影响的社区减少阿片类药物过量死亡的循证方案。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参考 在全美范围内实现治愈社区倡议目标的战略。

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.