Optimizing HEALing in Ohio Communities (OHiO)

项目总结 阿片类药物流行在俄亥俄州已经根深蒂固，年龄调整后的阿片类药物过量死亡率 32.9/10万人(2017年)，居全国第二位。无论是农村地区还是城市地区都未能幸免， 俄亥俄州88个县中有38个县(43%)报告的阿片类药物相关死亡人数超过25/10万人。 自2012年以来，俄亥俄州采取了前所未有的努力，以减少阿片使用障碍(OUD)的发病率和 通过在预防、治疗和恢复工作中的政策和投资来降低死亡率。然而，挑战 跨部门整合和部署循证干预措施(EBI)的固有限制了其 对受影响社区的影响。 俄亥俄社区(俄亥俄州)优化治疗的目标是系统地计划、实施和评估 数据驱动的方法，将多管齐下的EBI集成到医疗保健、行为健康、司法系统、 和社区在3年内将19个受影响较高的县的阿片类药物过量死亡人数减少40%。俄亥俄州是 由NCATS资助的三个CTSA和NIDA资助的俄亥俄山谷临床试验节点支撑 网络并利用与社区联盟、州和县的广泛现有合作 政府，以及医疗保健、行为健康和刑事司法部门。俄亥俄州的做法是基于 并与国家规定的社区健康评估和社区健康改善保持一致 计划，利用州和联邦资助的项目已经到位。总体目标将会实现 通过完成三个目标。目标1)计划：我们将评估与OUD有关的当前政策/计划， 阿片类药物滥用和与阿片类药物有关的死亡；利用探索、采用/制备、实施和 维持模式，与社区合作选择EBI，以减少过量和过量死亡；并确定 易于干预的服务/服务协调方面的差距。目标2)实施：通过 务实的社区临床试验，我们将使用集群阶梯式楔形设计在 哪些协作社区通过接收所选干预的时间来随机化。 目标3)评估：我们将持续收集和分析数据，使用REACH、有效性、采用率、 实施和维护(RE-AIM)模型，以评估综合干预措施和 实施结果包括可接受性、采用(包括对干预的忠诚度)、可行性、 多管齐下的方法的渗透率、增量成本和成本效益。我们还将建立 学习健康社区，为社区利益相关者提供实时、可操作的信息。 最终，俄亥俄州将为综合预防的有效性提供严格和可重复的证据， 社区背景下的治疗和康复方案；可出口和可扩展的服务模式 评估、社区参与的决策；以及可以实施的集成的、数据驱动的EBI 俄亥俄州、该地区和全美受影响的社区。

PROJECT SUMMARY The opioid epidemic has become entrenched in Ohio, with an age-adjusted opioid-related overdose death rate of 32.9/100,000 people (2017), ranking second nationally. Neither rural nor urban areas have been spared, with 38 of Ohio’s 88 counties (43%) reporting opioid-related deaths exceeding 25/100,000 people. Since 2012, Ohio has mounted an unprecedented effort to reduce opioid use disorder (OUD) morbidity and mortality through policies and investments in prevention, treatment, and recovery efforts. However, challenges inherent in integrating and deploying evidence-based interventions (EBI) across sectors has limited their impact in affected communities. The goal of Optimizing Healing in Ohio Communities (OHiO) is to systematically plan, implement, and evaluate data-driven approaches that integrate multi-pronged EBI within healthcare, behavioral health, justice systems, and communities to reduce opioid overdose deaths in 19 highly affected counties by 40% in 3 years. OHiO is anchored by three NCATS-funded CTSAs and the NIDA-funded Ohio Valley Node of the Clinical Trials Network and leverages extensive existing collaborations with community coalitions, state and county governments, and healthcare, behavioral health and criminal justice sectors. OHiO’s approach is based upon and aligned with the state-mandated Community Health Assessments and Community Health Improvement Plans, leveraging state and federally funded programs already in place. The overarching goal will be met through completion of three aims. Aim 1) Plan: We will assess current policies/programs regarding OUD, opioid misuse, and opioid-related fatalities; using the Exploration, Adoption/Preparation, Implementation and Sustainment model, work with communities to select EBI to reduce OUD and overdose deaths; and identify gaps in services/service coordination that are amenable to intervention. Aim 2) Implement: Through a pragmatic community-based clinical trial, we will deliver EBI packages using a cluster stepped-wedge design in which collaborating communities are randomized by the timing of which selected interventions are received. Aim 3) Evaluate: We will continuously collect and analyze data using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) model to assess the impact of the integrated interventions and implementation outcomes including acceptability, adoption (including fidelity to the intervention), feasibility, penetration, and incremental cost and cost-effectiveness of the multipronged approach. We will also establish Learning Health Communities to provide community stakeholders access to real-time, actionable information. Ultimately, OHiO will provide rigorous and reproducible evidence of the effectiveness of integrated prevention, treatment, and recovery programs in the community context; an exportable and scalable model of service assessment, community-engaged decision-making; and integrated, data-driven EBI that can be implemented by affected communities in Ohio, the region, and across the US.