Health Systems Node of the NIDA Clinical Trials Network

这项研究是NIH帮助结束长期成瘾（HEAL）计划的一部分，旨在加速科学解决国家阿片类药物公共卫生危机。NIH HEAL倡议支持整个NIH的研究，以改善阿片类药物滥用和成瘾的治疗。物质使用（SU）和物质使用障碍（SUD）引起广泛的发病率和死亡率，但一直被忽视的主流卫生保健的历史。卫生系统节点于2015年加入了国家药物滥用研究所的临床试验网络（CTN），由坎贝尔博士，韦斯纳和布拉德利博士领导，成瘾 在医疗环境中创新实施研究和务实试验的研究领导者。我们的节点包括16个具有国家代表性和丰富人口多样性的学习健康系统，代表了2600多万患者。我们的教师是谁是嵌入在他们的健康系统，并致力于尖端成瘾研究的研究人员。他们带来了多学科的专业知识，在进行研究， 在不同的医疗环境（如初级保健、成瘾医学、妇产科、精神病学、农村社区）和不同的人群（如代表性不足的少数民族、青少年、孕妇、艾滋病毒感染者）中采用创新方法。该节点在其前5年领导了6项多地点研究，包括CTN的第一个完全基于电子健康记录（EHR）的务实实施试验， 以及参与其他节点领导的几项研究。该更新申请建立在这一成功的基础上，通过3个广泛的研究领域在未来5年内实现CTN的目标：1）测试增加SU和SUD识别以及参与治疗的方法。例如，我们建议进行多地点实施试验，以测试实施大麻和其他药物的创新方法。 SUD的药物筛选和评估; 2）测试在医疗环境中改善SUD结局的新方法。例如，我们提出了一个护理点的实用有效性试验的电话护士协作护理和有效的基于智能手机的SUD治疗，在新诊断的SUD患者;和3）开发新的措施和方法，SUD研究使用EHR。例如，我们建议验证由NIH路线图倡议患者报告结果测量信息系统（PROMIS）开发的7项SU严重程度测量，用于SUD的基于测量的护理。这些议程强调基于人群的研究，包括实用的随机对照试验，比较有效性研究和实施研究，并利用EHR。公共卫生和临床实践的影响。在美国，每年有超过1490万未经治疗的SUD患者接受医疗保健访问。如果这些患者中有10%被识别、参与并成功治疗，那么每年将有150万SUD患者得到解决，否则这些患者将无法得到治疗。卫生系统节点的教师和基础设施，与CTN合作，具有独特的优势，可以进行和传播研究，促进SUD治疗融入常规医疗保健，并最终改善患者的预后和公共卫生。

This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction. Substance use (SU) and substance use disorders (SUD) cause extensive morbidity and mortality but have been neglected historically by mainstream health care. The Health Systems Node joined the National Institute on Drug Abuse’s Clinical Trials Network (CTN) in 2015, led by Drs. Campbell, Weisner and Bradley, addiction research leaders in innovative implementation research and pragmatic trials in medical settings. Our node includes 16 Learning Health Systems with national representation and rich population diversity, and represents over 26 million patients. Our faculty are researchers who are embedded in their health systems and committed to cutting-edge addiction research. They bring multidisciplinary expertise in conducting research using innovative methods in different medical settings (e.g. primary care, addiction medicine, OB/GYN, psychiatry, rural communities), and with diverse populations (e.g. under-represented minorities, adolescents, pregnant women, patients with HIV). The node had an outstanding track record in its first 5 years leading 6 multi-site studies, including the CTN’s first entirely electronic health record (EHR)-based pragmatic implementation trial as well as participating in several studies led by other nodes. This renewal application builds upon that success to address the CTN’s objectives over the next 5 years through 3 broad Research Agendas: 1) To test approaches to increasing identification of SU and SUD, and engagement in treatment. For example, we propose a multisite implementation trial to test an innovative approach to implementing cannabis and other drug screening and assessment for SUD; 2) To test new approaches to improve SUD outcomes in medical settings. For example, we propose a point-of-care pragmatic effectiveness trial of telephonic nurse collaborative care and an efficacious smartphone-based SUD treatment, in patients with newly diagnosed SUD; and 3) To develop novel measures and methods for SUD research using EHRs. For example, we propose to validate a 7-item SU severity measure developed by the NIH Roadmap initiative Patient Reported Outcome Measurement Information System (PROMIS) for use in measurement-based care of SUD. These agendas emphasize population-based studies, including pragmatic randomized controlled trials, comparative effectiveness studies, and implementation research, and leverage EHRs. Public Health and Clinical Practice Impact. Over 14.9 million patients with untreated SUD have health care visits annually in the US. If 10% of these patients were identified, engaged and successfully treated, it would translate to 1.5 million patients with resolved SUD each year who otherwise would have gone untreated. The Health Systems Node faculty and infrastructure, in collaboration with the CTN, are uniquely positioned to conduct and disseminate research that advances the integration of SUD treatment into routine medical care, and ultimately to improve patient outcomes and public health.