The Ohio Valley Node of the Clinical Trials Network

公共卫生摘要 阿片类药物使用障碍(Moud)，如美沙酮、丁丙诺啡(与或 不含纳洛酮)和缓释纳曲酮已被证明可以减少过量用药 和吸毒。然而，保持Moud对于实现这些结果是必不可少的。 不幸的是，只有50%或更少的患者在开始治疗6个月后仍在接受Moud治疗， 国家质量论坛制定的最低标准。一种可能的方法是 提高保留率将是利用患者的特征来选择Moud 患者最有可能成功。这项研究将利用VHA数据集来识别患者 按Moud类型和患者改善MUD保持的相关特征 与成功停用Moud而不复发相关的特征。我们将使用 采用国际疾病分类第9版和第10版的回溯性队列设计 (ICD-9/10-CM)自本研究使用的年份数据交叉以来实施OUD的代码 在ICD-10实施期间(2015年)。目标1是确定患者的特征 按Moud类型与Moud滞留和阿片类药物过量死亡相关。我们的初选 目标1的结果将是保留率的二元衡量标准，其定义为连续覆盖 患者最初在索引日期后180天内开始的Moud类型，没有28- 治疗中的一天间隔。次要结果衡量标准将包括(1)以下两种衡量标准 保留与主要结果相似，但在索引日期和(2)之后的365天内 使用VHA死亡率数据在指数日期后365天内阿片类药物过量死亡 存储库。目标2是量化MMUD后复发概率之间的联系 停药时间长短和患者的特点。的结果是 目标2将是停药与不复发。

PUBLIC HEALTH ABSTRACT Medications for Opioid Use Disorder (MOUD), such as methadone, buprenorphine (with or without naloxone), and extended-release naltrexone, have been shown to reduce overdoses and drug use. However, MOUD retention is essential to attaining these outcomes. Unfortunately, only 50% or less of patients remain on MOUD 6 months after initiating treatment, a minimum standard established by the National Quality Forum. One possible approach to improving retention would be using patient characteristics to select the MOUD with which patients are most likely to be successful. This study will utilize VHA data sets to identify patient characteristics associated with improved MOUD retention by MOUD type as well as patient characteristics associated with successful MOUD discontinuation without relapse. We will use a retrospective cohort design using the International Classification of Disease, 9th and 10th edition (ICD-9/10-CM) codes to operationalize OUD since the years of data used for this study cross over the time of ICD-10 implementation (2015). Aim 1 is to identify patient characteristics associated with MOUD retention and opioid overdose death by MOUD type. Our primary outcome for Aim 1 will be a binary measure of retention defined as continuous coverage with the type of MOUD the patient originally initiated for 180 days after the index date without a 28- day gap in treatment. Secondary outcome measures will include (1) a binary measure of retention similar to the primary outcome but over the 365 days after the index date and (2) opioid overdose death in the 365 days after the index date using the VHA Mortality Data Repository. Aim 2 is to quantify the association between probability of relapse after MOUD discontinuation and both length of MOUD therapy and patient characteristics. The outcome for Aim 2 will be discontinuation with vs. without relapse.