Stagewise Implementation-To-Target- Medications for Addiction Treatment (SITT-MAT)

项目总结/摘要 为了打击美国阿片类药物的流行，人们一直在努力扩大药物的可及性。 阿片类药物使用障碍（MOUD）虽然有迹象表明覆盖率和采用率有所提高，但具有讽刺意味的是， 只有大约三分之一的专业成瘾治疗机构提供MOUD。这项提议， 分阶段实施目标药物成瘾治疗（SITT-MAT），不仅 推进了实施科学，但推进了我们对如何最好地应对 一种与毒品有关的流行病这是响应PAR-19-274：传播和 实施健康研究”，并与国家药物滥用研究所战略计划保持一致 “确保科学研究成果的有效转化和实施， 和治疗药物使用障碍。”在适应性实施战略试验设计中，使用 创新的分阶段实施目标的方法，72个社区成瘾治疗方案将 参加逐步实现目标，逐步“照顾”型的方法，部署越来越多， 只有在必要时才采取强化战略。实施战略的顺序是：1）加强监测 2）“NIATx/MAT学院”，为期两天的MOUD和NIATx（改进网络）研讨会 成瘾治疗）-循证过程改进策略; 3）随机分配至NIATx 内部促进或NIATx外部促进;以及，4）如果在NIATx中未实现结果目标 内部促进组，分配至NIATx外部促进组。我们评估了5的相对影响 RE-AIM目标成果实施战略的可能途径：覆盖面、有效性、采用率和 执行质量。对成果的维持进行评价，以确定是否可持续。多层次措施 背景决定因素是严格和系统的。在打开执行战略的“黑匣子”时， 我们使用标准化的措施详细说明程序、忠诚度、参与和成本。的集体智慧 研究小组与国家护理和成瘾治疗系统建立了伙伴关系， 组织，预测成功的项目执行。在我们提交这份申请时，美国仍在应对 COVID 19大流行。全球卫生状况可能在2015年至2016年的几个月内恢复到相对正常水平。 2020年12月与此同时，疾病预防控制中心，SAMHSA，CMS和华盛顿卫生保健管理局 所有人都做出了调整，继续为接受治疗的患者启动和管理MOUD 戒毒治疗服务。因此，即使目前的检疫限制持续下去，我们预计， 对研究方案的重大修改，除亲自实施支持活动外， 转换为视频会议格式。在这场大流行期间，对于阿片类药物患者来说， 使用障碍来获得需要与提供者进行最少身体接触的药物干预。 这项研究有可能改变公共卫生和实施研究的范式。

PROJECT SUMMARY/ABSTRACT To combat the US opioid epidemic, massive efforts have been focused on expanding access to medications for opioid use disorder (MOUD). While there are indications of improved reach and adoption, an ironic gap persists—only about one-third of specialty addiction treatment organizations offer MOUD. This proposal, Stagewise Implementation-To-Target – Medications for Addiction Treatment (SITT-MAT), not only advances the science of implementation, but advances our empirical understanding of how to best respond to a substance-related epidemic. This is a revised application in response to PAR-19-274: Dissemination and Implementation Research in Health” and aligned with the National Institute on Drug Abuse Strategic Plan “ensuring the effective translation and implementation of scientific research findings to improve the prevention and treatment of substance use disorders.” Within an adaptive implementation strategy trial design, using an innovative stagewise implementation-to-target approach, 72 community addiction treatment programs will participate. The stagewise implementation-to-target, stepped “care” type approach, deploys increasingly intensive strategies only if needed. The sequence of implementation strategies are: 1) Enhanced Monitoring and Feedback; 2) “NIATx/MAT Academy,” a 2-day workshop on MOUD and NIATx (Network for Improvement of Addiction Treatment)—an evidence-based process improvement strategy; 3) Randomization to either NIATx Internal Facilitation or NIATx External Facilitation; and, 4) If outcome targets are not achieved in the NIATx Internal Facilitation arm, assignment to NIATx External Facilitation. We evaluate the relative impact of 5 possible paths of implementation strategies on RE-AIM target outcomes: reach, effectiveness, adoption, and implementation quality. Maintenance of outcomes is evaluated for sustainment. Measures of multi-level contextual determinants are rigorous and systematic. In opening the “black box” of implementation strategies, we detail procedures, fidelity, participation and costs using standardized measures. The collective expertise of the research team, the established partnership with a state system of care and addiction treatment organizations, forecasts successful project execution. As we submit this application, the US is still coping with the COVID19 pandemic. The global health situation may rebound to relative normalcy in the months from December 2020. Meanwhile, the CDC, SAMHSA, CMS, and the State of Washington Health Care Authority have all made accommodations to continue the initiation and management of MOUD for patients receiving addiction treatment services. Therefore, even if the current quarantine restrictions persist, we do not anticipate major modifications to the study protocol, except in-person implementation support activities would be transitioned to videoconference formats. During this pandemic, it is even more critical for patients with opioid use disorders to access pharmacological interventions that require minimal physical contact with providers. This study has the potential to shift the paradigm in public health and implementation research.