HEALing Measurement Center: Enhancing Opioid Use Disorder Recovery through Measurement Based Care

摘要 阿片类药物使用障碍(OUD)在宾夕法尼亚州仍然是一个严重的公共卫生危机。宾夕法尼亚州中心 卓越公司负责提供阿片类药物治疗，包括治疗阿片类药物使用障碍 (Moud)，以改善治疗机会，促进康复，并减少致命过量的影响 州政府。尽管努力改善获得OUD循证治疗的机会，如药物和 综合行为健康服务，国家行为健康服务和阿片类药物涉及的过量死亡率仍然存在 高得惊人。目前主要针对减少OUD症状的Moud干预措施具有显著的 辍学率(20%-50%)，并导致约36%的OUD个人得到缓解。患有辅助性疾病的患者 正在发生的药物使用和精神健康障碍导致不良结果的风险更大，通常是因为它们 有更复杂的治疗需求，很难实时识别、跟踪和响应。潜在地 改善OUD干预结果，这是加州大学康复措施中心的首要目标 匹兹堡将加强社区阿片类药物治疗中提供的护理的测量、质量和公平性 通过持续实施以测量为基础的护理(MBC)计划(OTP)。具体地说， 三个拟议的项目旨在解决我们的合作伙伴所表达的直接关切 同时填补关键的研究空白。研究计划1将开发MBC 实施蓝图，包括技术援助、学习网络和减少文书工作 战略。研究计划2将展示实施增强型MBC的保真度和有效性 通过阶梯式楔形混合II实施(MBC+)与正常测量(MAU) 有效性--执行试验。研究计划3将展示MBC+的临床疗效 与MAU相比，对于同时有精神疾病和精神疾病诊断的患者。拟议的研究将 提供关键的初步证据，说明在OUD中利用MBC的作用和意义 干预，通过以下方式加强实施可持续、公平和有效的MBC干预 与利益相关者(政策制定者、付款人和OTP)共同设计的实施战略，以及 潜在地加强与症状相关的结果和治疗保留的替代途径 具有下游社会、心理和公共健康效益的干预措施。

Abstract Opioid use disorder (OUD) remains a critical public health crisis in Pennsylvania. The Pennsylvania Centers of Excellence have been charged with providing opioid treatment, including medication for opioid use disorder (MOUD), to enhance treatment access, promote recovery, and reduce the impact of fatal overdose throughout the state. Despite efforts to improve access to evidence-based treatments for OUD such as medications and integrated behavioral health services, national OUD and opioid involved overdose death rates remain alarmingly high. Current MOUD interventions primarily targeting reduction in OUD symptoms have significant dropout rates (20-50%) and result in remission of OUD for ~36 percent of individuals. The patients with co- occurring substance use and mental health disorders are at greater risk for poor outcomes, often because they have more complex treatment needs that are hard to identify, track, and respond to in real time. To potentially improve OUD intervention outcomes, the overarching goal of the HEALing Measures Center at University of Pittsburgh is to enhance the measurement, quality, and equity of care delivered in community opioid treatment programs (OTPs) through sustained implementation of measurement-based care (MBC). Specifically, the three proposed projects were designed to address the immediate concerns expressed by our partners while simultaneously meeting critical research gaps. Research Plan 1 will develop an MBC Implementation Blueprint including technical assistance, learning networks, and paperwork reduction strategies. Research Plan 2 will demonstrate the fidelity and effectiveness of implementing enhanced MBC implementation (MBC+) versus measurement as usual (MAU) via a stepped-wedge, hybrid type II effectiveness-implementation trial. Research Plan 3 will demonstrate the clinical effectiveness of MBC+ relative to MAU for patients with co-occurring OUD and mental health diagnoses. The proposed study will provide critical preliminary evidence regarding the role and significance of capitalizing on MBC in OUD interventions, enhanced implementation of a sustainable, equitable, and effective MBC intervention via implementation strategies that are co-designed with stakeholders (policymaker, payer, and OTP), and alternative avenues to potentially enhance symptom-related outcomes and treatment retention of OUD interventions with downstream societal, psychological, and public health benefits.