Identifying High Utilizing Patients with Opioid Use Disorder to Engage in Primary Care

项目摘要/摘要 Brian Chan医学硕士，内科医生和健康服务研究员，热衷于改善健康 阿片类药物使用障碍(OUD)患者的预后。这个职业发展奖将设立 作为临床医生兼研究员，陈医生专注于实施和传播新的初级保健 在安全网环境中针对OUD高危患者的干预措施。K23奖项提供了指导 培训以发展3个领域的专门知识：1)开展混合方法研究，以制定以部署为重点的研究 干预措施；2)临床试验设计和实施科学；3)成瘾药物治疗 联邦合格的医疗中心(FQHC)设置。为了实现这些目标，陈冯富珍博士组建了一个 多学科指导团队，具有卫生服务研究、成瘾药物、干预方面的专业知识 设计和实施科学，以及FQHC卫生系统，成功地指导教职员工进行研究 独立。 2018年，210万人患有与海洛因或处方疼痛有关的阿片类药物使用障碍(OUD) 救援队员。虽然OUD的认可度越来越高，但很少有患者接受循证治疗。这是 对于在安全网环境中患有OUD的医学复杂患者尤其如此。OUD使管理复杂化 与其他慢性疾病有关，并与医疗保健资源的高利用率有关。健康状况 系统感兴趣的是对复杂患者进行风险分层，以改善干预措施的针对性，如门诊 重症监护病房(A-ICU)；这些可以适用于复杂的OUD患者，但可伸缩性有限 传播。根据他作为内科医生的临床经验和他K12奖的数据评估A- 对于FQHC中医学上复杂的高利用率患者，陈医生将完成以下3个目标：1)适应 利用社区利益相关者解决高复杂性OUD患者的现有A-ICU干预 采用的方法；2)通过迭代实施案例研究细化干预措施，并确定 可接受性、可行性和实施战略的衡量标准；3)评估和试行 评估精细化干预措施的可行性、可接受性和初步效果的干预措施 改善临床结果，并在FQHC使用实施和混合-OUD治疗 方法：研究方法。研究结果为今后R01方案的实效性试验提供了初步数据 在多个FQHC站点进行干预。这项提议直接符合国家研究所关于 药物滥用“药物使用障碍的复杂性”战略规划工作组及其优先事项 “制定和测试有效和可持续地实施循证治疗的战略。” 这些研究的完成将为实施可扩展的初级保健干预措施铺平道路，以缩小 扩大治疗差距，改善对高危人群的护理。

PROJECT SUMMARY/ABSTRACT Brian Chan MD MPH is an internist and health services researcher passionate about improving health outcomes for vulnerable patients with opioid use disorder (OUD). This career development award will establish Dr. Chan as a clinician-investigator focused on implementing and disseminating novel primary care interventions that target high-risk patients with OUD in safety-net settings. The K23 award provides mentored training to develop expertise in 3 areas: 1) conduct of mixed-methods research to develop deployment-focused interventions; 2) clinical trial design and implementation science; and 3) addiction medicine treatment in federally qualified health center (FQHC) settings. To achieve these goals, Dr. Chan has assembled a multidisciplinary mentoring team with expertise in health services research, addiction medicine, intervention design and implementation science, and FQHC health systems, with success in mentoring faculty to research independence. In 2018, 2.1 million people had an opioid use disorder (OUD) related to heroin or prescription pain relievers. While the recognition of OUD is increasing, few patients receive evidence-based treatment. This is particularly true for medically complex patients with OUD in safety-net settings. OUD complicates management of other chronic medical conditions and is associated with high utilization of healthcare resources. Health systems are interested in risk stratifying complex patients to improve targeting of interventions, like ambulatory intensive care teams (A-ICU); these could be adapted for complex patients with OUD, but scalability limit dissemination. Informed by his clinical experience as an internist and data from his K12 award evaluating an A- ICU for medically complex high-utilizers in an FQHC, Dr. Chan will complete the following 3 aims: 1) Adapt an existing A-ICU intervention to address high complexity patients with OUD using community stakeholder engaged methods; 2) Refine the intervention through an iterative implementation case study, and identify measures of acceptability, feasibility, and implementation strategy; 3) Evaluate and pilot a randomized trial of the intervention to assess feasibility, acceptability, and preliminary efficacy of the refined intervention to improve clinical outcomes, and retention in OUD treatment at a FQHC using implementation and mixed- methods. The results provide preliminary data for a future R01 proposal pragmatic efficacy trial of the refined intervention at multiple FQHC sites. This proposal directly aligns with the priorities of the National Institute on Drug Abuse’s strategic planning workgroup on the “complexity of substance use disorders” and its priority to “develop and test strategies for effectively and sustainably implementing evidence-based treatments.” Completion of these studies will pave the way for implementing scalable primary care interventions to narrow OUD treatment gaps and improve care for high-risk populations.