METHODOLOGY FOR DEVELOPING ADAPTIVE INTERVENTIONS

该项目的长期目标是，通过促进以证据为基础构建有效、适应性强的预防性干预措施和药物滥用治疗方法，改善临床实践，从而改善公共健康。临床医生自然会根据患者的结果，如严重程度，对过去治疗的反应，风险，压力源，依从性，偏好和负担，调整治疗的水平和类型。该项目将开发用于通知和增强这种适应性临床实践的方法。适应性干预由可操作的决策规则组成，这些规则输入患者结局并输出建议的治疗强度和/或类型的改变。制定适应性干预措施需要解决以下问题， “我们如何最好地使用风险和其他结果的措施，以决定何时需要加强或减少患者的治疗？".“什么样的治疗顺序是最好的，以实现最大的改善或防止药物依赖？和“这种治疗顺序是否应该因患者的结果而异？“该项目通过开发以下方法创新，促进了适应性干预措施的构建。首先，将开发实用的实验设计，这些设计将产生在构建基于证据的适应性干预措施方面最有用的数据。其次，本项目将改进和评价可用于受试者数据的分析方法，其中治疗变化和治疗改变的时间是随机的。这些方法可用于构建包含自适应干预的决策规则。第三，该项目将提供方法， 与受试者数据一起使用，其中根据决策规则进行治疗变化和治疗改变的时间。该第三组方法可以用于评估包括所实施的自适应干预的决策规则的效用。为了确保适用性和获得反馈，这项工作将包括与对构建适应性干预措施感兴趣的卫生科学家进行合作研究。目标是加快预防方案和治疗的改进。由于药物滥用和依赖对社会来说代价高昂，更广泛的公众受益于旨在减少药物滥用的改进预防方案和改善对药物依赖者的治疗。

The long-term goal of this project is to improve clinical practice and thus public health by facilitating the evidence-based construction of efficacious, adaptive preventive interventions and treatments in drug abuse. Clinicians naturally adapt the level and type of therapy according to patient outcomes such as severity, response to past therapy, risk, stressors, adherence, preference and burden. This project will develop methods for informing and enhancing this adaptive clinical practice. Adaptive interventions are composed of operationalized decision rules that input patient outcomes and output recommended alterations in intensity and/or type of therapy. The construction of adaptive interventions requires addressing questions such as, "How do we best use measures of risk and other outcomes in order to decide when a patient's therapy needs to be intensified or stepped down?". "What sequence of therapies is best for achieving maximal improvement or preventing drug dependence?" and "Should this sequence of therapies vary by patient outcomes?" This project facilitates the construction of adaptive interventions by developing the following methodological innovations. First, practical experimental designs that will yield data most useful in constructing evidence-based adaptive interventions will be developed. Second, this project will improve and evaluate analysis methods that can be used with subject data in which either or both the timing of therapeutic changes and therapy alterations are randomized. These methods can be used to construct the decision rules that comprise an adaptive intervention. Third, this project will provide methods that can be used with subject data in which the timing of therapeutic changes and therapy alterations were made according to decision rules. This third group of methods can be used to assess the utility of the decision rules comprising an implemented adaptive intervention. To ensure applicability and receive feedback this work will include collaborative research with health scientists interested in constructing adaptive interventions. The goal is to accelerate the improvement of both prevention programs and treatments. Because drug abuse and dependence are costly to society, the broader public benefits from improved prevention programs aimed at reducing drug abuse and from improved treatment for drug dependent individuals.