Reward-based technology to improve opioid use disorder treatment initiation after an ED visit

项目摘要/摘要 美国每年有数百万人滥用阿片类药物，导致数千人死亡，数十亿美元 总的经济负担。治疗阿片使用障碍(Moud)的药物非常有效，但只有一小部分 使用阿片类药物的人使用障碍(OUD)Access Moud，进一步治疗不坚持是常见的，而且是 与糟糕的结果相关。这项申请将扩大我们的父母R42阿片成瘾的范围 采用应急管理的恢复支持(OARS+CM)研究评估了OARS+CM的影响 通过扩大招生地点将更多的ED纳入Moud治疗启动和依从性的技术 以及住院精神病和戒毒机构，以达到充分分析数据所需的样本量。 由于目前招生地点的招生数量低于预期，扩大招生规模是必要的。在父母的资助中， 该项目加强了阿片成瘾恢复支持(OARS)的应用，增加了基于证据的 奖励、应急管理(CM)功能。CM干预系统地奖励(加强)特定的 行为，如开始治疗和坚持治疗，出席治疗和无药物尿检， 非常有效。使用CM组件(OARS+CM)增强的OARS解决方案，允许自动 基于治疗行为的客观证据的奖励的计算、交付和兑换可以 成为提高Moud启蒙和坚持的关键。在父拨款的第一阶段之后，现有的桨 对临床医生门户和患者移动应用程序进行了修改，以适应从 急性护理设置，并使用患者-自动管理和提供奖励来创建OARS+CM- 以设计原则为中心。与OUD患者和其他关键利益相关者举行的可用性会议提供了知情设计。 检查了主要的可用性结果，并迭代更新了程序。在达到里程碑之后， 对10名患者进行了可用性、可接受性和对初始行为目标的影响的概念验证试点。 目前处于第二阶段，RCT正在进行中，在该阶段中，急诊患者适合门诊Moud (n=102)被招募并分配到两种研究条件之一：1)照常治疗(TAU)，包括 筛查、简短干预和由受过训练的临床医生转介到MyMAT治疗，这是一种注意力控制 移动应用，以及2)桨+CM。两个干预组的主动干预窗口为12 几周。参与者在从急性护理环境(即急诊室，住院医疗护理， 急性精神病和戒毒机构)。在门诊Moud设置中，关于治疗依从性和阿片类药物的数据 使用情况将从临床记录中记录六个月。电话随访评估和生命统计 注册审查将在1个月、3个月(研究结束干预期)和6个月进行。 治疗开始的结果将是计划和完成Moud的摄入。一次霉菌治疗 结果将是在第6个月持续禁欲，并持续最长时间的禁欲。分析将检查数据 关于通过减少研究条件之间的急性护理就诊来避免和节省成本。

Project Summary/Abstract Millions of people in the US misuse opioids each year, leading to thousands of deaths and billions of dollars in total economic burden. Medications for opioid use disorder (MOUD) are highly efficacious, but only a fraction of people with Opioid Use Disorder (OUD) access MOUD, and further treatment non-adherence is common and is associated with poor outcomes. This application will extend the scope of our parent R42 Opioid Addiction Recovery Support with Contingency Management (OARS+CM) study assessing the impact of OARS+CM technology on MOUD treatment initiation and adherence by expanding enrollment sites to include additional EDs and inpatient psychiatric and detox facilities to reach the sample size needed to adequately analyze the data. Expansion is necessary as volume at the current enrollment sites are lower than predicted. In the parent grant, the project enhanced the Opioid Addiction Recovery Support (OARS) application by adding an evidence-based reward, contingency management (CM) function. CM interventions systematically reward (reinforce) specific behaviors like treatment initiation and adherence with therapy attendance and drug-free urine tests and are highly efficacious. An OARS solution enhanced with a CM component (OARS+CM) that allows for the automatic calculation, delivery, and redemption of rewards contingent on objective evidence of treatment behaviors may be key to improving MOUD initiation and adherence. After Phase 1 of the parent grant, the existing OARS clinician portal and patient mobile application was modified to accommodate entry into the software system from an acute care setting and to automatically manage and deliver rewards to create OARS+CM using patient- centered design principles. Usability sessions with OUD patients and other key stakeholders informed design. Primary usability outcomes were examined, and the program iteratively updated. Upon meeting milestones, there was proof-of-concept pilot of usability, acceptability, and effects on initial behavior targets with 10 patients. Currently in Phase 2, an RCT is in progress, in which acute care OUD patients appropriate for outpatient MOUD (N = 102) are recruited and allocated to one of two study conditions: 1) treatment as usual (TAU), comprised of screening, brief intervention, and referral to treatment by a trained clinician with MyMAT, an attentional control mobile application, and 2) OARS+CM. The active intervention window for the two intervention groups is 12 weeks. Participants are onboarded prior to discharge from acute care settings (i.e., ED, inpatient medical care, acute psychiatric and detox facilities). In the outpatient MOUD setting, data on treatment adherence and opioid use will be captured from clinical records for six months. Telephone follow-up assessments and vital statics registry reviews will be at month 1, month 3 (end-of-study intervention period), and month 6. Primary MOUD treatment initiation outcomes will be scheduling and completing the MOUD intake. Primary MOUD treatment outcomes will be sustained abstinence at Month 6 and longest duration of abstinence. Analysis will examine data on cost avoidance and cost savings through reduced acute care visits between study conditions.