Emergency department community health worker-peer recovery navigation for linkage to recovery: A mixed methods evaluation

项目摘要 急诊室（艾德）处于药物过量流行病的前线，治疗的人数不断增加 物质使用障碍（Substance Use Disorders，SUD）在物质使用相关艾德访视后的一年中，死亡风险 是其他患者的六倍，对于阿片类药物过量后接受治疗的人， 病人会死。每次物质使用相关的艾德访视都是将患者与 然而，在提供服务方面存在重大差距，不到三分之一的人接受了恢复服务， 行为咨询，只有五分之一的人与成瘾治疗有关。改善与复苏的联系， 从艾德戒瘾服务开始，我们推出了多学科、艾德社区健康工作者同行 恢复专家计划（PCHW），物质滥用援助反应小组（SMART），在一个大的， 学术性的城市医疗中心，照顾罗得岛的大多数SUD患者。绘图 从现有的同伴康复专家，CHW和健康促进倡导计划的模型来看，SMART是一个 一种新的基于ED的计划，为人们提供与物质使用相关的艾德访问个性化支持， 短期病例管理、社会服务导航、减少伤害、康复和成瘾治疗 SMART将自己与其他艾德患者导航和/或 通过在艾德内外工作，专注于社会决定因素， 复苏近年来，艾德同伴康复计划越来越多，但人们对它知之甚少。 他们的有效性。我们将对既定的艾德PCHW计划进行务实的混合方法研究， 评估项目交付、与循证康复服务的联系以及短期和长期患者 结果。本研究的目的是：1）了解参与者使用SMART PCHW的经验， 确定成功恢复联系的可能机制; 2）评估SMART对患者的有效性- 以结果为中心，建立恢复资本和恢复联系; 3）评估SMART实施情况， 随着时间的推移对患者结局的影响。参与者访谈将检查参与者的经验， SMART、恢复服务参与，并确定潜在有效的参与策略。重新瞄准 框架将用于评估项目实施（过程结果）和有效性（患者 成果）。调查和数据链接到医院和国家行政数据库将被用来衡量 恢复资本、社交网络、接受社会服务、与减少危害的联系、恢复、 和成瘾治疗服务，以及接受治疗的人中急性护理利用率和死亡率的变化 聪明本研究的结果将提供有关艾德同伴康复专家计划过程的可靠数据 和患者水平的结果需要一个后续的多层次，全面的研究，以确定和测试 艾德同伴康复计划组成部分有效性和实施策略 增强、传播和可持续性。

Project Summary The emergency department (ED) is on the front lines of the overdose epidemic, treating an increasing number of people with substance use disorders (SUD). In the year after a substance use-related ED visit, risk of death is six time higher than other patients, and for people treated after an opioid overdose, more than one in twenty patients will die. Each substance use-related ED visit represents a crucial opportunity to link patients to recovery services, however there are significant gaps in service provision with less than one in three receiving behavioral counseling and only one in five linked to addiction treatment. To improve linkage to recovery and addiction treatment services from the ED, we launched a multidisciplinary, ED community health worker-peer recovery specialist program (PCHW), the Substance Misuse Assistance Response Team (SMART), at a large, academic, urban medical center which cares for the majority of patients with SUDs in Rhode Island. Drawing from models of existing peer recovery specialist, CHW, and health promotion advocate programs, SMART is a novel ED-based program that provides people with a substance-use related ED visit individualized support, short term case management, navigation to social services, harm reduction, recovery, and addiction treatment services in and out of the ED. SMART distinguishes itself from other models of ED patient navigation and/or peer recovery specialist programs by working in and out of the ED and focusing on social determinants of recovery. In recent years there has been a proliferation of ED peer recovery programs, but little is known about their effectiveness. We will conduct a pragmatic, mixed methods study of an established ED PCHW program to evaluate program delivery, linkage to evidence-based recovery services, and short- and long-term patient outcomes. Aims of this study are to 1) understand participant experiences working with a SMART PCHW and identify possible mechanisms for successful recovery linkage; 2) Evaluate SMART effectiveness on patient- centered outcomes, building recovery capital, and recovery linkage; 3) Evaluate SMART implementation and effectiveness on patient outcomes over time. Participant interviews will examine participant experiences with SMART, recovery services engagement, and identify potentially effective engagement strategies. A RE-AIM framework will be used to evaluate program implementation (process outcomes) and effectiveness (patient outcomes). Surveys and data linkage to hospital and state administrative databases will be used to measure changes in recovery capital, social networks, receipt of social services, linkage to harm reduction, recovery, and addiction treatment services, and changes in acute care utilization and mortality among people receiving SMART. Results from this study will provide robust data about ED peer recovery specialist program process and patient-level outcomes needed for a subsequent multilevel, comprehensive study to identify and test effectiveness of ED peer recovery program components and implementation strategies for program enhancement, dissemination, and sustainability.