Beyond Treatment Initiation: Enhancing Opioid Use Disorder Care Transitions Across Health System Touchpoints

7.项目摘要/摘要 阿片类药物的流行继续肆虐，在美国各地造成了巨大的发病率和死亡率损失，尽管 努力扩大阿片使用障碍(MOUD)救命药物的可获得性，这是一个重大差距 这些治疗的主要途径和连续性。考虑到遇到急诊护理的频率很高 阿片类药物使用障碍(OUD)患者、急诊科和医院的设置正在增加- 被戏剧性地视为促进Moud治疗开始的“触点”。越来越多的证据表明， 在医院发起Moud并将人们与社区治疗联系起来，导致了这种情况的快速增长 以医院为基础的干预。然而，人们对用来过渡的策略的性质或成功与否知之甚少。 将患者从医院环境转移到以社区为基础的穆德治疗。了解哪些过渡策略 在提高Moud治疗参与度方面最有效住院后治疗是支持的关键 患者通过“OUD级联护理”降低过量用药风险和改善健康。 K01奖的目标是解决这些差距，同时推动候选人的职业目标成为- 在干预和实施研究的界面上工作的独立调查员，EPIDE- 促进有关战略的知识，以改善获得、吸收和可持续发展疫苗的机会。 以Dence为基础的阿片类药物和其他物质使用障碍的服务。通过课程学习，科学讨论- 体验学习，以及成瘾、健康服务研究和专家的密切指导 纽约大学格罗斯曼医学院及其合作机构的定性和定量方法。 Krawczyk将发展提供成瘾服务和急性护理干预的能力；混合 收集和分析有关保健实践及其实施的数据的方法 来自不同数据集的医疗保健数据水平；以及拨款撰写和研究伙伴关系的专业技能。 拟议的研究将采用定量和定性的方法来研究 用于将OUD患者从医院连接到社区中持续的Moud参与的过渡战略 使用了纽约市11家公立医院的案例研究。研究的目标是：(1)发展一种分类法，并取代- 通过文献回顾和专家意见对医院护理转型战略进行量化调查 Delphi小组；(2)就主要障碍与提供者和患者利益相关者进行深入访谈 和促进者进行有效的过渡，以及(3)探索患者特征之间的多层次关联， 医院过渡战略，以及出院后穆德参与的结果。这项工作符合 NIDA的目标是进行研究，解决现实世界的复杂性，探索可持续实施 药物使用治疗的循证做法，并研究#年治疗服务的整合 多样化的医疗保健环境。通过提供工资支持、培训和正式的指导结构，这 该奖项将促进Krawczyk博士在成瘾健康服务研究领域向独立职业生涯的过渡。

7. PROJECT SUMMARY/ABSTRACT The opioid epidemic continues to rage, taking a vast toll on morbidity and mortality across the U.S. Despite efforts to expand availability of life-saving medications for opioid use disorder (MOUD), a significant gap re- mains in access to and continuity in these treatments. Given the high frequency of encounters with acute-care settings among patients with opioid use disorder (OUD), emergency departments and hospitals are increas- ingly seen as ‘touchpoints’ to promote initiation of MOUD treatment. Growing evidence around the efficacy of initiating MOUD in the hospital and linking people to community treatment has led to a rapid growth of such hospital-based interventions. However, little is known about the nature or success of strategies used to transi- tion patients from hospital settings to community-based MOUD treatment. Knowing which transition strategies are most effective in improving engagement in MOUD treatment post-hospitalization is critical to supporting patients through the ‘OUD Cascade of Care’ towards reduced overdose risk and improved health. The goal of this K01 Award is to address these gaps while advancing the candidate’s career goal of becom- ing an independent investigator who works at the interface of intervention and implementation research, epide- miology, and policy to advance knowledge on strategies to improve access to, uptake and sustainability of evi- dence-based services for opioid and other substance use disorders. Through coursework, scientific confer- ences, experiential learning, and close mentorship from experts in addiction, health services research and qualitative and quantitative methods at the NYU Grossman School of Medicine and partner institutions, Dr. Krawczyk will develop competency in the delivery of addiction services and acute care interventions; mixed methods for collecting and analyzing data on healthcare practices and their implementation; analysis of multi- level healthcare data from diverse datasets; and professional skills for grant writing and research partnerships. The proposed research will employ quantitative and qualitative methods to study the nature and role of transition strategies used to link OUD patients from hospitals to ongoing MOUD engagement in the community using a case study of 11 public hospitals in NYC. Research aims are to (1) Develop a taxonomy and subse- quent survey of hospital OUD care transition strategies via review of the literature and input from an expert Delphi panel; (2) Conduct in-depth interviews with provider and patient stakeholders regarding primary barriers and facilitators to effective transitions, and; (3) Explore multi-level associations between patient characteristics, hospital transition strategies, and post-discharge MOUD engagement outcomes. This work is in line with NIDA’s goals to conduct research that addresses real-world complexities, explores sustainable implementation of evidence-based practices for substance use treatment, and studies the integration of treatment services in diverse health care settings. By providing salary support, training, and a formal mentorship structure, this award will facilitate Dr. Krawczyk’s transition to an independent career in addiction health services research.