Treating Addiction as a Chronic Illness

描述（由申请人提供）：挑战区域：5。比较有效性研究挑战主题：行为和药物干预治疗非专科护理环境中的药物滥用障碍（05-DA-101）物质使用障碍（SUD）是美国最普遍和最昂贵的健康状况之一。专家们一致认为，目前对SUD的护理质量是平庸的，必须在护理系统中发生深刻的变化，以便将突破性的科学转化为对数百万患有SUD的美国人来说，这是一个有意义的改善。由于缺乏关于医疗保健系统变化的良好科学，复杂的多层次（例如，监管、临床交付、融资）的障碍，以及比较有效性研究的局限性，以提供信息性知识来指导政策。该提案将利用州长帕特森领导的纽约州（NYS）发生的一系列独特的政策事件，这些事件旨在改变整个SUD护理系统，特别关注SUD刑事犯罪者。我们相信，可以利用这些事件创造的势头，启动以科学为基础的系统级SUD护理系统转型，并在此过程中创建一个国家级干预措施的国家模式。具体来说，我们计划与艾德瓦格纳和同事们合作，以纽约州为实验室，将他们的州一级CCM干预措施扩展到SUD。我们得到了州长办公室和相关州机构专员的大力支持，以合作开展这项业务。该提案有两个具体目标：1）建立一个州一级的模型，在多个机构（例如，药物滥用和刑事司法）和系统组成部分（例如，融资，监管，服务提供）和2）进行所有必要的发展工作，设计一个严格的比较有效性研究（CER）试验，以测试一个长期护理模式的SUD罪犯。在资助期间，我们将召集一个由科学家和政府领导人组成的多专业小组。如申请中所述，该小组将监督活动，并在两年内完成一套明确定义的与研究目标相关的产品。物质使用障碍（SUD）是美国最普遍和最昂贵的健康状况之一。专家们一致认为，SUD的护理质量一般。该提案将利用纽约州发生的一系列独特的政策事件，启动基于科学的系统级SUD护理系统转型，并在此过程中创建一个国家级干预模式，以提高护理质量并降低与SUD相关的成本。

DESCRIPTION (provided by applicant): Challenge Area: 5. Comparative Effectiveness Research Challenge Topic: Behavioral and Medication Interventions To Treat Drug Abuse Disorders in Non-Specialty Care Settings (05-DA-101) Substance Use Disorders (SUD) are among the most prevalent and costly health conditions in the U.S. Experts agree that the current quality of care for SUD is mediocre and that profound changes must occur in systems of care in order to translate groundbreaking science into meaningful improvement for the millions of Americans suffering with SUD. Progress on solving systemic problems in SUD care has been impeded by a lack of good science regarding system change in healthcare, the complex multi-level (e.g., regulatory, clinical delivery, financing) obstacles to SUD system change, and limitations in comparative effectiveness research to provide informative knowledge to guide policy. This proposal will capitalize on a unique set of policy events occurring in New York State (NYS) led by Governor Paterson that seeks to transform the entire SUD care system, with a special focus on criminal offenders with SUD. We believe the momentum created by these events can be harnessed to jumpstart a science-based, systems-level transform of the SUD care system and in the process create a national model for state-level interventions. Specifically, we plan to work with Ed Wagner and colleagues to extend their state-level CCM interventions to SUD using NYS as a laboratory. We have strong support from the Governor's Office and the relevant state agency Commissioners to partner in this venture. The proposal has two specific aims: 1) to develop a state-level model to treat addiction as a chronic illness across multiple agencies (e.g., substance abuse and criminal justice) and system components (e.g., financing, regulation, service delivery) and 2) to conduct all developmental work necessary to design a rigorous comparative effectiveness research (CER) trial to test a chronic care model for SUD offenders. During the grant period, we will convene a multi-specialty group comprised of scientists and government leaders. As described in the application, this group will oversee activities and complete a clearly defined set of products related to study aims within a two year time period. Substance Use Disorders (SUD) are among the most prevalent and costly health conditions in the U.S. Experts agree that the quality of care for SUD is mediocre. This proposal will capitalize on a unique set of policy events occurring in New York State to jump start a science-based, systems-level transform of the SUD care system and in the process create a national model for state-level interventions to improve the quality of care and reduce costs associated with SUD.