Integrated Collaborative Care for Substance Use Disorders (SUMMIT)
Primary care settings (PCS) are a missed opportunity for delivering evidence-based treatments for opiate and alcohol-use disorders (OAUD). The investigators propose to evaluate the costs and effectiveness of two strategies to increase the delivery of OAUD treatments in PCS, integrated collaborative care (ICC) and education and resources (E&R). The investigators hypothesize that ICC will be more effective than E&R in promoting A. Implementation outcomes B. Service system outcomes and C. Patient outcomes.
Results from our study will help providers choose between two different strategies and advance the field of implementation research.
研究概览
详细说明
Most individuals with opiate and alcohol-use disorders (OAUD) do not receive treatment. Primary care is an ideal setting in which to deliver OAUD treatment, yet evidence-based OAUD treatment is rarely provided.
Barriers to delivery include insufficient organizational support and lack of provider role models and clinical support. The investigators propose to evaluate the effectiveness of two strategies for increasing use of evidence-based treatment for OAUD within primary care: integrated collaborative care (ICC) and education and resources (E&R). While both strategies provide primary care practices with the same clinical information, ICC addresses these barriers by including organizational and technical support for delivering evidence-based care. ICC is grounded in the chronic care model and includes a behavioral health provider working as part of the care team.
Essential elements of ICC strategy include a decision support component to help providers with complex patients, and a restructuring of the delivery and clinical information systems to support the delivery of evidence-based care. Our approach to implementing ICC is based on the organizational transformation model and quality improvement. The investigators define the E&R strategy as providing printed educational materials and access to resources along with provider education. Both strategies are designed to increase the delivery of two evidence-based practices: motivational enhancement therapy and medication assisted therapy.
The investigators propose a 5-year mixed methods study and will conduct a RCT, with randomization occurring at the level of the care team and patient. The investigators partner with 5 Venice Family Clinic (VFC) clinics, two hospitals in LA County, and COPE Health Solutions. VFC is a large federally qualified health center (FQHC) and the largest free clinic in the United States. Our approach includes document review, focus groups, interviews, and surveys for obtaining data on the adoption process and implementation outcomes; analysis of patient records and patient surveys on service system and patient outcomes; and analysis of provider financial records and patient records and surveys for estimating costs. The investigators will enroll 400 patients with an OAUD diagnosis and follow them at 3 and 12 months. Our specific aims are: 1) To measure the process and extent of ICC and E&R implementation; 2) To test the effectiveness of ICC compared to an E&R strategy in promoting A. Implementation outcomes B. Service system outcomes and C. Patient outcomes; and 3) To estimate provider costs for each strategy. The investigators define implementation outcomes as measures of the acceptability, adoption, appropriateness, feasibility, and sustainability of evidence-based OAUD treatment. The investigators define service system outcomes as 1) process measures of treatment quality and 2) treatment co-morbidities. The investigators define patient outcomes as hospital readmissions, OAUD outcomes, patient functioning, negative consequences from substance use, and unmet need. The investigators define cost outcomes as start-up costs, operating costs and medical/psychiatric cost offsets.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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California
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Santa Monica、California、美国、90405
- Venice Family Clinic-Simms Mann Health Center
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Venice、California、美国、90291
- Venice Family Clinic-Rose lAvenue
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- opiate or alcohol use disorder
- not currently in substance use disorder treatment
- past 30 day use of alcohol or opioids
- English or Spanish speaking
Exclusion Criteria:
- co-morbid severe mental illness
- medically unstable
学习计划
研究是如何设计的?
设计细节
- 主要用途:卫生服务研究
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:单身的
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
实验性的:ICC
Integrated collaborative care
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|
有源比较器:E&R
Education and Resources--enhanced usual care
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
unmet need
大体时间:past 6 months
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Of those identified as screening positive for an opiate or alcohol use disorder, proportion who did not receive treatment for their substance use
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past 6 months
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abstinent from alcohol and opioid use, past 30 days
大体时间:past 30 days
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change in abstinence from alcohol and opioid use between baseline and 6 month follow up
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past 30 days
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negative consequences related to substance use
大体时间:past 3 months
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SIP-AD frequency questionnaire
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past 3 months
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Functioning
大体时间:past 4 weeks
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change in SF-12 between baseline and follow up
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past 4 weeks
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Engagement
大体时间:30 days of initiation
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Proportion with at least 2 SUD-related visits within 30 days of initiation, Washington Circle
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30 days of initiation
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initiation
大体时间:Within 14 days of index visit
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Washington Circle initiation indicator--at least one SUD-related visit within 14 days of index visit
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Within 14 days of index visit
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heavy alcohol use
大体时间:6 months
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among people at baseline with heavy alcohol use, proportion with heavy alcohol use in past 30 days
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6 months
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Proportion initiating Brief therapy
大体时间:6 months
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Proportion initiating brief therapy within 6 months
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6 months
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Proportion initiating MAT
大体时间:6 months
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Proportion initiating MAT within 6 months, among those eligible for MAT, and if N's are large enough, stratified by type of MAT
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6 months
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abstinence from alcohol, opioids and all other drugs in the previous 30 days
大体时间:collected at six months at the past 30 days
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abstinence from alcohol, opioids and all other drugs in the past 30 days
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collected at six months at the past 30 days
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合作者和调查者
赞助
出版物和有用的链接
一般刊物
- Hunter SB, Ober AJ, McCullough CM, Storholm ED, Iyiewuare PO, Pham C, Watkins KE. Sustaining alcohol and opioid use disorder treatment in primary care: a mixed methods study. Implement Sci. 2018 Jun 18;13(1):83. doi: 10.1186/s13012-018-0777-y.
- Watkins KE, Ober AJ, Lamp K, Lind M, Setodji C, Osilla KC, Hunter SB, McCullough CM, Becker K, Iyiewuare PO, Diamant A, Heinzerling K, Pincus HA. Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care: The SUMMIT Randomized Clinical Trial. JAMA Intern Med. 2017 Oct 1;177(10):1480-1488. doi: 10.1001/jamainternmed.2017.3947.
- Ober AJ, Watkins KE, Hunter SB, Lamp K, Lind M, Setodji CM. An organizational readiness intervention and randomized controlled trial to test strategies for implementing substance use disorder treatment into primary care: SUMMIT study protocol. Implement Sci. 2015 May 8;10:66. doi: 10.1186/s13012-015-0256-7.
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
其他研究编号
- R01DA034266 (美国 NIH 拨款/合同)
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