Williams Arthur Robin, Johnson Kimberly A, Thomas Cindy Parks, Reif Sharon, Socías M Eugenia, Henry Brandy F, Neighbors Charles, Gordon Adam J, Horgan Constance, Nosyk Bohdan, Drexler Karen, Krawczyk Noa, Gonsalves Gregg S, Hadland Scott E, Stein Bradley D, Fishman Marc, Kelley A Taylor, Pincus Harold A, Olfson Mark
Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA.
University of Southern Florida, Tampa, Florida, USA.
Subst Abus. 2022;43(1):1207-1214. doi: 10.1080/08897077.2022.2074604.
Unintentional overdose deaths, most involving opioids, have eclipsed all other causes of US deaths for individuals less than 50 years of age. An estimated 2.4 to 5 million individuals have opioid use disorder (OUD) yet a minority receive treatment in a given year. Medications for OUD (MOUD) are the gold standard treatment for OUD however early dropout remains a major challenge for improving clinical outcomes. A Cascade of Care (CoC) framework, first popularized as a public health accountability strategy to stem the spread of HIV, has been adapted specifically for OUD. The CoC framework has been promoted by the NIH and several states and jurisdictions for organizing quality improvement efforts through clinical, policy, and administrative levers to improve OUD treatment initiation and retention. This roadmap details CoC design domains based on available data and potential linkages as individual state agencies and health systems typically rely on limited datasets subject to diverse legal and regulatory requirements constraining options for evaluations. Both graphical decision trees and catalogued studies are provided to help guide efforts by state agencies and health systems to improve data collection and monitoring efforts under the OUD CoC framework.
意外过量用药死亡，其中大多数涉及阿片类药物，已超过美国50岁以下人群的所有其他死因。估计有240万至500万人患有阿片类药物使用障碍（OUD），但在特定年份接受治疗的只是少数。用于治疗OUD的药物（MOUD）是治疗OUD的金标准，但早期停药仍然是改善临床结果的主要挑战。一种级联护理（CoC）框架，最初作为一种公共卫生问责战略而推广，用于阻止艾滋病毒的传播，现已专门针对OUD进行了调整。CoC框架已由美国国立卫生研究院以及几个州和司法管辖区推广，用于通过临床、政策和行政手段组织质量改进工作，以改善OUD治疗的启动和留存率。本路线图根据现有数据和潜在联系详细说明了CoC设计领域，因为各个州机构和卫生系统通常依赖有限的数据集，这些数据集受到各种法律和监管要求的限制，从而限制了评估选项。同时提供了图形决策树和编目研究，以帮助指导州机构和卫生系统在OUD CoC框架下改进数据收集和监测工作。
