Examining linkage to care after nonfatal opioid overdoses: A mixed-methods study. - PROJECT SUMMARY/ABSTRACT The goal of the proposed fellowship is to prepare Mr. Jirka Taylor for an independent research career utilizing qualitative and quantitative approaches to inform the development of drug policy, with a particular focus on challenges and opportunities located at the intersection of various policy systems. The proposed fellowship will help Mr. Taylor achieve this long-term career goal by enabling opportunities for individualized training: (1) to become proficient in quantitative analyses using medical claims data, (2) to build expertise in advanced statistical techniques, with a particular focus on causal inference, and (3) to gain in-depth understanding of the health policy environment related to substance use and illicit drugs and become skilled in using policy data for research purposes. To achieve these goals, Mr. Taylor will engage in activities including mentored research, structured training via Johns Hopkins University coursework and informal training via independent study programs, and attendance and presentations at seminars and conferences. Throughout the training period, Mr. Taylor will receive support from a wide array of resources at the Johns Hopkins Bloomberg School of Public Health and from a strong mentorship team with complementary expertise in policy research, large data set analysis, advanced statistical and causal inference methods, and issues related to drug policy and care for people who use drugs. The mentored research will consist of a mixed methods study focused on improving care for people experiencing nonfatal opioid overdoses. Non-fatal overdoses attended by emergency provide a chance to initiate the treatment cascade of care by facilitating patients’ linkage to treatment and other services to help address their needs. However, in practice, there are multiple points at which patients may disengage before receiving effective care or where the cascade of care is interrupted. The proposed research aims to address existing research gaps by analyzing individual, structural, and policy-related factors determining service use at key post-overdose points of care. It will use advanced causal inference methods to investigate the impact of Medicaid expansion on rates of non-transport by EMS after nonfatal overdoses. It will also analyze national Medicaid claims data to identify predictors of post-ED treatment service update, focusing on the characteristics of hospital-based care. Lastly, it will use qualitative interviews to describe the implementation of crisis stabilization centers as an alternative to emergency departments for post-overdose care. Taken together, the proposed research will strengthen the understanding of gaps in effective post-overdose linkage to care and identify potential policy and practice mechanisms to mitigate their impact. The proposed research is strongly aligned with NIDA’s Priority Scientific Area #4 to study the implementation of evidence-based strategies in real- world settings.
