Fatal Overdose Review Teams - Research to Enhance Surveillance Systems

Official title

Fatal Overdose Review Teams - Research to Enhance Surveillance Systems (FORTRESS)

Overview

This project seeks to address the overdose epidemic by working with overdose fatality review (OFR) teams. Current OFR practices rely on a case review model where OFR teams assess one or two overdose cases to make policy and program recommendations. However, the continued rise in overdose rates and number of preventable overdose deaths suggest a need to shift OFR teams away from case review and toward using timely population-level data to better inform their recommendations and actions. The goal of this project, Fatal Overdose Review Teams - Research to Enhance Surveillance Systems (FORTRESS), is to improve standard OFR practices by equipping OFRs with a data dashboard built on near real-time aggregate data, linked across multiple sources and presented in a way that helps identify common "overdose touchpoints," or opportunities to connect individuals at risk for overdose with evidence-based treatment. During the first project phase, the FORTRESS team will design the "Overdose Touchpoints Dashboard'' (Aim 1). The FORTRESS team will also train OFR team members in "Data-Driven Decision Making" (DDDM) to effectively use the dashboard. The FORTRESS team also includes individuals involved in developing the CDC's OFR best practice guidelines and a pilot study of OFR adherence to these guidelines, which will inform the FORTRESS team's development of an "OFR Fidelity Tool'' (Aim 2). This tool will be the first of its kind. For the second project phase, the FORTRESS team will conduct a cluster-randomized stepped-wedge trial comparing the impact of the intervention (dashboard + DDDM training) versus standard OFR practices on both implementation (Aim 3) and effectiveness outcomes (Aim 4). Implementation outcomes include implementation process fidelity (Stages of Implementation Completion), staff acceptance of harm reduction philosophies (qualitative interviews), OFR fidelity to CDC best practices (FORTRESS OFR Fidelity Tool), and usability of the Overdose Touchpoint Dashboard, (Systems Usability Scale). A statewide OFR data repository serves as a rich source of data on effectiveness outcomes, including OFR team recommendation quality and local actions to implement recommended overdose prevention strategies. The FORTRESS team will also survey OFR team members to assess changes in their attitudes toward evidence-based overdose prevention strategies. In sum, the FORTRESS team is uniquely qualified to help OFRs use more comprehensive available data to inform quality, action-oriented recommendations to reduce overdose. Funding for this project comes from the HEAL Initiative (https://heal.nih.gov/).

Interventions

• Behavioral Data-Driven Decision Making (DDDM)
  The intervention consists of providing real-time data on overdose touchpoints to OFRs and training in DDDM for continuous quality improvement cycles, leading to improved OFR recommendations and implementation of overdose prevention strategies.
• Behavioral Overdose-prevention strategies inventory
  A list of overdose prevention and harm reduction strategies will be provided to OFRs for possible implementation, depending on local needs and final dashboard development.

Primary outcome measures

• Organizational readiness to implement change [Time frame: Months 18, 24, 30, 36, 42, 48, 54, & 60]
• Cultural Exchange Inventory (adapted to evaluate OFR team alliance) [Time frame: Months 18, 24, 30, 36, 42, 48, 54, & 60]
• Harm reduction acceptability scale [Time frame: Months 18, 24, 30, 36, 42, 48, 54, & 60]
• Systems Usability Scale [Time frame: Months 18, 24, 30, 36, 42, 48, 54, & 60]
• Stages of Implementation Completion (SIC) [Time frame: Baseline through study completion, an average of 5 years]
• OFR Fidelity Tool [Time frame: Months 18-54]
• Dashboard Aggregate Usage [Time frame: Months 14-54]
• Organization's implementation climate (adapted to evaluate overdose prevention strategies) [Time frame: Months 18, 24, 30, 36, 42, 48, 54, & 60]
• Quality OFR Recommendations [Time frame: Months 14-54]
• Uptake of OFR Interventions [Time frame: Months 14-54]

Eligibility criteria

Inclusion Criteria for FORTRESS staff personnel recruited to complete surveys, focus groups and/or interviews:

• 1\) member of local overdose fatality review (OFR) team; OR 2) local county leader of organizations represented by OFR (OFR facilitator, public jail administrators, chief of police, judge, addiction treatment CEO/CFO, public health director, etc.).

Inclusion criteria for FORTRESS administrative data:

• all residents of Indiana that have experienced fatal and/or non-fatal overdose as identified by administrative data sources.

Exclusion criteria

• N/A

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Prevention

Study locations

United States · 1 center

• Indiana University School of Medicine — Indianapolis

Identifiers

NCT: NCT06084221 · 15922 · 1R61DA057660-01 · 4R33DA057660-02

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗