Identifying Low Barrier Wound Care Models for People Who Inject Drugs

Candidate: To achieve her career goal of becoming an independent investigator, Eleanor Turi PhD, RN, CCRN seeks mentored research training in ethical research with people who inject drugs, mixed methods, coincidence analysis, hybrid implementation-effectiveness trials, and wound care for people who inject drugs. This career development award identifies low barrier wound care models associated with positive patient outcomes among people who inject drugs, while collecting implementation data. This K23 will equip the PI with the necessary pilot data and training to submit a hybrid implementation-effectiveness R01 proposal. Research Context: Low barrier wound care, which is wound care delivered in walk-in, outpatient settings with harm reduction philosophies, has the potential to meet the high demand for wound care in the context of rising xylazine prevalence in the street opioid supply. However, there is very little published literature on the characteristics of care models that are associated with positive patient outcomes in the time of xylazine. This study will identify characteristics of low barrier wound care models associated with positive patient outcomes, while collecting implementation data. Specific Aims. 1) Assess the relationship between low barrier wound care models for people who inject drugs (PWID) and patient outcomes (i.e., initiation, engagement, and retention in medication treatment for opioid use disorder, return visits for wound care, safe injection practices, wound improvement, acute care services use, and trust and satisfaction with care). 2) Identify barriers to and facilitators of implementing low barrier wound care models for PWID. Research Plan: This study utilizes a mixed methods convergent design, prospectively collecting 1) survey data on care models and implementation from 20 low barrier wound care providers and administrators and 2) interview data on patient outcomes from 100 patients of low barrier wound care sites. We will include sites in 6 Northeastern United States cities. Associations between care models and outcomes will be analyzed via coincidence analysis, a mathematical method for identifying conditions associated with an outcome. Career Development Plan: With an interdisciplinary and experienced team of mentors, Dr. Turi will pursue didactics, workshops and conferences to complete the training goals, which are to 1) learn to conduct ethical and effective recruitment and retention of people who inject drugs in research, 2) develop expertise in mixed methods research, 3) build skills in coincidence analysis, 4) learn how to conduct hybrid implementation- effectiveness trials, and 5) gain content expertise in wound care provision for people who inject drugs. Environment: The University of Pennsylvania School of Nursing offers an ideal environment to pursue the proposed training and research. Dr. Turi is well-positioned to successfully complete the proposed aims and training because of her experienced mentorship team and extensive resources for career development.