Collaborative care teams for hospitalized patients with opioid use disorders: Translating evidence into practice

项目摘要/摘要 住院期间未充分使用有效的行为健康治疗是一个翻译科学问题。 这会产生重要的后果。行为健康合并症在住院患者中很常见， 并与更长的住院时间、更高的费用和更糟糕的结果相关。阿片类药物使用的治疗 无序(OUD)就是这个问题的一个例子。患有OUD的患者经常住院，虽然 治疗是有效的，但它的利用严重不足，使患者面临继续滥用的高风险，未来 服药过量，以及再次入院。造成这种翻译效率低下的原因有很多。在住院期间 医生经常治疗急性服药过量和戒断，他们在以下方面的知识和培训有限 行为健康。考虑到尽量减少逗留时间的压力，团队通常会优先处理紧急情况 入院理由。此外，很少有医院拥有治疗行为障碍所需的组织基础设施 有效的健康状况，如专职团队、循证方案或协调能力 过渡护理，使患者可以链接到门诊和社区资源。 跨学科协作护理团队(CCT)是解决OUD中翻译障碍的新方法 提供治疗，并有可能为缩小治疗差距作出重大贡献。我们的 先前的工作证明了CCT在用于有毒瘾的初级保健患者时的有效性，但CCT 从未在住院环境中作为一种翻译方法进行过测试。如果有效，CCT完全可以 改变在住院环境中解决行为健康障碍的模式。我们建议一个混合的- 方法：在三个地点进行多点随机语用试验，评估CCT是否增加翻译 效率，在住院的OUD患者中。我们将随机抽取来自西奈雪松的414名患者 洛杉矶医疗中心、新墨西哥大学医院和马萨诸塞州贝州健康 接受CCT或常规护理。我们的主要结果是住院患者的垫子启动和与后 出院和治疗；次要结果包括活着和在社区生活的天数，治疗 交战和阿片类药物滥用。为了给未来的传播工作提供信息，我们还评估了背景因素 影响执行、实施后有条件现金转移的可持续性和费用。通过混合组件 临床有效性和实施研究，利用包括治疗在内的CTSA联盟 创新网络和招聘创新中心，这种翻译研究的创新方法可以 产生更快速的转换收益、更有效的下游实施，并将增强 翻译研究的效率和科学性。CCT提供的专业知识比大多数医院医生 缺乏，创造了一个有组织的护理系统，并解决了后续护理的障碍。通过这项研究获得的知识 可以将医院体验转变为与OUD患者接触的机会，从而 减少痛苦，为患者健康带来即时和长期收益，并降低医疗成本。

Project Summary/Abstract The underuse of effective behavioral health treatments during the hospital stay is a translational science problem that has important consequences. Behavioral health comorbidities are common among hospitalized patients, and are associated with longer lengths of stay, higher costs and worse outcomes. Treatment for opioid use disorder (OUD) is an exemplar of this problem. Patients with OUD are frequently hospitalized, and while treatment is effective, it is dramatically underutilized, leaving patients at high-risk of continued misuse, future overdose, and readmission. There are multiple reasons for this translational inefficiency. While inpatient physicians frequently treat acute overdose and withdrawal, they have limited knowledge and training in behavioral health. Given pressures to minimize length of stay, the team usually prioritizes addressing the acute reason for admission. Moreover, few hospitals have the organizational infrastructure needed to treat behavioral health conditions effectively, such as dedicated teams, evidence-based protocols, or the ability to coordinate transitions of care such that patients can be linked to outpatient and community resources. Interdisciplinary, collaborative care teams (CCT) are a new approach to address translational roadblocks in OUD treatment delivery and have the potential to make a significant contribution to narrowing the treatment gap. Our prior work demonstrated the effectiveness of CCT when used with primary care patients with addiction, but CCT have never been tested as a translational approach in the inpatient setting. If effective, CCT could completely change the paradigm for addressing behavioral health disorders in the inpatient setting. We propose a mixed- methods, multi-site, randomized pragmatic trial in three sites to evaluate whether CCT increase translational efficiency, among hospitalized patients with OUD. We will randomize 414 patients total from Cedars Sinai Medical Center in Los Angeles, the University of New Mexico Hospital, and Baystate Health in Massachusetts to receive either CCT or usual care. Our primary outcomes are inpatient MAT initiation and linkage with post- discharge OUD treatment; secondary outcomes include days spent alive and in the community, treatment engagement, and opioid misuse. To inform future dissemination efforts, we also evaluate contextual factors affecting implementation, the sustainability of the CCT post-implementation, and costs. By blending components of clinical effectiveness and implementation research, leveraging the CTSA consortium including the Treatment Innovation Network and Recruitment Innovation Center, this innovative approach to translational research can generate more rapid translational gains, more effective downstream implementation, and will enhance the efficiency and science of translational research. The CCT offers expertise that most hospital-based physicians lack, creates an organized system of care, and addresses barriers to follow-up care. Knowledge from this study could transform the hospital experience into an opportunity to engage patients with OUD in MAT, resulting in reduced suffering, immediate and long-term gains in patient health, and decreased healthcare costs.