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

阿片类药物使用障碍住院患者的协作护理团队：将证据转化为实践

• 批准号: 10410407
• 负责人: Itai Danovitch
• 金额: $ 123.4万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10410407
• 关键词: Acute; Address; Admission activity; Affect; Aftercare; Buprenorphine; Caring; Case Manager; Cessation of life; Chronic; Clinical effectiveness; Communities; Consult; Consultations; Discharge Plannings; Disease; Effectiveness; Evidence based intervention; Funding; Future; Health; Health Care Costs; Hospitalization; Hospitals; Individual; Infrastructure; Injectable; Inpatients; Intervention; Knowledge; Length of Stay; Link; Los Angeles; Massachusetts; Medical; Medical center; Medicine; Methadone; Methods; Modeling; Naltrexone; New Mexico; Opioid; Outcome; Outpatients; Overdose; Patient Care; Patient Self-Report; Patients; Pharmacotherapy; Physicians; Population; Primary Health Care; Protocols documentation; Provider; Public Health; Randomized; Resources; Site; Specialist; Stigmatization; Substance Use Disorder; Testing; Training; Translating; Translational Research; Treatment outcome; Universities; Vulnerable Populations; Waiting Lists; Withdrawal; Work; acceptability and feasibility; addiction; arm; barrier to care; base; behavioral health; care systems; collaborative care; comorbidity; contextual factors; cost; dissemination strategy; effective therapy; effectiveness research; effectiveness testing; evidence base; experience; experimental study; follow-up; high risk; hospital readmission; implementation cost; implementation research; implementation strategy; improved; innovation; inpatient service; medication-assisted treatment; novel strategies; opioid misuse; opioid use disorder; post implementation; pragmatic trial; pressure; primary outcome; recruit; secondary outcome; social stigma; tool; translational approach; treatment as usual

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.

项目总结/摘要 住院期间有效的行为健康治疗的使用不足是一个转化科学问题 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， 并且与更长的停留时间、更高的成本和更差的结果相关。阿片类药物使用的治疗 OUD（OUD）是这个问题的一个例子。OUD患者经常住院，而 治疗是有效的，它是大大利用不足，使患者在高风险的继续滥用，未来 吸毒过量再入院这种翻译效率低下的原因有很多。住院期间 医生经常治疗急性过量和戒断，他们在这方面的知识和培训有限。 行为健康考虑到尽量缩短住院时间的压力，团队通常会优先解决急性 录取的理由。此外，很少有医院拥有治疗行为障碍所需的组织基础设施。 健康状况，如专门的团队，循证协议，或协调的能力， 护理的过渡，使患者可以与门诊和社区资源联系起来。 跨学科协作护理团队（CCT）是解决OUD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 先前的工作证明了CCT用于成瘾的初级保健患者时的有效性，但CCT 从未在住院患者中作为一种转化方法进行过测试。如果有效，CCT可以完全 改变解决住院患者行为健康障碍的模式。我们提出一个混合- 方法：多中心、随机、务实的试验，在三个地点评估CCT是否增加翻译 在OUD住院患者中，我们将从Cedars Sinai随机分配414例患者 洛杉矶的医疗中心、新墨西哥州大学医院和马萨诸塞州的Baystate健康中心 接受CCT或常规护理。我们的主要结果是住院MAT的启动和与术后的联系。 出院OUD治疗;次要结局包括存活天数和在社区中的天数，治疗 参与和阿片类药物滥用为了告知未来的传播工作，我们还评估了环境因素 影响实施、有条件现金援助实施后的可持续性以及成本。通过混合成分 临床有效性和实施研究，利用CTSA联盟，包括治疗 创新网络和招聘创新中心，这种创新的转化研究方法可以 产生更快的转化收益，更有效的下游实施，并将提高 翻译研究的效率和科学性。CCT提供的专业知识， 这一计划旨在消除缺乏保健的现象，建立一个有组织的保健系统，并消除后续保健的障碍。本研究的知识 可以将医院的经验转化为一个机会，让OUD患者参与MAT， 减少痛苦，患者健康的直接和长期收益，并降低医疗保健成本。