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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

基本信息

批准号：
9890409
负责人：
Itai Danovitch
金额：
$ 131.53万
依托单位：
CEDARS-SINAI MEDICAL CENTER
依托单位国家：
美国
项目类别：
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/9890409
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 addiction arm barrier to care base behavioral health care systems collaborative care comorbidity contextual factors cost effective therapy effectiveness research effectiveness testing evidence base experience experimental study follow-up high risk hospital readmission implementation research improved innovation inpatient service medication-assisted treatment novel strategies opioid misuse opioid use disorder pragmatic trial pressure primary outcome recruit secondary outcome social stigma tool translational approach treatment as usual

项目摘要

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.

项目概要/摘要住院期间有效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，并且与更长的住院时间、更高的费用和更差的结果相关。阿片类药物使用的治疗紊乱（OUD）就是这个问题的一个例子。 OUD 患者经常住院，同时治疗是有效的，但它的利用严重不足，使患者面临继续滥用的高风险，未来用药过量和再次入院。这种翻译效率低下的原因有多种。住院期间医生经常治疗急性药物过量和戒断症状，但他们的知识和培训有限行为健康。考虑到尽量减少住院时间的压力，团队通常会优先考虑解决急性问题入学理由。此外，很少有医院拥有治疗行为病所需的组织基础设施。有效的健康状况，例如专门的团队、基于证据的协议或协调能力护理的转变，使患者能够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 转化障碍的新方法提供治疗并有可能为缩小治疗差距做出重大贡献。我们的先前的工作证明了 CCT 在用于初级保健成瘾患者时的有效性，但 CCT 从未在住院环境中作为转化方法进行过测试。如果有效，CCT 可以完全改变住院环境中解决行为健康障碍的范式。我们建议采用混合- 方法，在三个地点进行多中心、随机实用试验，以评估 CCT 是否会增加转化住院 OUD 患者的效率。我们将对来自 Cedars Sinai 的 414 名患者进行随机分组洛杉矶医疗中心、新墨西哥大学医院和马萨诸塞州 Baystate Health 接受 CCT 或常规护理。我们的主要结局是住院患者 MAT 的启动以及与术后治疗的联系出院OUD处理；次要结局包括活着和在社区度过的天数、治疗参与和阿片类药物滥用。为了为未来的传播工作提供信息，我们还评估了背景因素影响实施、实施后 CCT 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，利用包括治疗在内的 CTSA 联盟创新网络和招聘创新中心，这种转化研究的创新方法可以产生更快速的转化收益、更有效的下游实施，并将增强转化研究的效率和科学。 CCT 提供大多数医院医生都具备的专业知识缺乏，创建一个有组织的护理系统，并解决后续护理的障碍。本研究的知识可以将医院体验转变为让 OUD 患者参与 MAT 的机会，从而减少痛苦，提高患者健康的短期和长期效益，并降低医疗费用。