The Emergency Department Longitudinal Integrated Care (ED-LINC) Effectiveness Randomized Trial Targeting Opioid Use and Related Comorbidity from the ED

美国目前正在经历阿片类药物的流行，阿片类药物过量，阿片使用障碍(OUD)和 与阿片类药物有关的急诊科就诊人数呈上升趋势。教育署走在公众健康的最前列 紧急情况，通常是患者来这里治疗医疗问题的地方，两者都有关 与阿片类药物的使用无关。针对OUD(Moud)的药物以及与急诊护理的联系是一个关键部分 在解决这场危机方面。急诊室的患者有一系列复杂的药物使用情况， 精神和医学并存，往往经历零散的医疗保健提供。全面 疾病管理战略，如协作护理模式，为解决 急诊科OUD患者的治疗需求急诊科纵向综合护理 (ED-LINC)干预源自协作护理模式，是一种多组件的纵向干预 对急诊科就诊期间开始的OUD患者及相关合并症患者的干预。ED-LINC 临床试验将把500名在华盛顿州两家急诊室寻求治疗的OUD患者随机分配到ED-LINC 干预组(n=250)或常规护理对照组(n=250)。随机接受ED-LINC干预的患者 将接受；1)过量教育；2)针对参与门诊的动机的短暂床边干预 护理；3)使用治疗决策支持工具以患者为中心的MOD方法；4)纵向和 积极主动的护理管理，为期三个月，同时每周对 心理健康专业人员的干预者，允许针对阿片类药物的使用和 相关的合并症。急诊部信息交换中心(EDIE)为ED-LINC提供支持 平台，这是一个新的护理协调工具，从30多个州的医院收集数据，并 将此信息打包为实时警报通知中的紧急提供程序。伊迪的进一步特点 包括创建量身定做护理计划。该试验纳入了务实的结果评估要素， 包括使用伊迪和全州行政数据来评估意向- 处理样品。ED-LINC试验测试了这样的假设：随着时间的推移，患者被随机分配到ED-LINC 与随机接受常规护理的患者相比，干预措施将显示：1)显著减少 自我报告非法阿片类药物的使用；2)Moud的启动和保留显著增加；3)显著 减少ED使用率。二次分析将探索甲基苯丙胺使用共病的影响 而性行为对干预治疗效果的影响。研究小组还计划进行一项实施进程 使用新的混合方法进行评估，以了解可持续实施的潜力 干预要素。来自形成性评估的数据将用于准备演示文稿 在试验的最后一年的政策峰会上公布研究结果，这将允许迅速传播和 可能的政策变化与护理来自急诊室的OUD患者有关。

The US is currently experiencing an opioid epidemic with opioid overdose, opioid use disorder (OUD) and Emergency Department (ED) visits related to opioids on the rise. The ED is at the forefront of this public health emergency and often a place where patients with OUD come for treatment of medical problems, both related and unrelated to opioid use. Medications for OUD (MOUD) and linkage to care from the ED are a critical piece in addressing this crisis. Patients in the ED with OUD present with a complex constellation of substance use, psychiatric and medical comorbidity, and often experience fragmented healthcare delivery. Comprehensive disease management strategies, such as the Collaborative Care model, hold great promise for addressing the treatment needs of patients with OUD in the ED. The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention derives from the Collaborative Care model and is a multi-component, longitudinal intervention for patients with OUD and related comorbidity that is initiated during an ED visit. The ED-LINC clinical trial will randomize 500 patients with OUD seeking care at two Washington State EDs to the ED-LINC intervention (n=250) or usual care control (n=250) conditions. Patients randomized to the ED-LINC intervention will receive; 1) overdose education; 2) brief bedside intervention targeting motivation to engage in outpatient care; 3) a patient-centered approach to MOUD using a treatment decision support tool; 4) longitudinal and proactive care management which will proceed for three months along with weekly caseload supervision of the interventionist by a mental health professional allowing for stepped-up care targeting opioid use and associated comorbidity. ED-LINC is supported by the Emergency Department Information Exchange (EDIE) platform, which is a novel care coordination tool that collects data from hospitals in over 30 states and packages this information for emergency providers in real-time alert notifications. Further features of EDIE include creation of tailored care plans. The trial incorporates pragmatic outcome assessment elements, including the use of EDIE and statewide administrative data to assess important outcomes on the intent-to- treat sample. The ED-LINC trial tests the hypotheses that over time, patients randomized to the ED-LINC intervention, when compared to patients randomized to usual care, will demonstrate: 1) significant reductions in self-report illicit opioid use; 2) significant increases in MOUD initiation and retention, and 3) significant reductions in ED utilization. Secondary analyses will explore the impact of methamphetamine use comorbidity and sex on intervention treatment effects. The study team also plans to conduct an implementation process assessment using novel mixed methods to understand the potential for sustainable implementation of intervention elements. Data derived from this formative evaluation will be used to prepare for the presentation of study results at a policy summit in the final year of the trial which will allow for rapid dissemination and potential policy changes related to care for patients with OUD from the ED.