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：
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
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/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

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.

项目摘要/摘要住院期间有效的行为健康治疗不足是一个转化科学问题这有重要的后果。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，更高的成本和较差的结果有关。使用阿片类药物的治疗疾病（OUD）是此问题的一个例子。 OUD患者经常住院，而治疗是有效的，它被大大未充分利用，使患者处于持续滥用，未来的高风险用药过量和再入院。这种转化效率低下的原因有很多。同时住院医师经常治疗急性过量和戒断，他们的知识和培训有限行为健康。给定压力以最大程度地减少住宿时间，团队通常优先解决急性入场的原因。此外，很少有医院拥有治疗行为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过渡，使患者可以与门诊和社区资源联系起来。跨学科的协作护理团队（CCT）是一种解决OUD转化障碍的新方法治疗交付，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与成瘾的初级保健患者一起使用CCT的有效性，但是CCT 从未在住院环境中将其作为转化方法测试。如果有效，CCT可以完全更改在住院环境中解决行为健康障碍的范式。我们提出了一个混合方法，三个地点的多站点，随机务实的试验，以评估CCT是否会增加翻译效率，在住院的OUD患者中。我们将将414名来自雪松西奈的患者随机洛杉矶的医疗中心，新墨西哥大学医院和马萨诸塞州的Baystate Health 接受CCT或通常的护理。我们的主要结果是住院垫的启动和与后的联系排出Oud治疗；次要结果包括活着的日子和社区，治疗参与和阿片类药物滥用。为了告知未来的传播工作，我们还评估了上下文因素影响实施，CCT实施后的可持续性和成本。通过混合组件临床有效性和实施研究，利用CTSA财团（包括治疗）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的转化增长，更有效的下游实施，并将增强转化研究的效率和科学。 CCT提供了大多数基于医院的医生的专业知识缺乏，创建一个有组织的护理系统，并解决了后续护理的障碍。这项研究的知识可以将医院的经验转变为使Oud患者在垫子中吸引患者的机会，从而导致减少了痛苦，患者健康的立即和长期收益，并降低了医疗保健费用。