Abstract
BackgroundTreatment for opioid use disorder (OUD) is highly effective, yet it remains dramatically underutilized. Individuals with OUD have disproportionately high rates of hospitalization and low rates of addiction treatment. Hospital-based addiction consult services offer a potential solution by using multidisciplinary teams to evaluate patients, initiate medication for addiction treatment (MAT) in the hospital, and connect patients to post-discharge care. We are studying the effectiveness of an addiction consult model [Consult for Addiction Treatment and Care in Hospitals (CATCH)] as a strategy for engaging patients with OUD in treatment as the program rolls out in the largest municipal hospital system in the US. The primary aim is to evaluate the effectiveness of CATCH in increasing post-discharge initiation and engagement in MAT. Secondary aims are to assess treatment retention, frequency of acute care utilization and overdose deaths and their associated costs, and implementation outcomes.MethodsA pragmatic trial at six hospitals, conducted in collaboration with the municipal hospital system and department of health, will be implemented to study the CATCH intervention. Guided by the RE-AIM evaluation framework, this hybrid effectiveness-implementation study (Type 1) focuses primarily on effectiveness and also measures implementation outcomes to inform the intervention’s adoption and sustainability. A stepped-wedge cluster randomized trial design will determine the impact of CATCH on treatment outcomes in comparison to usual care for a control period, followed by a 12-month intervention period and a 6- to 18-month maintenance period at each hospital. A mixed methods approach will primarily utilize administrative data to measure outcomes, while interviews and focus groups with staff and patients will provide additional information on implementation fidelity and barriers to delivering MAT to patients with OUD.DiscussionBecause of their great potential to reduce the negative health and economic consequences of untreated OUD, addiction consult models are proliferating in response to the opioid epidemic, despite the absence of a strong evidence base. This study will provide the first known rigorous evaluation of an addiction consult model in a large multi-site trial and promises to generate knowledge that can rapidly transform practice and inform the potential for widespread dissemination of these services.Trial registration: NCT03611335
Highlights
Treatment for opioid use disorder (OUD) is highly effective, yet it remains dramatically underutilized
Study objectives and specific aims The overarching objective of our study is to evaluate the effectiveness of CATCH as a strategy for engaging patients with OUD in medication for addiction treatment (MAT)
Adoption is defined as the utilization of the CATCH teams by clinical staff, and measured by the rate of referrals of patients with OUD; and Implementation fidelity is the ability of the CATCH teams to identify and reach their target population, and deliver high-quality care
Summary
Treatment for opioid use disorder (OUD) is highly effective, yet it remains dramatically underutilized. The primary aim is to evaluate the effectiveness of CATCH in increasing post-discharge initiation and engagement in MAT. In NYC, the Mayor’s Office launched in March 2017 the ambitious HealingNYC initiative, committing $38 million each year to programs aimed at reducing opioid overdose deaths [7]. This initiative leverages the resources of the city’s public hospital system (NYC Health + Hospitals (H + H)) and the Department of Health and Mental Hygiene (DOHMH) to increase access to OUD treatment. A key component of this initiative is the introduction of addiction consult services, through the ‘Consult for Addiction Treatment and Care in Hospitals (CATCH)’ program, which is being introduced into six H + H hospitals
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