Study protocol for a pragmatic trial of the Consult for Addiction Treatment and Care in Hospitals (CATCH) model for engaging patients in opioid use disorder treatment

Abstract

Background Treatment 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. Methods A 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. Discussion Because 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

Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol

“…Combining two implementation frameworks to supplement one another is commonly used in the literature [ 59 – 62 ]. The CFIR is comprehensive regarding the assessment, and the RE-AIM framework is the intervention approach.…”

“…The RE-AIM evaluation framework may also be useful in implementing an intervention similar to ours on a larger scale. This framework was utilized by McNeely and colleagues to rigorously evaluate an OUD treatment consult model in a large multi-site trial, generating knowledge for how OUD treatment practices can be widely disseminated and adopted across healthcare systems [ 59 ]. Similarly, we may be able to apply our RE-AIM evaluation findings to larger scale interventions.…”

Trends in inpatient discharges with drug or alcohol admission diagnoses to a skilled nursing facility among older adults, New York City 2008–2014

“…The priority should be to ensure that all Medicare-certified SNFs are able to provide evidence-based medications, therapy, and counseling for patients with substance use disorders. A possible solution to reduce the burden for SNF staff who do not have expertise in substance use disorder treatment would be to develop addiction medicine consultant services, similar to ones developed for inpatient hospital settings [ 31 ]. These multidisciplinary teams could see patients with SUDs in the post-acute setting in SNFs.…”

Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality

“…Recent research has shown that evidence-based MOUD has superior outcomes in preventing mortality and decreasing opioid use (7). For this reason, we defined post-discharge OUD treatment engagement as: 1) at least two filled prescriptions for buprenorphine, extended-release naltrexone, or methadone from an Opioid Treatment Program in the 30 days following hospital discharge, or 2) a prescription for extended-release naltrexone or buprenorphine that covered 28 of the 30 days post-hospital discharge (24).…”