Tarrant County Hospital District (dba JPS Health Network) Right Treatment Right Time project creates system changes to increase opioid alternatives for emergency department (ED) patients. The project will create a MAT (Medication-Assisted Treatment) Bridge Clinic for patients with Opioid Use Disorder (OUD) to assist in their recovery. JPS is the publicly supported safety net hospital in Tarrant County, Texas. JPS' ED is ranked in the 25 busiest EDs in the nation.
The population to be served are patients who visit the JPS Emergency Department (ED) with painful conditions. More than 10,000 patients visited the JPS ED last year with painful conditions and were prescribed opioids. The most frequent painful presenting conditions were injury, musculoskeletal pain, and abdominal pain. Half of the patients were male. The majority of patients (92%) were between the ages of 18 and 64. Patients were ethnically diverse with nearly equal numbers of White, Hispanic, and Black patients. Most patients (71%) were low income. As the safety-net hospital, JPS treats patients at high-risk for OUD, including people who are homeless, incarcerated, low-income, and with severe mental illness. This project will allow SAMHSA to evaluate the effectiveness of interventions among diverse high-risk populations and in a safety-net hospital.
Strategies and interventions include all required activities. JPS will target the most common ED painful conditions for opioid treatment alternatives. JPS has developed a multi-modal pain management treatment program that reduces patient initial exposure to addictive opioids and helps patients with OUD to transition to MAT and other pain treatments. JPS will train physicians, residents, mid-levels, and nurses in the ED and selected outpatient clinics in best practices for opioid alternatives. In this training, JPS will consult with the SAMHSA-funded Opioid Response Network. Training will include JPS' nine residency programs, including a behavioral health residency, Fort Worth's only Emergency Medicine program and the nation's largest hospital-based Family Medicine program. To identify patients with OUD, JPS will implement the Opioid Risk Tool. ED physicians will offer patients with OUD an initial MAT dose. With grant funds, JPS will develop a MAT Bridge Clinic supported by case management and patient navigation. JPS will pursue the new Pain and Addiction Care in the Emergency Department (PACED) accreditation. JPS will disseminate best practice across local hospitals, medical schools, the American College of Emergency Physicians, and national publications. In a pilot project, JPS was able to initially reduce opioid prescriptions by 60%. This project builds on this success.
The goal of Right Treatment Right Time is to increase the use of opioid alternatives in JPS Health Network and to help patients with OUD use other alternatives for pain management. Measurable objectives include: 1) Reduce ED opioid prescriptions by 20%. 2) Reduce opioid prescriptions in JPS identified clinics by 20%. 3) 100% of people identified with OUD will be offered an alternative to an opioid for pain management. 4) 25% of people identified with OUD will accept the offer to receive MAT in the ED. 5) 70% of people identified with OUD who receive MAT in the ED and are referred to the MAT Bridge Clinic will receive MAT. The total unduplicated number of patients served is 300 over the grant period (60 patients in year 1, 120 patients in year 2, and 120 patients in year 3).