Saturday, September 7, 2024
9/7/2024
Summary: Ohio is ranked as the sixth highest state for opioid overdose deaths in 2021 with a rate of 41.1 per 100,000 persons. Located in Northeast Ohio, UH Cleveland Medical Center (UHCMC) Emergency Department (ED) serves a broad catchment area including urban, suburban, and rural counties, and is a primary source of care for the predominantly minority and socioeconomically disadvantaged local population. In a 2022 review of 66,086 ED visits in our electronic health record (EHR), 15,546 ED visits were for patients presenting with pain and discharged home. Of these visits, over 25% received an opioid medication in the ED, representing an opportunity to reduce that percentage. The overall goal of this proposal is to decrease opioid usage in the ED by (1) increasing ED provider knowledge and (2) implementing ALTO therapies in the ED for patients presenting with pain. We will carry out this objective through a longitudinal ALTO implementation project with initial intervention in the ED and sustained follow-up in the outpatient UH Connor Whole Health (UHCWH) clinics. Specific Objectives: (1) Understand current UHCMC ED pain complaints, approaches, and potential barriers to implementation of ALTO; (2) Train ED providers on Medications for Opioid Use Disorder (MOUD) and ALTO interventions; (3) Implement acupuncture and music-assisted relaxation imagery (MARI) ALTO approaches in the UHCMC ED.; (4) Disseminate best practices through three planned publications in peer reviewed journals and numerous presentations at national/international conferences of emergency medicine and integrative medicine. Plan to Meet Objectives: Key personnel include a (1) Program Director with training and expertise in system-level project and program management, (2) Emergency Medicine physician (Co-PI) with expertise in implementation science of interventions in the ED, (3) Integrative Medicine researcher (Co-PI) with NIH-funded expertise of deploying non-pharmacologic interventions in the ED and acute care and assessing outcomes, and (4) Emergency medicine physician (Co-I) with expertise in addiction medicine. To assess and improve development and uptake of these ALTO approaches, the team will conduct a ~10 item survey of ED providers to understand their knowledge, perspectives, and potential biases regarding pain management and ALTO techniques, including barriers to ALTO implementation in the ED. The team will conduct a pre-survey (initial 3-month start-up period) and will re-assess providers’ perspectives halfway through (Year 2) and at the end (Year 3) (Obj 1). The overarching goal of this proposal is to use the combination of ED provider training on MOUD and ALTO techniques (Obj 2) to increase referrals for ALTO interventions, specifically evidence-based acupuncture and MARI in the ED (Obj 3), in order to decrease the current rate of opioids used in the ED to treat acute and chronic pain. As a novel innovation, ED providers will be able to refer patients to one of the five UH UHCWH outpatient clinics to receive ALTO interventions that are covered by Medicare, Ohio Medicaid, or by patients’ private insurance. Rationale: There is a need nationwide for emergency medicine professionals to use MOUD and ALTO interventions to safely manage acute/chronic pain. The Dept of Emergency Medicine and UHCWH successfully collaborated on a feasibility pilot of bringing acupuncture to the UHCMC in a NIH-funded trial. However, the study team contends that: (1) reduction of ED opioid use by ED providers AND (2) increased use of ALTO interventions to reduce pain in the ED would provide a unique two-pronged approach to begin to combat the opioid epidemic. With widespread dissemination of results (Obj 4), this project would provide robust evidence for a scalable intervention with the potential to readily expand to other EDs.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
