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Pilot Test of a Collaborative Care Team for Medical Inpatients with Opioid and Alcohol Use Disorders

Award Number: R34DA047492
ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 01/15/2019
PERIOD OF PERFORMANCE END DATE: 12/31/2022

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Pilot Test of a Collaborative Care Team for Medical Inpatients with Opioid and Alcohol Use Disorders - PROJECT SUMMARY/ABSTRACT The specific aims of this three-year R34 are to prepare for a clinical trial by (1) developing the protocol and resources for a consultation-liaison service-based collaborative care team (CCT) intervention to address untreated opioid and alcohol use disorders (OAUDs) among hospitalized inpatients and actively link them to follow-up care, and by (2) conducting a pilot RCT to assess (a) implementation feasibility; and (b) acceptability among patients and providers. The study is of critical importance to public health because millions of people in the United States need, but do not receive, treatment for substance-use disorders. OAUDs are of particular concern because of high rates of morbidity, mortality, hospitalizations, and readmissions, as well as the increasing incidence of opioid-use disorders and associated medical consequences and overdose deaths. Moreover, OAUDs are the most common substance use disorders among medical inpatients. However, despite high prevalence, few inpatients with OAUDs receive evidence-based treatments while in the hospital. Most physicians and other providers in acute hospital settings are not trained to assess or manage patients with OAUDs, contributing to low rates of OAUD identification and treatment initiation. Pharmacotherapies to address OAUDs are effective for use across medical settings but are seldom initiated in hospitals or recommended as part of follow-up care. Inpatient hospitalization offers a pivotal opportunity to decrease unmet need. Starting treatment in the hospital and effectively linking patients with follow-up care could not only improve outcomes, but also could decrease high rates of hospital readmission and ultimately lower costs. The current standard of care for hospitalized patients with OAUD—screening, brief intervention and referral to treatment—is not effective for those with OAUDs, possibly because it does not include initiation of medication or facilitate linkage to follow-up OAUD care. Barriers to OAUD treatment for inpatients include lack of expertise on the medical team, absence of an organized system for assessing and treating patients with OAUD, patient ambivalence about treatment, and lack of follow-up after discharge. The CCT will consist of a psychiatrist and care manager team with OAUD expertise who provide population-focused monitoring and measurement-based decision-making to support the medical team. The CCT will use evidence-based components, including a motivational interviewing-based therapeutic intervention, targeted discharge planning, and active referral. To develop the protocol, we will draw from our prior work in primary care and other evidence-based resources, and obtain input from a stakeholder advisory board comprised of patients and providers. To assess feasibility, we will enroll 80 patients admitted to the hospital over 5 months in a pilot RCT and collect baseline and 1-month follow-up data. To determine acceptability, we will conduct interviews with providers and patients. The proposed study would be the first to test a consultation-liaison service-based CCT to improve care for inpatients with OAUD.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = -$4,423 )
2024	2021	THE RAND CORPORATION	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Drug Use and Addiction Research Programs	000	3	10/18/2023	NON-COMPETING CONTINUATION	-$4,423
														Subtotal = -$4,423

Issue Date FY: 2021 ( Subtotal = $270,125 )
2021	2021	RAND CORPORATION, THE	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Drug Use and Addiction Research Programs	001	3	2/26/2021	NON-COMPETING CONTINUATION	$27,015
2021	2021	RAND CORPORATION, THE	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Drug Use and Addiction Research Programs	000	3	12/22/2020	NON-COMPETING CONTINUATION	$243,110
														Subtotal = $270,125

Issue Date FY: 2020 ( Subtotal = $272,653 )
2020	2020	RAND CORPORATION, THE	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Drug Use and Addiction Research Programs	001	2	2/11/2020	NON-COMPETING CONTINUATION	$27,267
2020	2020	RAND CORPORATION, THE	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Drug Use and Addiction Research Programs	000	2	12/11/2019	NON-COMPETING CONTINUATION	$245,386
														Subtotal = $272,653

Issue Date FY: 2019 ( Subtotal = $279,084 )
2019	2019	RAND CORPORATION, THE	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Drug Use and Addiction Research Programs	000	1	1/14/2019	NEW	$279,084
														Subtotal = $279,084

Grand Total All Awards = $817,439

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Pilot Test of a Collaborative Care Team for Medical Inpatients with Opioid and Alcohol Use Disorders

Award Number: R34DA047492

ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 01/15/2019

PERIOD OF PERFORMANCE END DATE: 12/31/2022

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