ED-LINC: Emergency Department Longitudinal Integrated Care
Study Details
Study Description
Brief Summary
The overarching goal of this investigation is to develop and determine the feasibility of a multi-component intervention adapted from a collaborative care framework initiated in the ED for patients at risk for opioid use disorder. This study will provide important feasibility information for future studies of ED-LINC. The collaborative care intervention (ED-LINC) will be supported by a novel Emergency Departement (ED) health information exchange platform.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
The overarching goal of this investigation is to develop and determine the feasibility of a multi-component intervention adapted from a collaborative care framework initiated in the ED for patients at risk for opioid use disorder. According to the 2015 national survey on drug use and health, an estimated 3.8 million individuals over 12 years of age were currently misusing opioid pain relievers. An additional 329,000 people use heroin. The Emergency Department (ED) is currently at the forefront of this public health emergency and often a place where patients come for treatment of overdose and for treatment of medical problems related to illicit opioid use.
Overall, the goal is to establish the feasibility of a multi-component intervention called 'Emergency Department Longitudinal Integrated Care (ED-LINC)' which is guided by principles of collaborative care and is comprised of components that are evidence-based. ED-LINC is initiated from the ED and continues longitudinally for patients at-risk for opioid use disorder.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: ED-LINC Intervention Condition Patients in this arm will receive the ED-LINC intervention. Elements of ED-LINC are based on evidence-based treatments and are central components of collaborative care. ED-LINC will be supported by a novel Emergency Department Information Exchange (EDIE) technology platform that allows for the creation of ED care plans and electronic alerts and will assist in care coordination of this complex population. |
Behavioral: ED-LINC
ED-LINC will include 1) A brief negotiated interview at the bedside with an emphasis on motivation to link to services 2) Pharmacotherapy including a discussion of opioid safety, take-home naloxone and initiation of buprenorphine from the ED for participants that are interested and eligible; 3) Longitudinal care management which will proceed for 3-months; and 4) Care plan in the Emergency Department Information Exchange (EDIE) system. This will be coupled with a study cell phone and a weekly supervisory case conference which is consistent with collaborative care principles.
|
| No Intervention: Usual Care Condition Patients in this arm may receive a spectrum of consulting services visits including social work services, psychiatric consultation, inpatient psychiatry consult, rehabilitation psychology consultation, addiction intervention services, pain team consultation services that include MD psychiatric and PhD psychologist providers, spiritual care or other consulting services which shall count as usual care. |
Outcome Measures
Primary Outcome Measures
- Enrollment Rates [Baseline]
To determine enrollment rates (patients enrolled/patients eligible), consent rates (consent obtained/patients approached)
- Follow up completion rates [6 months]
To determine follow-up completion rates we will calculate the number of possible follow-ups/number of actual completed followups at each follow-up time point.
- ED-LINC Intervention and Usual Care Process Outcomes [6 months]
Calculated by the number of elements of ED-LINC received by each participant, intervention completion rates and number and types of contacts made by the interventionist.
- Implementation Appropriateness [6 months]
The Intervention Appropriateness Measure (IAM) (0-20) will be used to assess appropriateness of the intervention for all participants randomized to ED-LINC
- ED-LINC satisfaction [6 months]
Client Satisfaction Questionnaire (CSQ-8) questions (8-32) will be used to assess satisfaction with ED-LINC
- Perception of Care Coordination [6 months]
The Patient Assessment of Chronic Illness Care - Coordination (PACIC-C) (0-25) questions will be asked of all participants
Secondary Outcome Measures
- Substance Use [6 months]
substance use will be measured utilizing a time-line follow back calendar administered by the research assistant to determine days of heroin or illicit opioid use and days of prescription opioid misuse.
- Health Care Utilization [6 months]
Emergency department (ED) utilization will be assessed using the Emergency Department Information Exchange (EDIE) . Participants will provide self-report information on primary care visits, mental health and substance use treatment visits.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Aged 18-65
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Patients with at least one risk factor for opioid use disorder via the EMR pre-screen
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Patients with score of ≥ 4 on the NIDA modified ASSIST for illicit opioids (e.g. heroin) OR a score of ≥ 4 on the NIDA modified ASSIST for prescription opioids
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Currently have a phone
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Able to provide a phone number and one additional piece of contact information
Exclusion Criteria:
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They are incarcerated or under arrest
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Non-English speaking
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Live beyond a 50 mile radius of HMC
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Require active resuscitation in the ED or other clinical area at the time of RA approach
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Are receiving palliative care services or hospice care for a chronic illness such as metastatic cancer
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Are in the ED or hospital for a primary psychiatric emergency such as suicidal ideation or attempt
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Receiving chronic opioid therapy (COT) defined as prescription opioids for most days out of the last 90 days for a chronic pain condition
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In the ED for sexual assault
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Harborview Medical Center | Seattle | Washington | United States | 98104 |
Sponsors and Collaborators
- University of Washington
- National Institute on Drug Abuse (NIDA)
Investigators
- Principal Investigator: Lauren Whiteside, MD, University of Washington
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- STUDY00005447
- K23DA039974