SUMMIT: Integrated Collaborative Care for Substance Use Disorders

Sponsor

RAND (Other)

Overall Status

Completed

CT.gov ID

NCT01810159

Collaborator

(none)

397

Enrollment

Locations

Arms

Duration (Months)

198.5

Patients Per Site

6.4

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Primary care settings (PCS) are a missed opportunity for delivering evidence-based treatments for opiate and alcohol-use disorders (OAUD). The investigators propose to evaluate the costs and effectiveness of two strategies to increase the delivery of OAUD treatments in PCS, integrated collaborative care (ICC) and education and resources (E&R). The investigators hypothesize that ICC will be more effective than E&R in promoting A. Implementation outcomes

Service system outcomes and C. Patient outcomes.

Results from our study will help providers choose between two different strategies and advance the field of implementation research.

Condition or Disease	Intervention/Treatment	Phase
Substance Use Disorders	Other: Integrated collaborative care Other: Education and Resources	N/A

Detailed Description

Most individuals with opiate and alcohol-use disorders (OAUD) do not receive treatment. Primary care is an ideal setting in which to deliver OAUD treatment, yet evidence-based OAUD treatment is rarely provided.

Barriers to delivery include insufficient organizational support and lack of provider role models and clinical support. The investigators propose to evaluate the effectiveness of two strategies for increasing use of evidence-based treatment for OAUD within primary care: integrated collaborative care (ICC) and education and resources (E&R). While both strategies provide primary care practices with the same clinical information, ICC addresses these barriers by including organizational and technical support for delivering evidence-based care. ICC is grounded in the chronic care model and includes a behavioral health provider working as part of the care team.

Essential elements of ICC strategy include a decision support component to help providers with complex patients, and a restructuring of the delivery and clinical information systems to support the delivery of evidence-based care. Our approach to implementing ICC is based on the organizational transformation model and quality improvement. The investigators define the E&R strategy as providing printed educational materials and access to resources along with provider education. Both strategies are designed to increase the delivery of two evidence-based practices: motivational enhancement therapy and medication assisted therapy.

The investigators propose a 5-year mixed methods study and will conduct a RCT, with randomization occurring at the level of the care team and patient. The investigators partner with 5 Venice Family Clinic (VFC) clinics, two hospitals in LA County, and COPE Health Solutions. VFC is a large federally qualified health center (FQHC) and the largest free clinic in the United States. Our approach includes document review, focus groups, interviews, and surveys for obtaining data on the adoption process and implementation outcomes; analysis of patient records and patient surveys on service system and patient outcomes; and analysis of provider financial records and patient records and surveys for estimating costs. The investigators will enroll 400 patients with an OAUD diagnosis and follow them at 3 and 12 months. Our specific aims are: 1) To measure the process and extent of ICC and E&R implementation; 2) To test the effectiveness of ICC compared to an E&R strategy in promoting

Implementation outcomes B. Service system outcomes and C. Patient outcomes; and 3) To estimate provider costs for each strategy. The investigators define implementation outcomes as measures of the acceptability, adoption, appropriateness, feasibility, and sustainability of evidence-based OAUD treatment. The investigators define service system outcomes as 1) process measures of treatment quality and 2) treatment co-morbidities. The investigators define patient outcomes as hospital readmissions, OAUD outcomes, patient functioning, negative consequences from substance use, and unmet need. The investigators define cost outcomes as start-up costs, operating costs and medical/psychiatric cost offsets.

Study Design

Study Type:

Interventional

Actual Enrollment :

397 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Single (Outcomes Assessor)

Masking Description:

We used an R software random number generator to randomly assign eligible participants to either CC or usual care. We used a concealed randomization protocol where neither participant nor researcher (outside of the statistician doing the randomization) was aware of the randomization until after the baseline interview. None of the participants or providers was blinded to treatment allocation after randomization. Interviewers were blinded to treatment allocation

Primary Purpose:

Health Services Research

Official Title:

Integrated Collaborative Care for Substance Use Disorders

Study Start Date :

Jun 1, 2014

Actual Primary Completion Date :

Sep 1, 2016

Actual Study Completion Date :

Jan 1, 2017

Arms and Interventions

Arm	Intervention/Treatment
Experimental: ICC Integrated collaborative care	Other: Integrated collaborative care
Active Comparator: E&R Education and Resources--enhanced usual care	Other: Education and Resources

Arm

Intervention/Treatment

Experimental: ICC

Integrated collaborative care

Other: Integrated collaborative care

Active Comparator: E&R

Education and Resources--enhanced usual care

Other: Education and Resources

Outcome Measures

Primary Outcome Measures

unmet need [past 6 months]
Of those identified as screening positive for an opiate or alcohol use disorder, proportion who did not receive treatment for their substance use
abstinent from alcohol and opioid use, past 30 days [past 30 days]
change in abstinence from alcohol and opioid use between baseline and 6 month follow up
negative consequences related to substance use [past 3 months]
SIP-AD frequency questionnaire
Functioning [past 4 weeks]
change in SF-12 between baseline and follow up
Engagement [30 days of initiation]
Proportion with at least 2 SUD-related visits within 30 days of initiation, Washington Circle
initiation [Within 14 days of index visit]
Washington Circle initiation indicator--at least one SUD-related visit within 14 days of index visit
heavy alcohol use [6 months]
among people at baseline with heavy alcohol use, proportion with heavy alcohol use in past 30 days

Secondary Outcome Measures

Proportion initiating Brief therapy [6 months]
Proportion initiating brief therapy within 6 months
Proportion initiating MAT [6 months]
Proportion initiating MAT within 6 months, among those eligible for MAT, and if N's are large enough, stratified by type of MAT
abstinence from alcohol, opioids and all other drugs in the previous 30 days [collected at six months at the past 30 days]
abstinence from alcohol, opioids and all other drugs in the past 30 days

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

opiate or alcohol use disorder
not currently in substance use disorder treatment
past 30 day use of alcohol or opioids
English or Spanish speaking

Exclusion Criteria:

co-morbid severe mental illness
medically unstable

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Venice Family Clinic-Simms Mann Health Center	Santa Monica	California	United States	90405
2	Venice Family Clinic-Rose lAvenue	Venice	California	United States	90291