Evaluating the Impact of the Bridge Clinic in Patients With Opioid Use Disorder

Study Overview
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Brief Summary
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This study aims to determine whether referral to the Bridge Clinic reduces overall index hospital length of stay when compared to direct referral to a long-term outpatient addiction provider for patients with active opioid use disorder (OUD) being considered for medications-for-addiction treatment (MAT).

Official Title
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Evaluating the Impact of the Bridge Clinic in Patients With Opioid Use Disorder

Conditions
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Opioid Use, Opioid-use Disorder

Intervention / Treatment
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* Other: Bridge Clinic
* Other: Usual Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Inpatients at VUH with active OUD being considered for MAT. Patient accepting a transitional prescription for buprenorphine-naloxone or IM naltrexone whose outpatient plans are not fixed Exclusion Criteria: Deemed ineligible for referral to outpatient Bridge Clinic by the Addiction Consult Team (examples include but are not limited to patients with severe, active co-occurring psychiatric disorders requiring a higher level of psychiatric care or patients for whom methadone maintenance is deemed the best choice of MAT). Patients previously randomized in this study.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Programmatic evaluation - eligible participants will be individually randomized to either direct referral to a long-term outpatient addiction provider or referral to the Bridge Clinic while long-term outpatient addiction provider is located/identified.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Usual Care<br>Participants randomized to this arm will receive care as usual. | Other: Usual Care<br>* Referral to an outpatient provider for addiction treatment.<br>|
| Active Comparator: Bridge Clinic<br>Participants randomized to this arm will be referred to the Bridge Clinic to facilitate identification and referral to an outpatient provider for addiction treatment. | Other: Bridge Clinic<br>* Referral to the Bridge Clinic for temporary outpatient addiction treatment while the bridge clinic identifies an outpatient addiction treatment provider to accept the patient for long term treatment.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital length of stay | Overall index hospital length of stay measured in days | approximately 3 to 42 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cost | Total costs, and costs for each admission and care resource used measured in dollars | 16 weeks post-randomization | 
| Successful care linkage | Dichotomous self-reported outcome of linkage to a MAT provider as defined by attending at least one visit with a MAT provider | 16 weeks post-randomization | 
| MAT prescription filled by participant | Reported buprenorphine-naloxone (or naltrexone) prescriptions filled | 16 weeks post-randomization | 
| Readmissions and Emergency Department (ED) visits | Composite number of ED visits and readmissions | 16 weeks post-randomization | 
| Hospital and ED free days | Days alive out of the hospital and/or ED | 16 weeks post-randomization | 
| Mortality | Death in hospital or documented at 16-week follow up or in the medical record - dichotomous measurement | 16 weeks post-randomization | 
| Recurrent opioid use | Reported recurrent opioid use and the approximate number of times of opioid use | 16 weeks post-randomization | 
| Overdose | Any overdose self-reported at the 16-week follow up | 16 weeks post-randomization | 
| Quality of Life - Schwartz Outcome Scale-10 (SOS10). | The SOS10 survey has ten questions scored on a 0 (never) to 6 (all or nearly all of the time) scale. A total score is computed as the sum across the 10 questions. | 16 weeks post-randomization |