TY - JOUR
AU - D. Marcovitz
AU - M. L. Dear
AU - R. Donald
AU - D. A. Edwards
AU - K. A. Kast
AU - T. D. V. Le
AU - M. V. Shah
AU - J. Ferrell
AU - C. Gatto
AU - C. Hennessy
AU - R. Buie
AU - T. W. Rice
AU - W. Sullivan
AU - K. D. White
AU - G. Van Winkle
AU - R. Wolf
AU - C. J. Lindsell
A1 - 
AB - IMPORTANCE: Co-located bridge clinics aim to facilitate a timely transition to outpatient care for inpatients with opioid use disorder (OUD); however, their effect on hospital length of stay (LOS) and postdischarge outcomes remains unclear. OBJECTIVE: To evaluate the effect of a co-located bridge clinic on hospital LOS among inpatients with OUD. DESIGN, SETTING, AND PARTICIPANTS: This parallel-group randomized clinical trial recruited 335 adult inpatients with OUD seen by an addiction consultation service and without an existing outpatient clinician to provide medication for OUD (MOUD) between November 25, 2019, and September 28, 2021, at a tertiary care hospital affiliated with a large academic medical center and its bridge clinic. INTERVENTION: The bridge clinic included enhanced case management before and after hospital discharge, MOUD prescription, and referral to a co-located bridge clinic. Usual care included MOUD prescription and referrals to community health care professionals who provided MOUD. MAIN OUTCOMES AND MEASURES: The primary outcome was the index admission LOS. Secondary outcomes, assessed at 16 weeks, were linkage to health care professionals who provided MOUD, MOUD refills, same-center emergency department (ED) and hospital use, recurrent opioid use, quality of life (measured by the Schwartz Outcome Scale-10), overdose, mortality, and cost. Analysis was performed on an intent-to-treat basis. RESULTS: Of 335 participants recruited (167 randomized to the bridge clinic and 168 to usual care), the median age was 38.0 years (IQR, 31.9-45.7 years), and 194 (57.9%) were male. The median LOS did not differ between arms (adjusted odds ratio [AOR], 0.94 [95% CI, 0.65-1.37]; P = .74). At the 16-week follow-up, participants referred to the bridge clinic had fewer hospital-free days (AOR, 0.54 [95% CI, 0.32-0.92]), more readmissions (AOR, 2.17 [95% CI, 1.25-3.76]), and higher care costs (AOR, 2.25 [95% CI, 1.51-3.35]), with no differences in ED visits (AOR, 1.15 [95% CI, 0.68-1.94]) or deaths (AOR, 0.48 [95% CI, 0.08-2.72]) compared with those receiving usual care. Follow-up calls were completed for 88 participants (26.3%). Participants referred to the bridge clinic were more likely to receive linkage to health care professionals who provided MOUD (AOR, 2.37 [95% CI, 1.32-4.26]) and have more MOUD refills (AOR, 6.17 [95% CI, 3.69-10.30]) and less likely to experience an overdose (AOR, 0.11 [95% CI, 0.03-0.41]). CONCLUSIONS AND RELEVANCE: This randomized clinical trial found that among inpatients with OUD, bridge clinic referrals did not improve hospital LOS. Referrals may improve outpatient metrics but with higher resource use and expenditure. Bending the cost curve may require broader community and regional partnerships. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04084392.
AD - Vanderbilt University School of Medicine, Nashville, Tennessee.; Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee.; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee.; Division of Pain Medicine, Department of Anesthesia, Vanderbilt University Medical Center, Nashville, Tennessee.; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.; Office of Episodes of Care, Vanderbilt University Medical Center, Nashville, Tennessee.; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.; Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee.
AN - 38411964
BT - JAMA Netw Open
C5 - Opioids & Substance Use; Measures; Financing & Sustainability
CP - 2
DA - Feb 5
DO - 10.1001/jamanetworkopen.2023.56430
DP - NLM
ET - 20240205
IS - 2
JF - JAMA Netw Open
LA - eng
N2 - IMPORTANCE: Co-located bridge clinics aim to facilitate a timely transition to outpatient care for inpatients with opioid use disorder (OUD); however, their effect on hospital length of stay (LOS) and postdischarge outcomes remains unclear. OBJECTIVE: To evaluate the effect of a co-located bridge clinic on hospital LOS among inpatients with OUD. DESIGN, SETTING, AND PARTICIPANTS: This parallel-group randomized clinical trial recruited 335 adult inpatients with OUD seen by an addiction consultation service and without an existing outpatient clinician to provide medication for OUD (MOUD) between November 25, 2019, and September 28, 2021, at a tertiary care hospital affiliated with a large academic medical center and its bridge clinic. INTERVENTION: The bridge clinic included enhanced case management before and after hospital discharge, MOUD prescription, and referral to a co-located bridge clinic. Usual care included MOUD prescription and referrals to community health care professionals who provided MOUD. MAIN OUTCOMES AND MEASURES: The primary outcome was the index admission LOS. Secondary outcomes, assessed at 16 weeks, were linkage to health care professionals who provided MOUD, MOUD refills, same-center emergency department (ED) and hospital use, recurrent opioid use, quality of life (measured by the Schwartz Outcome Scale-10), overdose, mortality, and cost. Analysis was performed on an intent-to-treat basis. RESULTS: Of 335 participants recruited (167 randomized to the bridge clinic and 168 to usual care), the median age was 38.0 years (IQR, 31.9-45.7 years), and 194 (57.9%) were male. The median LOS did not differ between arms (adjusted odds ratio [AOR], 0.94 [95% CI, 0.65-1.37]; P = .74). At the 16-week follow-up, participants referred to the bridge clinic had fewer hospital-free days (AOR, 0.54 [95% CI, 0.32-0.92]), more readmissions (AOR, 2.17 [95% CI, 1.25-3.76]), and higher care costs (AOR, 2.25 [95% CI, 1.51-3.35]), with no differences in ED visits (AOR, 1.15 [95% CI, 0.68-1.94]) or deaths (AOR, 0.48 [95% CI, 0.08-2.72]) compared with those receiving usual care. Follow-up calls were completed for 88 participants (26.3%). Participants referred to the bridge clinic were more likely to receive linkage to health care professionals who provided MOUD (AOR, 2.37 [95% CI, 1.32-4.26]) and have more MOUD refills (AOR, 6.17 [95% CI, 3.69-10.30]) and less likely to experience an overdose (AOR, 0.11 [95% CI, 0.03-0.41]). CONCLUSIONS AND RELEVANCE: This randomized clinical trial found that among inpatients with OUD, bridge clinic referrals did not improve hospital LOS. Referrals may improve outpatient metrics but with higher resource use and expenditure. Bending the cost curve may require broader community and regional partnerships. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04084392.
PY - 2024
SN - 2574-3805
SP - e2356430
ST - Effect of a Co-Located Bridging Recovery Initiative on Hospital Length of Stay Among Patients With Opioid Use Disorder: The BRIDGE Randomized Clinical Trial
T1 - Effect of a Co-Located Bridging Recovery Initiative on Hospital Length of Stay Among Patients With Opioid Use Disorder: The BRIDGE Randomized Clinical Trial
T2 - JAMA Netw Open
TI - Effect of a Co-Located Bridging Recovery Initiative on Hospital Length of Stay Among Patients With Opioid Use Disorder: The BRIDGE Randomized Clinical Trial
U1 - Opioids & Substance Use; Measures; Financing & Sustainability
U3 - 10.1001/jamanetworkopen.2023.56430
VL - 7
VO - 2574-3805
Y1 - 2024
ER -