Implementation of a comprehensive hospitalist‐led initiative to improve care for patients with opioid use disorder

Abstract

Background: As opioid-related hospitalizations rise, hospitals must be prepared to evaluate and treat patients with opioid use disorder (OUD). We implemented a hospitalist-led program, Project Caring for patients with Opioid Misuse through Evidence-based Treatment (COMET) to address gaps in care for hospitalized patients with OUD.

Non-overdose acute care hospitalizations for opioid use disorder among commercially-insured adults: a retrospective cohort study

“…Translating this observed treatment gap into practice may include expanding care pathways and programs that better identify patients with OUD and assess the need for treatment during general acute care hospitalizations [ 43 , 44 ], similar to the programs that actively screen and treat OUD in emergency or primary care settings [ 45 , 46 ]. There is increasing evidence that establishing structures and increasing capacity among inpatient physicians to prescribe medication for OUD during all types of hospitalizations effectively decreases substance use disorder symptoms and drug use, avoids self-directed discharges, and engages people with OUD in post-discharge treatment [ 24 , 25 , 47 , 48 ].…”

Medications for opioid use disorder: Education matters

“…Among all patients seen by the COMET consult service and diagnosed with OUD during their hospitalization, use of MOUD increased significantly from 36% in the pre‐COMET period to 57% in the post‐COMET period. The proportions of patients who were prescribed buprenorphine with naloxone at discharge also increased significantly from 2% to 20% in the pre‐COMET period and from 2% to 26% ( p < .001) in the post‐COMET period 8 …”

“…7 The May 2022 issue of the Journal of Hospital Medicine highlighted how focused education for hospitalists as part of a comprehensive, multidisciplinary program resulted in improved access to MOUD for patients admitted with OUD. The program, Project Caring for patients with opioid misuse through evidencebased treatment (COMET) 8 was launched in 2019 as an OUD consult service led by 14 hospitalists who were required to complete DATA waiver training and participate in an orientation prior to starting the service. Over 2 years, 512 patients were evaluated for OUD by the service and 71% received MOUD.…”

“…The proportions of patients who were prescribed buprenorphine with naloxone at discharge also increased significantly from 2% to 20% in the pre-COMET period and from 2% to 26% (p < .001) in the post-COMET period. 8…”

Treating hospitalized people who have opioid use disorder: Coming to consensus

“…Englander et al 4 recently produced a taxonomy of hospital-based addiction treatment models that distinguishes consult models and practice-based models, with the latter leveraging generalists. A growing number of practitioners have established hospitalist-led programs and reported their experience (e.g., Christian et al 5 and Clifton et al 6 ) and some states have supported implementation efforts focused on practice-based models by providing education, toolkits, consultation, and funding. 7,8 Telehealth addiction consults during hospitalization are feasible 9 In addition, the consensus statement highlights the need for research on MOUD initiation and dose adjustment in patients with OUD and pain, including chronic pain.…”