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Randomized Controlled Trial
. 2024 Feb 5;7(2):e2356430.
doi: 10.1001/jamanetworkopen.2023.56430.

Effect of a Co-Located Bridging Recovery Initiative on Hospital Length of Stay Among Patients With Opioid Use Disorder: The BRIDGE Randomized Clinical Trial

David Marcovitz  1   2 , Mary Lynn Dear  1   3 , Rebecca Donald  1   4 , David A Edwards  1   4 , Kristopher A Kast  1   2 , Thao D V Le  1 , Mauli V Shah  2 , Jason Ferrell  2 , Cheryl Gatto  3   5 , Cassandra Hennessy  5 , Reagan Buie  6 , Todd W Rice  3   7 , William Sullivan  8 , Katie D White  9 , Grace Van Winkle  3 , Rachel Wolf  8 , Christopher J Lindsell  5 ; Vanderbilt Learning Healthcare System Platform Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Effect of a Co-Located Bridging Recovery Initiative on Hospital Length of Stay Among Patients With Opioid Use Disorder: The BRIDGE Randomized Clinical Trial

David Marcovitz et al. JAMA Netw Open. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Marcovitz reported having equity in Better Life Partners LLC and Legion Health LLC. Dr Rice reported receiving grants from the Centers for Disease Control and Prevention (CDC) paid to his institution and the Department of Defense paid to institution and personal fees from Cumberland Pharmaceutical Inc and Sanofi outside the submitted work. Dr Lindsell reported receiving grants from the National Institutes of Health paid to institution and the Department of Defense paid to institution; contracts from the CDC, Entegrion, Endpoint Health, AstraZeneca, Cytokinetics, Biomeme, and Novartis for research services to institution; and personal fees from Emory University and Vanderbilt University for research services outside the submitted work; in addition, Dr Lindsell had a patent for risk prediction in sepsis and septic shock issued to Cincinnati Children’s Hospital Medical Center and stock options in Bioscape Digital unrelated to the current work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Diagram of Participant Flow Through the Trial
ACS indicates addiction consultation service; MOUD, medication for opioid use disorder; OPAT, outpatient parenteral antibiotic therapy; and OUD, opioid use disorder.
Figure 2.
Figure 2.. Primary Outcome: Length of Stay by Study Group
AOR indicates adjusted odds ratio.
See this image and copyright information in PMC

Comment in

References

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