Partnering with a large health system to study the effectiveness of an innovative clinical program to improve care for hospital patients with substance use disorders:  Pragmatic trial of the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in 6 New York City public hospitals

Jennifer McNeely, MD
NYU Grossman School of Medicine

ABSTRACT:
Individuals with substance use disorders (SUD) have high rates of hospitalization, and frequently have poor health outcomes and low rates of addiction treatment.  Hospital-based addiction consult services have the potential to improve inpatient and post-discharge care for patients with substance use disorders (SUD), and can be an important component of strategies to reduce opioid-related overdose.  Beginning in 2017, with special funds from the NYC Mayor’s Office to address the opioid crisis, the New York City Health + Hospitals (H+H) system began the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in 6 hospitals.  We partnered with H+H to design the program model and conduct a NIDA-funded pragmatic trial of the CATCH program focused on patients with opioid use disorder (OUD).  A hybrid effectiveness-implementation study (Type 1) studied the effectiveness of CATCH for increasing post-discharge initiation and engagement in OUD treatment, while studying the process of implementing this large new program in public hospital settings to inform its adoption and sustainability.  A stepped-wedge cluster randomized trial design compared treatment outcomes for patients hospitalized during the CATCH versus treatment as usual periods.  A mixed methods approach primarily utilized Medicaid claims data to measure outcomes, while electronic health records data and interviews with staff and patients provided additional information on implementation fidelity and barriers.  Our study involved active ongoing collaboration with the H+H system, including through the first year of the COVID-19 pandemic, which presented unprecedented challenges to the City’s public hospitals.  This talk will reflect on the process of partnering with a large health system to study a new program, present findings on the program’s effectiveness, and discuss the implementation process and outcomes.