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ED-Beobachtung für Opioidkonsumstörung

30. Oktober 2026 aktualisiert von: NYU Langone Health

Messung der Verbesserung der Qualität der von der Notaufnahme initiierten Behandlung von Opioidkonsumstörungen durch Beobachtung

This is a multicenter, randomized clinical comparative effectiveness trial (RCT) in which patients with untreated OUD presenting to a Northwell Health Emergency Department (ED), NYULH-Brooklyn, NYULH-Tisch, and Bellevue Hospital will be randomized (1:1) to be managed clinically through either a standard ED visit or an extended visit through ED observation (EDOU).

Studienübersicht

Status

Abgeschlossen

Bedingungen

Intervention / Behandlung

Detaillierte Beschreibung

In this hybrid implementation-effectiveness study, there is no direct research intervention. Rather, clinical care with well-documented effectiveness will be delivered at the discretion of clinical staff guided by clinical protocols for the management of OUD with MOUD (Medications for Opioid Use Disorder) introduced at each site prior to study enrollment. Enrolled patients will be randomized to ED vs. EDOU and to participate in assessments conducted at the index visit and at 30 days and 90 days. Patient level data will also be matched with Medicaid claims data for more robust analyses and to support the development of clinical quality measures.

Studientyp

Interventionell

Einschreibung (Tatsächlich)

170

Phase

  • Unzutreffend

Kontakte und Standorte

Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.

Studienorte

    • New Jersey
      • Newark, New Jersey, Vereinigte Staaten, 07103
        • Rutgers University-University Hospital
    • New York
      • Brooklyn, New York, Vereinigte Staaten, 11220
        • NYULH-Brooklyn
      • New Hyde Park, New York, Vereinigte Staaten, 11040
        • Northwell Health - Long Island Jewish Medical Center
      • New York, New York, Vereinigte Staaten, 10016
        • Bellevue
      • New York, New York, Vereinigte Staaten, 10016
        • NYULH-Tisch
      • Staten Island, New York, Vereinigte Staaten, 10305
        • Northwell Health - Staten Island University Hospital

Teilnahmekriterien

Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.

Zulassungskriterien

Studienberechtigtes Alter

18 Jahre bis 100 Jahre (Erwachsene, Älterer Erwachsener)

Akzeptiert gesunde Freiwillige

Nein

Studienberechtigte Geschlechter

Alle

Beschreibung

Inclusion Criteria:

  • Is 18 years of age or older
  • Is able to speak English sufficiently to understand study procedures
  • Has a history of non-medical opioid use
  • Is a potential candidate for ED-based MOUD treatment initiation and referral at the site as confirmed by clinical staff
  • s not receiving MOUD through ongoing formal addiction treatment or pain management at the time of index ED visit
  • Is willing to receive either standard ED care or enhanced ED care in EDOU depending on random assignment
  • Presents to the ED during study screening hours

Exclusion Criteria:

  • Unwilling or unable to provide written/electronic informed consent/HIPAA Authorization for research procedures, including research visits at baseline and Day 30 and Day 90, and/or consent for the release of health records and data matching for a period of 2 years following enrollment and 1 year prior to enrollment.
  • Currently in jail, prison or any inpatient overnight facility as required by court of law or have pending legal action or that could prevent participation in the study
  • Presents from a medical-based extended care facility (e.g., skilled nursing facility)
  • Previous participation in the current study
  • Inadequate locator information (unable or unwilling to provide one unique mean of contact).
  • Has acute, severe medical, psychiatric, or concurrent substance use problem or meets other criteria that would exclude the patient (clinically) from placement in EDOU according to EDOU placement clinical protocols.

Studienplan

Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.

Wie ist die Studie aufgebaut?

Designdetails

  • Hauptzweck: Behandlung
  • Zuteilung: Zufällig
  • Interventionsmodell: Parallele Zuordnung
  • Maskierung: Keine (Offenes Etikett)

Waffen und Interventionen

Teilnehmergruppe / Arm
Intervention / Behandlung
Aktiver Komparator: Standard visit

Participants will have standard Emergency Department visit as per standard operating procedures which should last approximately 3 -5 hours.

Standard visit

Experimental: Extended visit with Observation

Participants will have extended Emergency Department visit by having an observation (which could be up to 23 hours) time in addition to the standard ED visit. In addition, information will be gathered about about the participants, use of opioids, healthcare visits, the quality of health, life, and treatment, and other topics. Urine or saliva or both may also be collected.

Emergency Department Observation Units (EDOU) would allow the highest risk patients - those presenting for nonfatal overdose - to receive their first dose of BUP before leaving the ED.

Operationally defined to include placement in an observation unit and/or placement under observation status with care provided by Emergency Medicine and/or other services (e.g., Internal medicine, Psychiatry)

Was misst die Studie?

Primäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Proportion of participants who receive Emergency Department (ED)-initiated Buprenorphine (BUP)
Zeitfenster: Week 1 (~7-10 days)

Receipt of ED-initiated BUP will be operationally defined to include administration of BUP and/or prescription for BUP as part of the ED/Emergency Department Observation (Units) (EDOU) visit. This measure will be abstracted from the health record primarily.

Week 1 (~7-10 days)
Proportion of participants who receive ED-initiated or ED-expedited BUP
Zeitfenster: Week 1 (~7-10 days)

Receipt of ED-initiated/expedited BUP will be operationally defined to include the provision of a specific "warm" referral or transfer of care to a provider, clinic, or treatment setting with the capacity to administer and/or prescribe BUP within 24 hours of completion of the ED/EDOU visit. Eligible transition of care will be will described further in the Manual of Operations (MOP) and will include direct transport or handoff to an outpatient provider immediately from the ED, provision of an appointment within 24 hours (with a specific time and location), transfer to general inpatient or inpatient OUD/addiction treatment. Neither confirmation of a completed appointment (i.e., patient shows up and is seen) nor receipt of BUP at the dedicated follow-up appointment will be required as the patient and treating provider may elect to treat with alternative regimes (e.g., methadone, naltrexone). This measure will be abstracted from the health record primarily.

Week 1 (~7-10 days)
Proportion of participants who receive ED-initiated or ED-expedited Medications for Opioid Use Disorder (MOUD)
Zeitfenster: Week 1 (~7-10 days)

Receipt of ED-initiated MOUD, inclusive of BUP, methadone, or naltrexone.

Week 1 (~7-10 days)
The proportion of participants who are successfully linked to formal addiction treatment within one week following the completion of their index ED/EDOU visit
Zeitfenster: Week 1 (~7-10 days)

Successful linkage to formal addiction treatment will be defined as confirmed attendance at formal addiction treatment for OUD following completion of the ED/EDOU visit. Formal addiction treatment will be those treatments consistent with the American Society of Addiction Medicine's (ASAM) level of care (1-4) and will include a range of clinical settings, including office-based providers of BUP or naltrexone, Opioid Treatment Programs (OTPs), intensive outpatient, inpatient, or residential treatments. Means of confirmation will include direct contact with the facility and/or treating clinician or other objective means (e.g., medical record review).

Week 1 (~7-10 days)
The proportion of participants who are confirmed to be engaged in formal addiction treatment for OUD on the 30th day following the completion of their index ED/EDOU visit
Zeitfenster: Day 30

Engagement in treatment for OUD will be defined as confirmed enrollment in formal addiction treatment for OUD on the 30th day following completion of the ED/EDOU visit. Attendance at two or more visits for formal addiction treatment within the 30-day period also constitutes engagement.

Day 30

Sekundäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Änderung des Anteils der Teilnehmer, die positiv auf illegale Opioide/Substanzen getestet wurden
Zeitfenster: Baseline, Tag 30
Baseline, Tag 30
Änderung des Anteils der Teilnehmer, die positiv auf illegale Opioide/Substanzen getestet wurden
Zeitfenster: Tag 30, Tag 90
Tag 30, Tag 90
Änderung der Anzahl von Überdosierungsereignissen und Risikoverhaltensweisen
Zeitfenster: Baseline, Tag 30
Baseline, Tag 30
Veränderung der Anzahl von Überdosierungsereignissen und Risikoverhaltensweisen
Zeitfenster: Tag 30, Tag 90
Tag 30, Tag 90
Veränderung des Anteils der Teilnehmer, die eine Behandlungszufriedenheit berichteten
Zeitfenster: Ausgangswert, Tag 30
Ausgangswert, Tag 30
Veränderung des Anteils der Teilnehmer, die Behandlungsszufriedenheit berichteten
Zeitfenster: Tag 30, Tag 90
Tag 30, Tag 90
Change in number of days of opioid and other drug use
Zeitfenster: Baseline, Day 30

Measured by the Timeline Follow-Back (TLFB) procedure will be used to elicit the participant's self-reported use of illicit substances at baseline and throughout study participation.

Baseline, Day 30
Change in number of days of opioid and other drug use
Zeitfenster: Day 30, Day 90

Measured by the Timeline Follow-Back (TLFB) procedure will be used to elicit the participant's self-reported use of illicit substances at baseline and throughout study participation.

Day 30, Day 90
Change in score on EuroQol-5 Dimensions (EQ-5D) Scale
Zeitfenster: Baseline, Day 30

EuroQol-5 Dimensions (EQ-5D): The EuroQol is a structured interview that collects general health information applicable to a wide range of health conditions and treatment, providing a simple descriptive profile and a single index value for health status between 0 (dead) and 1 (full health).

Baseline, Day 30
Change in score on EuroQol-5 Dimensions (EQ-5D) Scale
Zeitfenster: Day 30, Day 90

EuroQol-5 Dimensions (EQ-5D): The EuroQol is a structured interview that collects general health information applicable to a wide range of health conditions and treatment, providing a simple descriptive profile and a single index value for health status between 0 (dead) and 1 (full health).

Day 30, Day 90
Change in Score on Patient-Reported Outcomes Measurement Information System (PROMIS-29) Scale
Zeitfenster: Baseline, Day 30

Assessment of quality of life in seven health domains (physical function, fatigue, pain interference, depressive symptoms, anxiety, ability to participate in social roles and activities, and sleep disturbance) all assessed using the PROMIS-29 questionnaire. PROMIS-29 is scored on a T-score metric with a mean of 50 and a standard deviation of 10 in the U.S. general population, with a higher score representing more symptoms.

Baseline, Day 30
Change in Score on Patient-Reported Outcomes Measurement Information System (PROMIS-29) Scale
Zeitfenster: Day 30, Day 90

Assessment of quality of life in seven health domains (physical function, fatigue, pain interference, depressive symptoms, anxiety, ability to participate in social roles and activities, and sleep disturbance) all assessed using the PROMIS-29 questionnaire. PROMIS-29 is scored on a T-score metric with a mean of 50 and a standard deviation of 10 in the U.S. general population, with a higher score representing more symptoms.

Day 30, Day 90
Change in score on Patient Health Questionnaire (PHQ)-9 Scale
Zeitfenster: Baseline, Day 30

The PHQ-9 is a 9-item instrument used for screening, diagnosing, monitoring and measuring the severity of depression. Each item is rated from 0 (not at all) to 3 (nearly every day). Total scores range from 0-27. Scores are interpreted as follows: Minimal Depression: 0-4, Mild depression: 5-9, Moderate depression: 10-14, Moderately severe depression: 15-19, Severe depression: 20-27.

Baseline, Day 30
Change in score on Patient Health Questionnaire (PHQ)-9 Scale
Zeitfenster: Day 30, Day 90

The PHQ-9 is a 9-item instrument used for screening, diagnosing, monitoring and measuring the severity of depression. Each item is rated from 0 (not at all) to 3 (nearly every day). Total scores range from 0-27. Scores are interpreted as follows: Minimal Depression: 0-4, Mild depression: 5-9, Moderate depression: 10-14, Moderately severe depression: 15-19, Severe depression: 20-27.

Day 30, Day 90
Change in score on Treatment Effectiveness Assessment (TEA) Scale
Zeitfenster: Baseline, Day 30

Treatment Effectiveness Assessment (TEA) scale is comprised of 4 questions about substance use, health, lifestyle, and community. Participants respond the questions on how they have improved in that area on a scale from 1 (not better at all) to 10 (very much better). Higher scores indicate overall improvement and effectiveness of treatment.

Baseline, Day 30
Change in score on Treatment Effectiveness Assessment (TEA) Scale
Zeitfenster: Day 30, Day 90

Treatment Effectiveness Assessment (TEA) scale is comprised of 4 questions about substance use, health, lifestyle, and community. Participants respond the questions on how they have improved in that area on a scale from 1 (not better at all) to 10 (very much better). Higher scores indicate overall improvement and effectiveness of treatment.

Day 30, Day 90
Change in proportion of participants who reported changes in social determinants of health (e.g., homelessness, employment)
Zeitfenster: Baseline, Day 30

Self reported by participants.

Baseline, Day 30
Change in proportion of participants who reported changes in social determinants of health (e.g., homelessness, employment)
Zeitfenster: Day 30, Day 90

Self reported by participants.

Day 30, Day 90

Mitarbeiter und Ermittler

Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.

Sponsor

Mitarbeiter

Ermittler

  • Hauptermittler: Ryan McCormack, MD, NYU Langone Health

Studienaufzeichnungsdaten

Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.

Haupttermine studieren

Studienbeginn (Tatsächlich)

21. April 2022

Primärer Abschluss (Tatsächlich)

1. Juni 2025

Studienabschluss (Tatsächlich)

31. Juli 2026

Studienanmeldedaten

Zuerst eingereicht

14. September 2021

Zuerst eingereicht, das die QC-Kriterien erfüllt hat

23. September 2021

Zuerst gepostet (Tatsächlich)

1. Oktober 2021

Studienaufzeichnungsaktualisierungen

Letztes Update gepostet (Tatsächlich)

3. November 2026

Letztes eingereichtes Update, das die QC-Kriterien erfüllt

30. Oktober 2026

Zuletzt verifiziert

1. Oktober 2026

Mehr Informationen

Begriffe im Zusammenhang mit dieser Studie

Andere Studien-ID-Nummern

  • 20-01951
  • 5R33DA049265-03 (US NIH Stipendium/Vertrag)

Plan für individuelle Teilnehmerdaten (IPD)

Planen Sie, individuelle Teilnehmerdaten (IPD) zu teilen?

JA

Beschreibung des IPD-Plans

Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices).

IPD-Sharing-Zeitrahmen

Beginning 9 months and ending 36 months following article publication or as required by a condition of awards and agreements supporting the research.

IPD-Sharing-Zugriffskriterien

The investigator who proposed to use the data.Upon reasonable request. Requests should be directed to ryan.mccormack@nyulangone.org. To gain access, data requestors will need to sign a data access agreement.

Art der unterstützenden IPD-Freigabeinformationen

  • STUDIENPROTOKOLL
  • SAFT

Arzneimittel- und Geräteinformationen, Studienunterlagen

Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt

Nein

Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt

Nein

Diese Informationen wurden ohne Änderungen direkt von der Website clinicaltrials.gov abgerufen. Wenn Sie Ihre Studiendaten ändern, entfernen oder aktualisieren möchten, wenden Sie sich bitte an register@clinicaltrials.gov. Sobald eine Änderung auf clinicaltrials.gov implementiert wird, wird diese automatisch auch auf unserer Website aktualisiert .