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ED-observatie voor stoornis in het gebruik van opioïden

30 oktober 2026 bijgewerkt door: NYU Langone Health

Meten van verbetering van de kwaliteit van door de spoedeisende hulp geïnitieerde behandeling van opioïdengebruiksstoornissen met behulp van observatie

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).

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

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.

Studietype

Ingrijpend

Inschrijving (Werkelijk)

170

Fase

  • Niet toepasbaar

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

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

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar tot 100 jaar (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

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.

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Actieve vergelijker: Standard visit

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

Standard visit
Experimenteel: 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.
Ander: Extended Visit with Observation

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)

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Proportion of participants who receive Emergency Department (ED)-initiated Buprenorphine (BUP)
Tijdsspanne: 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
Tijdsspanne: 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)
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Verandering in het aandeel deelnemers die positief testten op illegale opioïden/substanties
Tijdsspanne: Baseline, Dag 30
Baseline, Dag 30
Verandering in het aandeel deelnemers dat positief testte op illegale opioïden/substanties
Tijdsspanne: Dag 30, Dag 90
Dag 30, Dag 90
Verandering in aantal overdosisgebeurtenissen en risicogedrag
Tijdsspanne: Baseline, Dag 30
Baseline, Dag 30
Verandering in aantal overdosisgebeurtenissen en risicogedrag
Tijdsspanne: Dag 30, Dag 90
Dag 30, Dag 90
Verandering in het aandeel deelnemers dat tevredenheid met de behandeling rapporteerde
Tijdsspanne: Baseline, Dag 30
Baseline, Dag 30
Verandering in het aandeel deelnemers dat tevredenheid met de behandeling rapporteerde
Tijdsspanne: Dag 30, Dag 90
Dag 30, Dag 90
Change in number of days of opioid and other drug use
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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)
Tijdsspanne: 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)
Tijdsspanne: Day 30, Day 90

Self reported by participants.
Day 30, Day 90

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

NYU Langone Health

Medewerkers

National Institute on Drug Abuse (NIDA)

Onderzoekers

  • Hoofdonderzoeker: Ryan McCormack, MD, NYU Langone Health

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Werkelijk)

21 april 2022

Primaire voltooiing (Werkelijk)

1 juni 2025

Studie voltooiing (Werkelijk)

31 juli 2026

Studieregistratiedata

Eerst ingediend

14 september 2021

Eerst ingediend dat voldeed aan de QC-criteria

23 september 2021

Eerst geplaatst (Werkelijk)

1 oktober 2021

Updates van studierecords

Laatste update geplaatst (Werkelijk)

3 november 2026

Laatste update ingediend die voldeed aan QC-criteria

30 oktober 2026

Laatst geverifieerd

1 oktober 2026

Meer informatie

Termen gerelateerd aan deze studie

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • 20-01951
  • 5R33DA049265-03 (Subsidie/contract van de Amerikaanse NIH)

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

JA

Beschrijving IPD-plan

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

IPD-tijdsbestek voor delen

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

IPD-toegangscriteria voor delen

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.

IPD delen Ondersteunend informatietype

  • LEERPROTOCOOL
  • SAP

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .

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