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A Randomized Control Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related ED Visits

Center for Disease Control
5/23/2011 – 5/24/2013

Abstract

This funding will be used to conduct a randomized trial to determine the effectiveness of a city-wide ED care coordination model to reduce ED visits and opioid prescriptions for frequent ED users with complaints of pain. The trial will randomly assign patients into a city-wide ED care coordination program or treatment as usual (i.e., not being enrolled in the program). The city-wide ED care coordination program will be implemented at each of the three EDs in the Tri-Cities, Washington metropolitan area. The program will assure the patient receives appropriate ED care that is based on the patient’s medical history and consistent with the primary care provider’s treatment plan each time the patient presents at an ED. A computerized care coordination system will be implemented to share care coordination information with EDs at the time of treatment. Our research efforts are designed to determine if this model of ED care coordination can be successfully implemented in a new metropolitan area and if the model is significantly more effective than treatment as usual.

During the start-up stage of the proposed trial the hospital information systems of the three EDs will be connected securely over the internet to a citywide computerized care coordination system. A multi-disciplinary, care coordination team will be assembled that will enroll patients with high ED utilization (i.e., 5 or greater ED visits per year) for pain related complaints. This team will review medical information of patients randomized to the treatment arm of the study and create an ED care plan. The ED care plan will then be distributed on the city-wide care coordination system. When a patient in the treatment arm registers in one of the three EDs, the care coordination system will proactively send the ED care plan to the ED staff.

The ED provider will be able to review the care plan prior to examining the patient. Opioid prescription data from the three EDs will be analyzed to determine the effect of the program on ED opioid prescribing practices. To this end, this trial will determine if there is a significant decrease in ED visits for patients enrolled in the treatment arm compared to the control group. It is expected that our work will result in an evidence-based approach designed to reduce prescription drug misuse. Moreover, this trial will demonstrate that this model of care is a workable solution for other areas. Results are anticipated to enhance efforts to curtail prescription drug related overdose deaths by providing a prescription opioid management approach that can be implemented nationwide at multiple sites.

Primary Investigator

Darin Neven, MD, Providence Medical Center

Co-Investigators