Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.
J Hosp Med. 2022 Jun;17(6):427-436. doi: 10.1002/jhm.12837. Epub 2022 May 10.
As opioid-related hospitalizations rise, hospitals must be prepared to evaluate and treat patients with opioid use disorder (OUD). We implemented a hospitalist-led program, Project Caring for patients with Opioid Misuse through Evidence-based Treatment (COMET) to address gaps in care for hospitalized patients with OUD.
Implement evidence-based treatment for inpatients with OUD and refer to postdischarge care.
DESIGN, SETTING, AND PARTICIPANTS: Project COMET launched in July 2019 at Duke University Hospital (DUH), an academic medical center in Durham, NC.
INTERVENTION, MAIN OUTCOMES, AND MEASURES: We engaged key stakeholders, performed a needs assessment, and secured health system funding. We developed protocols to standardize OUD treatment and employed a social worker to facilitate postdischarge care. Electronic health records were utilized for data analysis.
COMET evaluated 512 patients for OUD during their index hospitalization from July 1, 2019 through June 30, 2021. Seventy-one percent of patients received medication for OUD (MOUD) during admission. Of those who received buprenorphine during admission, 64% received a discharge prescription. Of those who received methadone during admission, 83% of eligible patients were connected to a methadone clinic. Among all patients at DUH with OUD, MOUD use during hospitalization and at discharge increased in the post-COMET period compared to the pre-COMET period (p < .001 for both).
Our program is one of the first to demonstrate successful implementation of a hospitalist-led, comprehensive approach to caring for hospitalized patients with OUD and can serve as an example to other institutions seeking to implement life-saving, evidence-based treatment in this population.
随着阿片类药物相关住院人数的增加，医院必须做好准备，评估和治疗阿片类药物使用障碍（OUD）患者。我们实施了一项以医院医生为主导的项目，即通过循证治疗关爱阿片类药物滥用患者（COMET），以解决住院 OUD 患者护理方面的差距。
为 OUD 住院患者实施循证治疗，并转介至出院后护理。
设计、地点和参与者：COMET 项目于 2019 年 7 月在北卡罗来纳州达勒姆市的学术医疗中心杜克大学医院（DUH）启动。
干预措施、主要结果和测量：我们与主要利益相关者合作，进行需求评估，并获得了卫生系统的资金。我们制定了标准化 OUD 治疗方案，并聘请了一名社会工作者来促进出院后护理。电子健康记录用于数据分析。
COMET 在 2019 年 7 月 1 日至 2021 年 6 月 30 日期间对 512 名 OUD 患者进行了评估。71%的患者在住院期间接受了 OUD 药物治疗（MOUD）。在接受丁丙诺啡治疗的患者中，64%的患者获得了出院处方。在接受美沙酮治疗的患者中，83%符合条件的患者与美沙酮诊所建立了联系。在 DUH 所有患有 OUD 的患者中，与 COMET 实施前相比，COMET 实施后住院期间和出院时 MOUD 的使用率均有所增加（两者均 < .001）。
我们的项目是首批成功实施以医院医生为主导的综合性方法来照顾住院 OUD 患者的项目之一，可以为其他寻求在该人群中实施挽救生命、循证治疗的机构提供范例。
