Emergency department longitudinal integrated care (EDLINC) study: Protocol for a pragmatic effectiveness randomized clinical trial.

BACKGROUND

The US is experiencing an opioid epidemic with opioid overdose, opioid use disorder (OUD) and Emergency Department (ED) visits related to opioids on the rise. Evidence-based comprehensive disease management strategies such as the Collaborative Care model that can flex across care settings hold great promise for addressing the treatment needs of patients with OUD in the ED but have not been formally tested in large-scale randomized clinical trials.

METHODS

Emergency Department Longitudinal Integrated Care (EDLINC) is a multi-component intervention for patients with OUD and related comorbidity derived from the collaborative care model that is initiated during an ED visit or inpatient hospital stay. Using a pragmatic clinical trial design, patients with OUD seeking care in the ED will be randomized to the EDLINC intervention or usual care control conditions. Patients in the trial randomized to the EDLINC intervention will receive; 1) overdose education; 2) brief intervention targeting motivation to engage in outpatient care; 3) a patient-centered approach to MOUD using a treatment decision support tool; and 4) longitudinal and proactive care management which will proceed for three months with weekly caseload supervision. EDLINC is supported by the Emergency Department Information Exchange (EDIE), a health information exchange platform. Outcomes will be obtained at scheduled intervals from baseline to 12 months.

DISCUSSION: This pragmatic clinical trial simultaneously aims to establish the effectiveness of the EDLINC intervention while also addressing sustainable implementation.