Navigation Services to Avoid Rehospitalization (NavSTAR)
- Conditions
- Cocaine Use DisorderOpioid-use DisorderAlcohol Use Disorder
- Interventions
- Behavioral: NavSTAR
- Registration Number
- NCT02599818
- Lead Sponsor
- Friends Research Institute, Inc.
- Brief Summary
This study will examine the clinical effectiveness and health economic profile of services to link hospital patients with substance use disorders to addiction treatment, promote their medical stabilization, and reduce hospital re-admissions.
- Detailed Description
In recent years, the problem of rehospitalization has come under intense focus as a major contributor to preventable morbidity and escalating healthcare costs. Substance use disorders are strongly associated with poor health outcomes and highly inefficient use of healthcare services, including repeat hospitalizations. Interventions that increase adherence to recommendations for outpatient medical care and substance abuse treatment could potentially help recently-hospitalized individuals with substance use disorders to avoid unnecessary rehospitalization, associated morbidity, and medical expenses. The current study is a randomized controlled trial comparing the effectiveness of Navigation Services to Avoid Rehospitalization (NavSTAR) vs. Treatment-as-Usual (TAU) for hospital patients with co-occurring medical problems and substance use disorders. Applying Andersen's theoretical model of health service utilization, NavSTAR will employ the promising strategies of Patient Navigation and motivational interventions to facilitate engagement in outpatient medical and substance abuse treatment, thereby lowering the likelihood of rehospitalization. Patient Navigators embedded within the substance abuse consultation liaison service at a large urban hospital will deliver patient-centered, proactive navigation and motivational services initiated during the hospital stay and continued for 3 months post-discharge. Participants randomized to TAU will receive usual care from the hospital and the substance abuse consultation liaison service, which includes referral to substance abuse treatment but no continued contact post-hospital discharge. Participants will be assessed at study entry and again at 3-, 6-, and 12-months follow-up on various measures of healthcare utilization, substance use, and functioning. The primary outcome of interest is time-to-rehospitalization through 12 months. In addition, a range of secondary outcomes spanning the medical and substance abuse service areas will be assessed. The study will include an economic evaluation of the cost, incremental cost-effectiveness, and cost-benefits of NavSTAR from the service provider perspective.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 400
- adult (ages 18 and older) hospital patients;
- current DSM-5 SUD (not in remission) for alcohol, cocaine, or opioids
- willing and able to provide informed consent.
- current enrollment in SUD treatment;
- primary residence outside of Baltimore City;
- pregnant;
- terminal medical condition (e.g., planned discharge to hospice);
- hospitalized for a suicide attempt.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description NavSTAR NavSTAR Participants in this arm will receive services from the NavSTAR Patient Navigation team. The Patient Navigator will work with patients for up to 3 months post-hospital discharge to resolve internal barriers (e.g., ambivalence about treatment; low motivation; competing life demands, etc.) and external barriers (e.g., lack of transportation; lack of ID card, etc.) to appropriate utilization and engagement in addiction treatment and medical care. Interventions include motivational interventions and patient navigation with proactive case management, tailored to participants' specific needs.
- Primary Outcome Measures
Name Time Method Time-to-Rehospitalization 12 months Days to rehospitalization
- Secondary Outcome Measures
Name Time Method Mortality 3, 6, 12 months all-cause mortality
opioid use (urine test) 3, 6, 12 months opioid use assessed via urine test
Cumulative days of inpatient hospitalization 3, 6, 12 months cumulative days of inpatient hospitalization
Emergency Department utilization rate 3, 6, 12 months rate of Emergency Department utilization
30-day rehospitalization rate 30 days rate of rehospitalization within 30 days
Emergency Department visits 3, 6, 12 months cumulative number of Emergency Department visits
opioid use (self-report) 3, 6, 12 months days of opioid use in the past 30 days assessed via self-report
cocaine use disorder criteria 3, 6, 12 months acute substance use disorder criteria for cocaine
addiction treatment entry 3, 6, 12 months rate of entry into addiction treatment
alcohol use disorder criteria 3, 6, 12 months acute substance use disorder criteria for alcohol
medical follow-up care 3, 6, 12 months entry into recommended medical follow-up care post-hospital discharge
cocaine use (self-report) 3, 6, 12 months days of cocaine use in the past 30 days assessed via self-report
cocaine use (urine test) 3, 6, 12 months cocaine use assessed via urine test
self-reported quality of life rating 3, 6, 12 months quality of life scores as determined by the WHO-QOL BREF
alcohol use (self-report) 3, 6, 12 months days of alcohol use in the past 30 days assessed via self-report
opioid use disorder criteria 3, 6, 12 months acute substance use disorder criteria for opioids
Trial Locations
- Locations (1)
University of Maryland Medical Center
🇺🇸Baltimore, Maryland, United States