CE24-012 - Rigorous Evaluation of California Policies to Disseminate Emergency Department-based Services for Opioid Use Disorder

University Of California At Davis, Davis CA

Investigators

Abstract

PROJECT SUMMARY Medications for opioid use disorder (MOUD) can reduce overdose mortality risk, and emergency departments (EDs) have been urged to adopt policies and procedures to facilitate MOUD initiation for patients with untreated OUD. In California, major state policy initiatives have supported the dissemination of CA Bridge – an innovative ED-based substance use program emphasizing low-barrier, ED-initiated MOUD -- to most California EDs from 2018-2022. CA Bridge’s outreach and training has targeted vulnerable subpopulations, including Medicaid enrollees, non-White patients, and patients residing in rural areas. In response to the CDC’s call for rigorous evaluations of policies to address the overdose crisis, we will use Medicaid enrollment, inpatient, outpatient, and pharmacy Transformed Analytic Files (TAF) from California from 2018-2022 to conduct an observational analogue of a stepped-wedge trial among 186 California EDs that implemented CA Bridge during this period (58% of all California EDs). We will evaluate both short- and longer- term clinical impacts of CA Bridge implementation among Medicaid patients with OUD, and sub-analyses will examine impacts on racial/ethnic and rural/urban disparities by examining these factors as potential effect moderators. This project’s specific aims are: Aim 1) To determine the impact of CA Bridge implementation on rates of MOUD initiation (within 3 days of index ED visits) among Medicaid patients presenting to the ED with OUD. Aim 2) To assess whether CA Bridge implementation is associated with increased utilization of outpatient behavioral health services (within 90 days of index visits) and continued MOUD use (up to 360 days after index visits) among Medicaid patients presenting with OUD. Aim 3) To evaluate whether CA Bridge implementation is associated with reduced risk of fatal and non-fatal overdose (up to 360 days after index visits) among Medicaid patients presenting with OUD. For each aim, we will examine CA Bridge impacts on racial/ethnic and rural/urban disparities. Study results will have national health policy implications, as federal and state policymakers seek effective ED-based strategies to reduce overdose deaths. EDs nationwide are implementing programs to respond to the opioid epidemic, including ~600 EDs that have already adopted CA Bridge protocols. This work will inform researchers, clinicians, and program administrators regarding the strengths and limitations of implemented programs emphasizing ED-initiated MOUD, enabling program adaptation to maximally reduce overdose risk in the Medicaid population.