The Continuum of Care in Hospitalized Patients with Opioid Use Disorder and Infectious Complications of Drug Use (CHOICE)

Overview 

The Research Need 

People who inject opioids have high rates of serious infections that may require hospitalization (including systemic bacterial infections and heart infections), as well as chronic infections such as HIV and hepatitis C virus. If opioid use disorder is not addressed, these infections can relapse or recur, leading to preventable emergency department visits, hospitalizations, and deaths due to infection or opioid use. Pilot data obtained from four university hospitals show that we have incomplete understanding of how to optimize interventions to best reduce opioid-related harms and prevent further serious infections in these patients. There is a pressing need to understand the impact of interventions to address opioid use disorder across a patient’s continuum of care – both during initial hospitalization and after discharge – to improve long-term health of people who inject drugs.  

About the Program 

This program will evaluate patients hospitalized with an infectious complication of injection drug use and identify and understand gaps in care that arise across the continuum of care. That includes hospitalization, the transition from inpatient to outpatient care, and the year after discharge. The program will develop an informed intervention to eliminate barriers and improve health outcomes in this population.  

This implementation research will be a collaboration of scientists at four academic medical centers that collectively represent a broad framework of the U.S. healthcare system. Together, these institutions treat a range of patients from both urban and rural regions, Black- and White-predominant communities, and states with and without Medicaid expansion.  

The research will include retrospective analyses of patient data – as well as planning, implementation, and final effectiveness analyses of a package of interventions. This research will also determine which interventions are prioritized by institutions involved in the study, as well as which programs are the most successful, using a variety of outcome metrics. The research will also determine which interventions can generate revenue toward sustainability.