A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits

• Published in: The Journal of emergency medicine 2016-11, Vol.51 (5), p.498-507
• Main Authors: Neven, Darin, MS, MD, Paulozzi, Leonard, MD, MPH, Howell, Donelle, PhD, McPherson, Sterling, PhD, Murphy, Sean M., PhD, Grohs, Becky, RN, BSN, CCM, Marsh, Linda, RN, BSN, CCM, Lederhos, Crystal, MS, Roll, John, PhD
• Format: Article
• Language: English
• Subjects: Adult; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Chi-Square Distribution; Continuity of Patient Care - statistics & numerical data; Continuity of Patient Care - trends; Cooperative Behavior; Drug Overdose - prevention & control; ED care coordination; Emergency; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - utilization; Female; frequent ED users; Humans; Male; opioid prescribing; Pain - drug therapy; Prescription Drug Misuse - adverse effects; Prescription Drug Misuse - statistics & numerical data; prescription drug monitoring program; prescription opioid abuse; Washington
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2016.06.057

Abstract Background Increasing prescription overdose deaths have demonstrated the need for safer emergency department (ED) prescribing practices for patients who are frequent ED users. Objectives We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients. Methods We conducted a multisite randomized controlled trial (RCT) across all EDs in a metropolitan area; 165 patients with the most ED visits for complaints of pain were randomized. For the treatment arm, drivers of ED use were identified by medical record review. Patients and their primary care providers were contacted by phone. Each patient was discussed at a community multidisciplinary meeting where recommendations for ED care were formed. The ED care recommendations were stored in an ED information exchange system that faxed them to the treating ED provider when the patient presented to the ED. The control arm was subjected to treatment as usual. Results The intervention arm experienced a 34% decrease (incident rate ratios = 0.66, p