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Mancini Quality Improvement Project

Mancini Quality Improvement Project

Thanks to the generous donation from Janet and Vincent Mancini, the Division of General Internal Medicine is conducting a quality improvement project on opioid use disorder.

Inpatient setting:
Opioid use disorder (OUD) is a common diagnosis amongst hospitalized patients and may be the primary reason they are in the hospital or a large contributor to their presenting complaint. Patients with substance use disorders are among the highest users of health care, incurring disproportionately high health care costs and often requiring repeat hospital admissions 1.Despite this, a recent retrospective study concluded that addiction-specific interventions remain underutilized, both during hospital admission and at the time of discharge 2. Hospitalization is an ideal time to discuss opioid cessation for patients with OUD as well as to assist with detoxification and initiation of medication-assisted treatment (MAT). A randomized clinical trial involving patients with OUD showed that initiating buprenorphine during a hospitalization as well as linkage to outpatient buprenorphine treatment increased the likelihood of being on buprenorphine and reduced illicit opioid use at 6 months 3. Additionally, MAT during an acute hospital admission can facilitate management of other medical issues by relieving symptoms associated with withdrawal and reducing rates of discharge against medical advice. This approach has been shown to reduce illicit opioid use and increase retention in addiction treatment, thus leading to lower risk of opioid-associated health problems and mortality 4. With the introduction of the Addiction Medicine consult service, the University of Utah has made addressing substance use disorder a priority in the inpatient setting. To further address OUD in hospitalized patients, we hypothesize that the introduction of an inpatient OUD order set involving buprenorphine initiation will increase provider familiarity with and buy in of inpatient treatment for opioid withdrawal and OUD. This will be a multi-disciplinary project with Internal Medicine, Addiction 

Medicine/Psychiatry, social work, case management and nursing. Multiple Internal Medicine residents are also involved.

Outpatient Setting:
Harms associated with opioid misuse and opioid use disorder (OUD) continue to affect millions of Americans. Despite falling rates of opioid prescriptions and increased national efforts to reduce opioid misuse, a projected 700,000 people will die from opioid overdose between 2016 and 2025 1. Unfortunately, less than 35% of people with OUD receive any treatment, and fewer receive evidence-based medication treatment for OUD (MOUD). Integrating addiction treatment into primary care holds promise to vastly increase access as well as providing patients with more convenient and comprehensive care. Receiving OUD treatment in the context of primary care builds patient-provider continuity and removes perceived stigma from receiving care in an addiction clinic or program. 2-4. However, relatively few primary care clinicians currently prescribe medications to treat OUD, citing barriers such as inadequate time and lack of support.