Identifying High Utilizing Patients with Opioid Use Disorder to Engage in Primary Care

PROJECT SUMMARY/ABSTRACT
Brian Chan MD MPH is an internist and health services researcher passionate about improving health
outcomes for vulnerable patients with opioid use disorder (OUD). This career development award will establish
Dr. Chan as a clinician-investigator focused on implementing and disseminating novel primary care
interventions that target high-risk patients with OUD in safety-net settings. The K23 award provides mentored
training to develop expertise in 3 areas: 1) conduct of mixed-methods research to develop deployment-focused
interventions; 2) clinical trial design and implementation science; and 3) addiction medicine treatment in
federally qualified health center (FQHC) settings. To achieve these goals, Dr. Chan has assembled a
multidisciplinary mentoring team with expertise in health services research, addiction medicine, intervention
design and implementation science, and FQHC health systems, with success in mentoring faculty to research
independence.
In 2018, 2.1 million people had an opioid use disorder (OUD) related to heroin or prescription pain
relievers. While the recognition of OUD is increasing, few patients receive evidence-based treatment. This is
particularly true for medically complex patients with OUD in safety-net settings. OUD complicates management
of other chronic medical conditions and is associated with high utilization of healthcare resources. Health
systems are interested in risk stratifying complex patients to improve targeting of interventions, like ambulatory
intensive care teams (A-ICU); these could be adapted for complex patients with OUD, but scalability limit
dissemination. Informed by his clinical experience as an internist and data from his K12 award evaluating an A-
ICU for medically complex high-utilizers in an FQHC, Dr. Chan will complete the following 3 aims: 1) Adapt an
existing A-ICU intervention to address high complexity patients with OUD using community stakeholder
engaged methods; 2) Refine the intervention through an iterative implementation case study, and identify
measures of acceptability, feasibility, and implementation strategy; 3) Evaluate and pilot a randomized trial of
the intervention to assess feasibility, acceptability, and preliminary efficacy of the refined intervention to
improve clinical outcomes, and retention in OUD treatment at a FQHC using implementation and mixed-
methods. The results provide preliminary data for a future R01 proposal pragmatic efficacy trial of the refined
intervention at multiple FQHC sites. This proposal directly aligns with the priorities of the National Institute on
Drug Abuse’s strategic planning workgroup on the “complexity of substance use disorders” and its priority to
“develop and test strategies for effectively and sustainably implementing evidence-based treatments.”
Completion of these studies will pave the way for implementing scalable primary care interventions to narrow
OUD treatment gaps and improve care for high-risk populations.

Grant Number: 5K23DA053390-04
NIH Institute/Center: NIH
Principal Investigator: Brian Chan