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 an 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 and infectious complications 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, which includes hospitalization, the transition from inpatient to outpatient care, and the year after discharge. The program will develop informed interventions 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. health care system and treat a range of patients. The research includes a study across all sites to evaluate two interventions: (1) an integrated infectious diseases and medications for opioid use disorder (MOUD) clinic, and (2) a patient navigation intervention. The research will include retrospective analyses of patient data, as well as planning, implementation, and determination of which interventions are prioritized by institutions involved in the study. The research will also determine how well each intervention is accepted and adopted, and which are most cost effective.