A Pragmatic Trial of the Consult for Addiction Treatment and Care in Hospitals (CATCH) Model for Engaging Patients in Opioid Use Disorder Treatment

The overarching objective of our study is to evaluate the effectiveness of CATCH as a
strategy for engaging patients with OUD in MAT. A pragmatic trial at 6 hospitals, conducted
in collaboration with the New York City Health and Hospitals system (H+H) and the New York
City Department of Health and Mental Hygiene (DOHMH), will study the CATCH intervention in
real-world settings and at scale. Guided by the RE-AIM evaluation framework, this hybrid
effectiveness-implementation study (Type 1) focuses primarily on effectiveness, but also
measures implementation outcomes to inform the intervention's adoption and sustainability. A
rigorous stepped-wedge cluster randomized trial design determines the impact of CATCH on
opioid treatment outcomes in comparison to usual care for a control period, followed by a
12-month intervention period and a maintenance period, and utilizes existing administrative
data to evaluate outcomes. Aim 1 (primary aim) is to evaluate the effectiveness of CATCH in
increasing post-discharge initiation and engagement in MAT, defined respectively as receiving
outpatient MAT within 14 days of discharge, and having at least 2 additional MAT visits in
the first month. Aim 2 is to assess the effectiveness of CATCH for increasing treatment
retention, defined as continuous receipt of MAT for 6 months. Aim 3 is to compare the
frequency of acute care utilization and overdose deaths, and their associated costs, among
patients with OUD who are hospitalized during the CATCH period versus usual care. Aim 4 is to
evaluate implementation outcomes at CATCH sites using a mixed methods approach to assess the
intervention's Reach (proportion of eligible patients reached); Adoption (utilization by
medical staff); and Implementation fidelity (barriers to delivering high-quality MAT).

Inclusion Criteria:

- Adult patients (>18 years);

- Hospitalized for at least 1 night on an inpatient service (not including intensive
care);

- Admission or discharge diagnosis (based on ICD-10 codes) of opioid use disorder or
opioid poisoning.

Cases are excluded if they received MAT (buprenorphine, methadone maintenance treatment, or
naltrexone) in the 30 days prior to admission. Cases included in the intervention condition
must have been admitted on a date following implementation of CATCH.

Exclusion Criteria:

- Lack of fluency in English, unable to provide informed consent.