Opioid agonist treatment (OAT) is protective against overdose, yet less than 20% of
people with opioid use disorder (OUD) engage in such treatment. Hospital utilization is
high among people with OUD and can be a 'reachable moment' to initiate OAT. However, most
hospitals lack the capacity to follow up with patients after discharge. Theory-based,
empirically supported patient navigator (PN) interventions following hospital discharge
reduce inequities in accessing community-based OAT by helping patients navigate complex
systems of care. However, challenges persist in implementing PN interventions on a wide
scale, as they require coordination across institutions, data sharing, dedicated
personnel, and community resources. This is especially true in settings that reach
diverse, resource-challenged communities. To bring these interventions to scale,
strategies are needed to assess factors that influence PN implementation in hospitals to
increase feasibility, reach, and sustainability. Testing innovative implementation
strategies for PN interventions has the potential for significant impact, as it will
demonstrate implementation success of an intervention that can address the opioid
epidemic in real-world settings and close the research-to-practice translation gap. The
proposed study is a type II hybrid implementation-effectiveness trial of Navigation
Services To Avoid Rehospitalization (NavSTAR). Our research team showed in a single-site
randomized trial with 400 participants that NavSTAR significantly increased OAT entry,
reduced readmissions, and was highly cost-effective compared to treatment as usual. The
present study will test an Implementation Facilitation (IF) strategy following Proctor's
conceptual model using an external facilitator and an internal local clinical champion to
provide training, resources, and performance feedback to implement NavSTAR in four
hospitals. We hypothesize that engaging stakeholders (including patients, clinicians, and
community leaders) in an IF strategy will create and test an implementation process that
is feasible, acceptable, and effective in expanding access to OAT post-discharge. The R61
phase will conduct process mapping to identify existing hospital workflow and then refine
an IF strategy through sequential pilot trials at 4 hospital sites in preparation for the
R33 phase. The team's NavSTAR operations manual will be adapted to the sites to train the
existing staff. R61 milestones include the creation of an implementation toolkit and
data-sharing agreements.
The developmental R61 phase will focus on needs assessment and identifying IF strategies
for system-wide adoption of NavSTAR in preparation for the R33 trial phase. This will be
accomplished through four inter-related processes: 1) Process mapping with the CAB and
CAP, 2) Conducting qualitative interviews to gain diverse stakeholder input, 3) Modifying
the IF strategy, and 4) Conducting four short-duration, iterative pilot testing cycles in
four hospitals to examine the IF strategy for feasibility and acceptability. Pilot
testing will occur with existing personnel (master's level social workers) utilizing the
NavSTAR manual of operations. Interviews with current participants in the pilot testing,
organizational stakeholders, navigators, and clinician champions will be conducted both
before and after the pilot testing cycles.
Aim 1: Providers, staff, organizational leadership, and patients at the four hospitals
will be asked to participate in the study (N=40) by completing interviews about current
navigation/ discharge processes and optimal IF strategies.
Aim 2: Patients will be recruited across four hospitals (8 at each hospital) to conduct a
pilot trial (N=32) of NavSTAR implementation. The CAB/CAP feedback, stakeholder
interviews, and results of the pilot testing cycles will inform the final implementation
toolkit used in the R33 phase.