# A multi-team system implementation strategy to improve buprenorphine adherence for patients who initiate treatment in the emergency department

> **NIH NIH R61** · UNIVERSITY OF CALIFORNIA AT DAVIS · 2023 · $1,005,183

## Abstract

PROJECT SUMMARY/ABSTRACT
Drug overdose deaths continue to rise in the US due largely to opioid-related deaths, despite availability of
buprenorphine, a highly effective treatment for opioid use disorder (OUD). Starting buprenorphine for OUD in
emergency departments is an increasingly common practice across the US. A large clinical trial found that
emergency department-initiated buprenorphine plus referral to primary care for ongoing treatment significantly
increased buprenorphine treatment rates, but effects were not sustained past two months. Effective strategies
to help patients start, restart, and sustain buprenorphine treatment are urgently needed to reduce overdose
deaths. To increase buprenorphine treatment, California established CA Bridge, a state-funded program in
>200 hospitals that offers same-day buprenorphine initiation plus referral to primary care for patients with OUD
who seek care in emergency departments. However, suboptimal care coordination persists, especially for low-
income patients. This study’s overarching hypothesis is that an implementation strategy that encourages
coordination involving ongoing partnerships rather than one-time handoffs between emergency department
and primary care teams will improve buprenorphine treatment and retention rates for patients who start
buprenorphine in the emergency department. The objective is to refine an implementation strategy informed by
multiteam systems theory that is focused on improving OUD care coordination between emergency
department and primary care teams and then test this strategy in a hybrid type III effectiveness-implementation
study using a stepped wedge design randomized at the site level. The R61 phase will involve collecting and
analyzing data from two CA Bridge sites to identify core and peripheral elements of this implementation
strategy and develop an implementation strategy, a preliminary implementation blueprint, and data collection
protocols for the R33 phase. The stepped wedge study during the R33 phase will involve four CA Bridge sites.
Implementation outcomes will include between-team coordinating activities and care transitions. Effectiveness
outcomes will include rates of outpatient buprenorphine initiation (filling ≥1 outpatient prescription) and
sustained buprenorphine treatment 3, 6, and 12 months after patients leave the emergency department,
assessed with data from California’s prescription drug monitoring program. Factors associated with successful
implementation and sustainability will be identified through pre- and post-implementation interviews with
patients, staff, and managers at each emergency department and primary care clinic and through engagement
with relevant stakeholders, including patients, CA Bridge statewide leadership and prospective payers. Study
results will be used to develop an implementation blueprint that hospitals in California and across the US can
use to improve OUD treatment outcomes for patients who start buprenorphine in em...

## Key facts

- **NIH application ID:** 10740793
- **Project number:** 1R61DA059027-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA AT DAVIS
- **Principal Investigator:** Stephen G Henry
- **Activity code:** R61 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $1,005,183
- **Award type:** 1
- **Project period:** 2023-08-01 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10740793

## Citation

> US National Institutes of Health, RePORTER application 10740793, A multi-team system implementation strategy to improve buprenorphine adherence for patients who initiate treatment in the emergency department (1R61DA059027-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10740793. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*