Table 3 Study-informed START recommendations and implementation actions

Urgency for change

• More education about MOUD for providers could help raise awareness; residents, in particular, may be interested

• Pay attention to the availability and workload of the START during the study; demand may be high

• Lower perception of urgency or need for the START to address opioid use disorder at CSMC led to hospital-wide education about the need for and purpose of the START. This included Grand Rounds and other hospital presentations, led by the study PI

Culturally appropriate adaptations

• START team should be prepared to navigate common patient barriers (e.g., stages of readiness, lack of social support, socioeconomic challenges like being under- or uninsured, lack of regular access to a phone, unhoused, etc.)

• At all hospitals, the need to address cultural and linguistic diversity was met through some adaptations to language and goals of the START

• At UNMH, the need for deep cultural understanding of the Native American culture was met by a care manager with decades of experience working in Albuquerque with this population

Post-discharge linkage

• Detailed information about specific community provider services and their insurance policies will probably be useful to the care managers

• Make sure referral list is updated regularly to reflect changes in community service settings

• Over-communicate/demonstrate to medical staff that the START does not delay patient discharge by design

• Referral resources can be updated by care managers with additional, nuanced linkage/referral tips

• START CMs either already had or developed relationships with outpatient providers in each community to facilitation linkage

• At BMC and CSMC, the START addressed need for improved linkage through the 1-month of follow-up calls by the CM that already were part of the intervention

• At UNMH in particular, where linkage of OUD patients on MOUD to acute care facilities was typically impeded, the AMS and CM worked to change hospital and acute care facility policy and practice to allow for this transition

Opinion leader engagement

• Provide hospital-wide communication about the START including who is involved and how to refer patients

• Ensure that medical teams are aware of the START through Dear Doctor letter, FAQs, other site-specific methods

• Provide multiple ways to contact the START (e.g., via paging systems, EMR, texting app, weekly team meetings, etc.)

• All hospitals conducted hospital-wide outreach to inform departments about the START. This included presentations and grand rounds, emails to department heads, and a flyer posted in break rooms