Every three years, ThedaCare completes a comprehensive Community Health Needs Assessment (CHNA) and a Community Health Improvement Plan (CHIP) for each of the seven hospitals. In the most recent assessment, all seven plans clearly identified substance use as one of the top three health concerns in the ThedaCare service area, and this is largely driven by prescription opioids.
In fact, 2021 was the deadliest year on record for drug overdoses in U.S. history.
“Substance use disorders continue to increase throughout the country and in our region,” said Paula Morgen, Director of Community Health Improvement at ThedaCare. “We knew substance abuse was a significant problem pre-COVID, and the pandemic added to the issue. According to statistics from the Centers for Disease Control and Prevention (CDC), more than 107,000 Americans died from opioid or stimulant-related overdoses between December 2020 and December 2021. That was a 15% increase over the previous year.”
To help address the health concerns driven by prescription opioids, ThedaCare and partners launched the Emergency Department to Recovery Plus (ED2R+) program in December 2020.
“The Emergency Department to Recovery Plus (ED2R+)offers patients who come to an emergency department (ED) with an opioid or stimulant overdose the opportunity to engage with recovery coaches to address their substance abuse disorder,” explained Tracey Ratzburg, ThedaCare Community Health Coordinator. “ThedaCare partners with Apricity – a recovery nonprofit organization providing treatment, employment, transitional living and educational opportunities – to supply the recovery coaches who assist patients in recovery.”
ThedaCare and Apricity operate jointly under a grant that uses state opioid dollars funded through Wisconsin Voices for Recovery and supported by the Wisconsin Department of Health Services. The grant covers the cost of peer support from a recovery coach for up to 18 months.
ThedaCare introduced the ED2R+ program in December 2020 at ThedaCare Medical Centers in Berlin, Neenah and Shawano. ThedaCare initially planned to introduce ED2R+ to their remaining four hospitals over two to three years. That plan was quickly expanded in the summer of 2021 to include all seven ThedaCare Medical Centers, Behavioral Health and the inpatient behavioral health unit at ThedaCare Regional Medical Center-Neenah.
“It’s important to recognize that we implemented this program in December 2020, which was during the heart of the COVID-19 pandemic,” Morgen said. “While our health care teams were focused on responding to the pandemic, they also knew this program was vital to support those who were struggling most as a fallout of the pandemic.”
Seeing the Success of ED2R+
Since the launch, more than 200 people have been offered a recovery coach and the opportunity to begin the recovery journey through the program. Of those individuals who engaged with the program, 45% remained opioid-sober while connected to a recovery coach.
“When a patient arrives at one of our EDs and is identified as having an opioid or stimulant addiction crisis, an ED team member will contact the Apricity 24/7 Recovery Coach Hotline,” Ratzburg explained. “Within an hour, a recovery coach will respond. Once the recovery coach arrives onsite, the ED team will bring the coach to the patient’s door and let them know a recovery coach is available. If the patient is willing, the recovery coach will enter the room to determine how they can begin to support the individual toward recovery.”
Currently the ED2R+ program focuses on patients suffering addiction overdose issues from the use of opioids, synthetic opioids (fentanyl), heroin, cocaine, methamphetamines and other stimulants.
Dan Haak, Apricity President of Contract Packaging and Recovery Support, noted the first patient introduced to the ED2R+ program in December 2020 is still connected with her recovery coach.
“That’s a real success story,” he said. “Our hope is that during their first meeting at the hospital the patient and recovery coach will set up appointments to meet in person or online on a daily or weekly basis, as needed over time, to begin the recovery process. The coach can help their peer find the best program(s) to help that individual on the road to recovery.”
“While we only have year of data, it’s clear that patients who stay connected to their recovery coaches for a longer period of time will likely have better outcomes,” said Ratzburg. “Recovery coaches can help patients find the right help for their circumstances.”
More Programs to Promote Recovery
In addition to the ED2R+ program, ThedaCare has two other programs that support recovery. The first is an expansion of ThedaCare’s Behavioral Health Collaborative Care program.
Heather Pagel, Manager of Integrated Behavioral Health for ThedaCare, explained the program.
“Behavioral Health Collaborative Care is another method of integrating behavioral health services into primary care; providing team-based and patient-centered care that assists the primary care provider in working with patients who are being treated for mild to moderate behavioral health conditions,” she said. “The way it works is we add a collaboration manager – a registered nurse or mental health clinician/social worker – in the primary care clinic as a member of the care team to act as a coordinator between the primary care provider and the psychiatric consultants. Historically we have used this model for patients experiencing anxiety and depression, and now we are expanding that role to include substance use disorders.”
During a person’s primary care visit, the patient meets with the collaboration manager who will engage in specific behavioral interventions, such as behavioral activation or problem-solving treatment, set goals with the patient and talk about any problems the patient may be having, such as a medication not helping as expected. Then the collaboration manager would facilitate communication between the primary care provider and the psychiatric consultant to make a medication adjustment if necessary.
Pagel said ThedaCare began incorporating patients with substance use disorders (SUDs) into the collaborative care model in 2021 as the result of a grant from the Health Resources and Services Administration (HRSA).
“It was initiated to extend behavioral health services, including SUD treatment, into the Shawano and Waupaca clinics,” said Pagel. “Now we are working to expand that model throughout the ThedaCare system.”
That HRSA grant also supported bringing ambulatory pharmacists to the Shawano and Waupaca clinics, a second program ThedaCare is working to expand throughout its network. Ambulatory pharmacists educate primary care and specialty clinic providers on safe opioid prescribing practices and work with patients to reduce overdose situations because of drug interactions.
The success of the ED2R+ program, as well as the other programs, is leading teams to look ahead to future growth.
“There is a push to expand the ED2R+ program to primary care clinics and include other substances, especially alcohol,” said Morgen. “In a future state, we are looking at how we might expand into those areas. Our goal is to grow in a way that makes the most significant impact to improve the health and well-being of our communities – empowering people to live their unique, best life.”
For more than 110 years, ThedaCare® has been committed to improving the health of the communities it serves in northeast and central Wisconsin. The organization delivers care to more than 600,000 residents in 18 counties and employs approximately 7,000 health care professionals. ThedaCare has 180 points of care, including seven hospitals. As an organization committed to being a leader in Population Health, team members are dedicated to empowering people to live their best lives through easy access to individualized care, supporting each person’s own health and wellbeing. ThedaCare also partners with communities to understand unique needs, finding solutions together, and encouraging health awareness and action. ThedaCare is the first in Wisconsin to be a Mayo Clinic Care
Network Member, giving specialists the ability to consult with Mayo Clinic experts on a patient’s care. ThedaCare is a not-for-profit health system with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs, as well as primary care.
For more information, visit thedacare.org or follow ThedaCare on social media. Members of the media should call Cassandra Wallace, Public and Media Relations Consultant at 920.442.0328 or the ThedaCare Regional Medical Center-Neenah switchboard at 920.729.3100 and ask for the marketing person on call.