Quantitative Studies and Methodological Research
We are developing and quantitatively evaluating our methods of tele-OUD care delivery at Bicycle Health, as we seek to improve our internal services and external systems, ultimately striving to make large-scale impacts on the lives of individuals and within our communities.
Evaluation of Bicycle Health Tele-OUD Care Delivery Compared to In-Person Treatment
As Bicycle Health rapidly expands its innovative model across the United States, this matched cohort study compares treatment retention and healthcare costs among Bicycle Health patients to those receiving in-person OUD treatment with buprenorphine/naloxone (Suboxone). The primary outcome metric is length of time enrolled in treatment based on duration of uninterrupted buprenorphine prescriptions. Secondary outcomes include length of time enrolled in treatment, emergency room visit rate, inpatient hospitalization rate, likelihood of missed buprenorphine doses, per member per month allowed amount spending, and mortality rate.
Trend Analyses of Patient Outcomes Utilizing the Brief Addiction Monitor (BAM)
The Brief Addiction Monitor (BAM) is a 17-item questionnaire that measures a patient’s substance use and overall health. Bicycle Health patients are asked to complete this questionnaire at regular intervals, allowing the clinical and research teams to trend outcomes, including remission from opioid use disorder, other substance use, mood, relationships, healthcare utilization, and social determinants of health. Pre-visit questionnaires will also consider mobility, self-care, usual activities, pain/discomfort, and reduction in money spent on substances.
Evaluation of Buprenorphine Micro-Induction Compared to Standard Methods in an Innovative Telehealth Model of Care
As part of Bicycle Health’s innovative tele-OUD model of care, our clinicians prescribe buprenorphine/naloxone (Suboxone) to patients for medical treatment of opioid use disorder (OUD). The standard method for starting buprenorphine requires patients to be in partial opioid withdrawal and can often be an obstacle in initiating treatment. However, rapid micro-induction (micro-dosing) involves the administration of smaller doses of buprenorphine more frequently, removing the need for opioid withdrawal prior to starting buprenorphine. This matched cohort study compares Bicycle Health patients started on buprenorphine via rapid micro-induction versus standard methods. The primary outcome metric is successful induction of buprenorphine with low levels of opioid withdrawal. Secondary outcomes include pain, opioid cravings, illicit drug use, apparent adverse events, treatment retention, and patient satisfaction.
Identification of High-Risk Indicators for Patient Relapse
When working with individuals with opioid use disorder, it’s important to understand indicators of relapse and/or disengagement from care. This study is a retrospective analysis of indicators of churn in the Bicycle Health patient population, thereby allowing the medical and behavioral health teams to improve collaboration methods for warm handoffs and care integration. Behavioral health integration at early stages and critical recovery points may help reduce relapse and care disengagement.
Evaluation of the Behavioral Health Coordinator Role on Retention
Bicycle Health delivers integrated medical and behavioral health treatment of opioid use disorder via telehealth, and this research study seeks to quantitatively evaluate the impact of the behavioral health clinician role on patient retention. The Bicycle Health model borrows pieces from the collaborative care and integrated care models, which are well described in behavioral health research. This study is a novel evaluation as it applies to delivery of biopsychosocial tele-OUD care.
Evaluation of Buprenorphine Diversion amongst Bicycle Health Patients
Urine drug testing is an essential component of OUD treatment. It is an objective way to show progress toward goals, maintain patient accountability, prevent diversion, and ensure safety of treatment. As Bicycle Health expands its novel biopsychosocial tele-OUD treatment model throughout the United States, our research team seeks to determine what proportion of Bicycle Health patients divert their buprenorphine, as well as motivations for their diversion. This research study will utilize the Genotox Laboratories patented ToxProtect ™ urine test, a DNA-based identification method for urine sample authentication that compares biomarkers in the donor’s buccal cells with biomarkers in the urine sample, coupled with a novel test for synthetic urine. These results will allow Bicycle Health providers and leadership to better tailor this innovative program to better meet the needs of patients, as well as allow methods of telehealth-based toxicology testing to be replicated and improved broadly. Ultimately, this leads to expansion of patient access to biopsychosocial tele-OUD care and improved quality of that care.
Implementation and Evaluation of a Comprehensive Model to Address Social Determinants of Health
As Bicycle Health continues to expand its innovative tele-OUD model, we recognize the need to address psychosocial components of patients’ lives, which is of critical importance for maintaining long-term recovery from opioid use disorder. Thus, Bicycle Health has partnered with an academic affiliate to screen Bicycle Health patients with electronic computerized adaptive testing (CAT) for mental health and social determinants of health, which can help identify patients who need social support services, comprehensive mental health evaluation, stress reduction skill building, or some combination. This study implements a motivational interviewing intervention to guide patients toward achieving their individual goals related to social determinants of health and/or mental health and wellness.