In brief
A National Institute on Drug Abuse K23 career development proposal to adapt, refine, and pilot-test an ambulatory intensive care team model for medically complex, high-utilizing patients with opioid use disorder in a federally qualified health center. It describes aims and rationale, not results.
What this article is about
Quick Answer
A National Institute on Drug Abuse K23 career development proposal to adapt, refine, and pilot-test an ambulatory intensive care team model for medically complex, high-utilizing patients with opioid use disorder in a federally qualified health center. It describes aims and rationale, not results.
Student takeaways
Key Takeaways
- This is a National Institute on Drug Abuse K23 career development grant proposal, so it presents aims, rationale, and a training plan rather than empirical results.
- It reports that in 2018 roughly 2.1 million people in the United States had an opioid use disorder related to heroin or prescription pain relievers, and that few receive evidence-based treatment, especially medically complex patients in safety-net settings.
- The core plan is to adapt an existing ambulatory intensive care unit (A-ICU) team-based model specifically for high-complexity patients with opioid use disorder in a federally qualified health center.
- The project is structured in three sequential aims: community-engaged adaptation, iterative refinement with acceptability and feasibility measures, and a pilot randomized feasibility trial.
- The author names scalability as a key barrier, acknowledging that resource-intensive A-ICU models are difficult to disseminate widely.
Student summary
Why This Research Matters
This document is not a finished study with results. It is a career development grant proposal, a National Institute on Drug Abuse K23 award, written by Dr. Brian Chan, an internist and health services researcher. It has two purposes: to fund and structure Dr. Chan's training as a clinician-investigator, and to lay out a plan for developing and testing a new primary care approach for people who live with opioid use disorder (OUD) and who also have complex medical needs. Because it is a proposal, it describes goals, rationale, and planned steps rather than outcomes. There are no patient results to report yet, so every aim should be read as a plan, not as a proven finding.
The clinical problem it targets is important. The proposal states that in 2018 roughly 2.1 million people in the United States had an OUD related to heroin or prescription pain relievers, and that although recognition of OUD is rising, relatively few people receive evidence-based treatment. This gap is described as especially wide for medically complex patients cared for in safety-net settings, meaning health systems that serve people regardless of ability to pay, such as federally qualified health centers (FQHCs). The proposal notes that OUD often complicates the management of other chronic conditions and is associated with high use of healthcare resources, which is why it focuses on high-utilizing patients.
The proposed solution builds on an existing model called an ambulatory intensive care unit, or A-ICU. This is a team-based approach originally designed for medically complex patients who use a great deal of care. The proposal explains that health systems are interested in risk stratifying complex patients, meaning sorting them by level of need, so that intensive interventions can be aimed where they may help most. Dr. Chan proposes to adapt the A-ICU model specifically for complex patients with OUD, but he also names a real barrier: scalability. Intensive team-based care is resource heavy, which can limit how widely it spreads.
The proposal lists three aims. Aim 1 is to adapt an existing A-ICU intervention for high-complexity OUD patients using community stakeholder engaged methods, meaning the people affected help shape the design. Aim 2 is to refine the intervention through an iterative implementation case study and to identify measures of acceptability, feasibility, and implementation strategy. Aim 3 is to evaluate and pilot a randomized trial of the refined intervention to assess feasibility, acceptability, and preliminary efficacy for improving clinical outcomes and retention in OUD treatment at an FQHC, using implementation science and mixed methods. The training plan describes building expertise in three areas: mixed-methods research, clinical trial design and implementation science, and addiction medicine in FQHC settings, supported by a multidisciplinary mentoring team.
For nursing students, the value here is less about a new treatment and more about how careful clinical research is built. Notice the deliberate sequence: adapt, refine, then pilot test. Notice that acceptability and feasibility are studied before efficacy, because an intervention that patients or staff will not use cannot help anyone no matter how sound it looks on paper. Notice too the emphasis on engaging community stakeholders, which reflects a broader shift toward designing care with patients rather than only for them. The proposal states that results will provide preliminary data for a future larger trial across multiple FQHC sites.
A caution is important. Because this is a proposal, it contains no evidence yet that the adapted A-ICU improves outcomes for people with OUD. The proposal even acknowledges that scalability limits dissemination of such intensive models. Students should not conclude that A-ICU teams are proven to help OUD patients; the proposal is asking for the chance to test that idea safely. OUD is a treatable medical condition, and the most established evidence-based treatments are medications such as buprenorphine, methadone, and naltrexone combined with support; that broader background is context, not a finding of this proposal. Approach OUD care with a nonjudgmental, harm-reduction mindset, and recognize that stigma is itself a barrier to treatment. This proposal's real lesson for future nurses is how rigorous, stepwise, patient-centered research is designed to close a treatment gap responsibly.
Source abstract
Study Overview
PROJECT SUMMARY/ABSTRACT Brian Chan MD MPH is an internist and health services researcher passionate about improving health outcomes for vulnerable patients with opioid use disorder (OUD). This career development award will establish Dr. Chan as a clinician-investigator focused on implementing and disseminating novel primary care interventions that target high-risk patients with OUD in safety-net settings. The K23 award provides mentored training to develop expertise in 3 areas: 1) conduct of mixed-methods research to develop deployment-focused interventions; 2) clinical trial design and implementation science; and 3) addiction medicine treatment in federally qualified health center (FQHC) settings. To achieve these goals, Dr. Chan has assembled a multidisciplinary mentoring team with expertise in health services research, addiction medicine, intervention design and implementation science, and FQHC health systems, with success in mentoring faculty to research independence. In 2018, 2.1 million people had an opioid use disorder (OUD) related to heroin or prescription pain relievers. While the recognition of OUD is increasing, few patients receive evidence-based treatment. This is particularly true for medically complex patients with OUD in safety-net settings. OUD complicates management of other chronic medical conditions and is associated with high utilization of healthcare resources. Health systems are interested in risk stratifying complex patients to improve targeting of interventions, like ambulatory intensive care teams (A-ICU); these could be adapted for complex patients with OUD, but scalability limit dissemination. Informed by his clinical experience as an internist and data from his K12 award evaluating an A- ICU for medically complex high-utilizers in an FQHC, Dr. Chan will complete the following 3 aims: 1) Adapt an existing A-ICU intervention to address high complexity patients with OUD using community stakeholder engaged methods; 2) Refine the intervention through an iterative implementation case study, and identify measures of acceptability, feasibility, and implementation strategy; 3) Evaluate and pilot a randomized trial of the intervention to assess feasibility, acceptability, and preliminary efficacy of the refined intervention to improve clinical outcomes, and retention in OUD treatment at a FQHC using implementation and mixed- methods. The results provide preliminary data for a future R01 proposal pragmatic efficacy trial of the refined intervention at multiple FQHC sites. This proposal directly aligns with the priorities of the National Institute on Drug Abuse’s strategic planning workgroup on the “complexity of substance use disorders” and its priority to “develop and test strategies for effectively and sustainably implementing evidence-based treatments.” Completion of these studies will pave the way for implementing scalable primary care interventions to narrow OUD treatment gaps and improve care for high-risk populations.
Evidence appraisal
Main Findings
- This is a National Institute on Drug Abuse K23 career development grant proposal, so it presents aims, rationale, and a training plan rather than empirical results.
- It reports that in 2018 roughly 2.1 million people in the United States had an opioid use disorder related to heroin or prescription pain relievers, and that few receive evidence-based treatment, especially medically complex patients in safety-net settings.
- The core plan is to adapt an existing ambulatory intensive care unit (A-ICU) team-based model specifically for high-complexity patients with opioid use disorder in a federally qualified health center.
- The project is structured in three sequential aims: community-engaged adaptation, iterative refinement with acceptability and feasibility measures, and a pilot randomized feasibility trial.
- The author names scalability as a key barrier, acknowledging that resource-intensive A-ICU models are difficult to disseminate widely.
Practice transfer
Clinical Relevance
- Nurses should recognize opioid use disorder as a chronic, treatable medical condition that frequently complicates management of other chronic diseases and warrants coordinated, team-based care.
- Risk stratification can help direct intensive resources toward the highest-need patients, but nurses should remember such targeting is a planning tool, not a judgment of a patient's worth.
- Engaging patients and community stakeholders in designing care, as this proposal does, reflects patient-centered practice that nurses can champion in their own settings.
- Because this is a proposal, nurses should not adopt the adapted A-ICU model as proven; established evidence-based OUD care still centers on medications for OUD plus psychosocial support.
- A nonjudgmental, harm-reduction stance and attention to stigma are essential when engaging high-utilizing patients with OUD, since stigma itself blocks treatment access.
Faculty notes
Educational Relevance
Use this K23 career development proposal to teach the anatomy of translational research rather than clinical outcomes, because it reports aims and rationale, not results. It is an excellent artifact for showing students how implementation science works: the deliberate progression from adapting an evidence-based model (the ambulatory intensive care unit, or A-ICU), to refining it through an iterative case study, to piloting a feasibility randomized trial. Emphasize why acceptability and feasibility are measured before efficacy, and why community stakeholder engagement is built into the design. The setting, federally qualified health centers serving medically complex, high-utilizing patients with opioid use disorder, opens discussion of health equity, safety-net care, and the scalability barrier the author names explicitly. Pair this with a lesson on the established evidence base for OUD (medications for OUD plus psychosocial support) so students can distinguish general background from what this specific project proposes to test. It also models the structure of a mentored career award, useful for students considering research careers. Ask students to critique the plan: What outcomes would signal feasibility? How might stigma affect recruitment and retention? What ethical safeguards does a pilot trial with a vulnerable population require? The takeaway is appraisal of study design and honest recognition that nothing here is yet proven.
Critical appraisal
Limitations
- As a grant proposal, the document contains no outcome data; its claims are planned aims and hypotheses, not tested findings.
- The planned pilot is explicitly a feasibility study and, by design, cannot establish that the intervention improves clinical outcomes.
- The author acknowledges that the intensive A-ICU model faces scalability limits that constrain real-world dissemination.
Classroom use
Discussion Questions
- Why does this proposal test acceptability and feasibility before measuring whether the intervention actually improves outcomes?
- What does it mean to adapt an existing intervention using community stakeholder engaged methods, and why might that matter for people with opioid use disorder?
- The author names scalability as a barrier. How can a resource-intensive team-based model be made sustainable in a safety-net setting?
- How does opioid use disorder complicate the management of other chronic conditions, and what does that imply for nursing care planning?
- What ethical safeguards should protect a vulnerable population enrolled in a pilot randomized trial?
- How might stigma affect recruitment, engagement, and retention of high-utilizing patients with OUD?
- What outcomes would you choose to signal that this intervention is feasible and worth a larger trial?
- Why is it important to distinguish this proposal's plans from established evidence-based OUD treatments like medications for OUD?
- What role could nurses play within an ambulatory intensive care team for complex OUD patients?
- How does designing care with patients, rather than only for them, change the way you think about your future practice?
Search-ready answers
Frequently asked questions
Is this a study with results?
No. It is a K23 grant proposal describing planned aims, rationale, and a research-training plan, with no patient outcomes reported.
What problem is the project trying to solve?
The large gap in evidence-based treatment for medically complex, high-utilizing patients with opioid use disorder in safety-net settings.
What is an ambulatory intensive care unit (A-ICU)?
A team-based, high-intensity outpatient model originally built for medically complex patients who use a lot of care; the proposal adapts it for OUD.
Does the proposal prove this model works for OUD?
No. It plans to adapt, refine, and pilot the model; nothing is yet demonstrated to improve outcomes.
Why focus on federally qualified health centers?
FQHCs serve vulnerable, safety-net populations where OUD treatment gaps are widest, aligning the work with health equity goals.
What are the three aims in plain terms?
Adapt the model with community input, refine it and measure whether it is usable, then pilot a small randomized trial for feasibility.
What is the standard evidence-based treatment for OUD?
As general background, medications for OUD (buprenorphine, methadone, naltrexone) plus psychosocial support; this is context, not a finding of the proposal.
Why does scalability matter?
Intensive team-based care is resource heavy, so even an effective model may be hard to spread; the proposal acknowledges this openly.
How can nurses apply the ideas here now?
By using coordinated team-based care, engaging patients in planning, and approaching OUD with a nonjudgmental, harm-reduction mindset.
How should students use this document?
As a model of how careful translational research is structured, and as practice in distinguishing planned aims from proven results.