Browsing by Author "Rittenbach, Katherine"
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- ItemOpen AccessAssociation between harm reduction strategies and healthcare utilization in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a protocol for a systematic review and meta-analysis(2019-04-05) Deschamps, Jean; Gilbertson, James; Straube, Sebastian; Dong, Kathryn; MacMaster, Frank P; Korownyk, Christina; Montgomery, Lori; Mahaffey, Ryan; Downar, James; Clarke, Hance; Muscedere, John; Rittenbach, Katherine; Featherstone, Robin; Sebastianski, Meghan; Vandermeer, Ben; Lynam, Deborah; Magnussen, Ryan; Bagshaw, Sean M; Rewa, Oleksa GAbstract Introduction Opioids are routinely used to treat a variety of chronic conditions associated with pain. However, they are a class of medications with a significant potential for adverse health effects, with and without misuse. Opioid misuse, as defined as inappropriate use of appropriately prescribed opioids, is becoming more well-recognized publicly but does not have clear treatment options. Opioid misuse has been linked to variety of poor outcomes and its consequences have a significant impact on healthcare resource utilization. The evidence on harm reduction strategies to mitigate adverse events prompting presentation to acute care settings for patients presenting with long-term opioid use is sparse. Methods and analysis We will perform a systematic review and meta-analysis to catalog effective harm reduction strategies and identify the most effective ones to reduce avoidable healthcare utilization in patients on long-term opioid therapy who present to acute health care settings with complications attributed to opioid misuse. A search strategy will be developed and executed by an information specialist; electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Library) and additional sources will be searched. Search themes will include opioids, chronic drug use, and acute healthcare settings. Citation screening, selection, quality assessment, and data abstraction will be performed in duplicate. A comprehensive inventory of harm reduction strategies will be developed. Data will be collected on patient-related outcomes associated with each identified harm reduction strategy. When sufficiently homogeneous data on interventions, population, and outcomes is available, it will be pooled for aggregate analysis. Evaluation of the methodological quality of individual studies and of the quality of the body of evidence will be performed. Our primary objective will be to identify harm reduction strategies that have been shown to result in clinically relevant and statistically significant improvements in patient outcomes and/or decreased healthcare utilization. Discussion This study will better characterize harm reduction strategies for patients on long-term prescribed opioids presenting to acute healthcare settings. It will also add new knowledge and generate greater understanding of key knowledge gaps of the long-term prescribed opioid use and its impact on healthcare utilization. Systematic review registration CRD42018088962 .
- ItemOpen AccessAssociation between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis(2021-01-29) Deschamps, Jean; Gilbertson, James; Straube, Sebastian; Dong, Kathryn; MacMaster, Frank P; Korownyk, Christina; Montgomery, Lori; Mahaffey, Ryan; Downar, James; Clarke, Hance; Muscedere, John; Rittenbach, Katherine; Featherstone, Robin; Sebastianski, Meghan; Vandermeer, Ben; Lynam, Deborah; Magnussen, Ryan; Bagshaw, Sean M; Rewa, Oleksa GAbstract Background Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Supportive strategies in this population regarding acute healthcare settings may have substantial impact. Methods We performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a supportive strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of supportive strategies identified. We pooled patient and system related outcome data for each supportive strategy. Results A total of 5664 studies were screened and 19 studies were included. A total of 9 broad categories of supportive strategies were identified. Meta-analysis was performed for the “supports for patients in pain” supportive strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20–0.62], I2 = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61–0.82], I2 = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n = 3, 0.34, 95% CI [0.14–0.82], I2 = 78%). Conclusion For patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is “supports for patients in pain”.
- ItemOpen AccessCost-effectiveness analysis of a randomized study of depression treatment options in primary care suggests stepped-care treatment may have economic benefits(2019-08-05) Yan, Charles; Rittenbach, Katherine; Souri, Sepideh; Silverstone, Peter HAbstract Background The stepped-care pathway (SCP) model has previously been found to be clinically effective for depressive disorder in some studies, but not all. Several groups have suggested that a stepped-care approach is the most appropriate in primary care. There is relatively little information, however, regarding which specific stepped-care pathway may be best. This analysis aimed to determine cost-effectiveness of a stepped-care pathway for depression in adults in primary care versus standard care (SC), treatment-as-usual (TAU), and online cognitive behavioural therapy (CBT). Methods We conducted a randomized trial with 1400 participants and 12-week follow-up to assess the impact of the four treatment options on health-related quality of life and depression severity. Costs for the groups were calculated on the basis of physician, outpatient, and inpatient services using administrative data. We then calculated the incremental cost-effectiveness ratios using this information. Cost-effectiveness acceptability curves and incremental cost-effectiveness scatterplots were created using Monte Carlo simulation with 10,000 replications. A subgroup analysis was conducted for participants who screened as depressed at baseline. Results For all participants, TAU was the most expensive followed by CBT, SC, and SCP. QALYs were highest in SCP, followed by SC, CBT, and TAU. In the depressed subgroup, TAU was still the most expensive, followed by SC, SCP, and CBT, while QALYs were still highest in SCP, followed by SC, CBT, and TAU. The cost-effectiveness acceptability curves suggested that SCP had a higher probability for cost-effectiveness than the other three alternatives in all participants. In the depressed subgroup, CBT was associated with the highest probability of cost-effectiveness for a willingness-to-pay cut-off of less than approximately $50,000, while SCP was the highest at a cut-off higher than $50,000. There is considerable uncertainty around the cost-effectiveness estimates. Conclusions Our analysis showed that even where there are no clinically significant differences in health outcomes between treatment approaches, there may be economic benefit from implementing the stepped-care model. While more work is required to identify the most clinically effective versions of a stepped-care pathway, our findings suggest that the care pathway may have potential to improve health care system value. Trial registration NCT01975207 . The trial was prospectively registered on 4 November 2013.
- ItemOpen AccessDocumenting cannabis use in primary care: a descriptive cross-sectional study using electronic medical record data in Alberta, Canada(2023-02-01) Soos, Boglarka; Garies, Stephanie; Cornect-Benoit, Ashley; Montgomery, Lori; Sharpe, Heather; Rittenbach, Katherine; Manca, Donna; Duerksen, Kimberley; Forst, Brian; Drummond, NeilAbstract Objective Documenting cannabis use is important for patient care, but no formal requirements for consistent reporting exist in primary care. The objective of this study was to understand how cannabis use is documented in primary care electronic medical record (EMR) data. Results This was a cross-sectional study using de-identified EMR data from over 398,000 patients and 333 primary care providers in Alberta, Canada. An automated pattern-matching algorithm was developed to identify text and ICD-9 diagnostic codes indicating cannabis use in the EMR. There was a total of 11,724 records indicating cannabis use from 4652 patients, representing approximately 1.2% of the patient sample. Commonly used terms and ICD-9 codes included cannabis, marijuana/marihuana, THC, 304.3 and 305.2. Nabilone was the most frequently prescribed cannabinoid medication. Slightly more males and those with a chronic condition had cannabis use recorded more often. Overall, very few patients have cannabis use recorded in primary care EMR data and this is not captured in a systematic way. We propose several strategies to improve the documentation of cannabis use to facilitate more effective clinical care, research, and surveillance.
- ItemOpen AccessEfficacy of Connectivity-Based Targeting in TMS for Adolescents with Treatment-Resistant Depression(2021-04-29) Tapia Palacio, Clara; MacMaster, Frank; Bray, Signe; Rittenbach, Katherine; Kopala-Sibley, DanielBackground. Thirteen percent of 12- to 17-year-old adolescents suffer from depression, but only half respond to antidepressants and psychotherapy. Recent studies have successfully employed repetitive Transcranial Magnetic Stimulation (rTMS) to treat depression. However, there is a need to precisely determine the rTMS site of stimulation. A recent study in adults with depression (Fox et al., 2012) proposes that using the connectivity between the dorsolateral prefrontal cortex (DLPFC) and subgenual cingulate to define the site of stimulation for rTMS results in increased clinical efficacy. To date, no studies have investigated this phenomenon in the pediatric population. Methodology. Functional magnetic resonance imaging (fMRI) scans of 37 adolescents with treatment-resistant depression (TRD) and 18 controls were analysed. TRD individuals underwent 15 consecutive rTMS sessions and were assessed for depression before and after treatment by the Hamilton Depression Rating Scale (Ham-D). We calculated the DLPFC-Subgenual connectivity for the seven different rTMS targeting approaches described in Fox et al. (2012). Then, we measured the DLPFC-Subgenual connectivity from the individual stimulation sites and explored any correlation with clinical efficacy. Results. Contrary to Fox et al. (2012), four and three targeting approaches presented a positive correlation for the TRD and control groups respectively. Moreover, more positive values of DLPFC-Subgenual connectivity were significantly associated with a higher decrease in Ham-D scores (p = 0.025, one-tailed). Limitations. We used coordinates for the targeting approaches and subgenual cingulate that had been originally defined in adults. Furthermore, small changes in the noise reduction procedure causes great divergence in the outcomes. Conclusions. Since adolescents showed a distinctive and stronger functional connectivity between DLPFC and the subgenual cingulate, depression treatments have to be directly adjusted to pediatric population. Additionally, higher DLPFC-Subgenual positive connectivity predicted a higher clinical efficacy. This suggests that future work should consider defining the stimulation site at the DLPFC location with the strongest positive connectivity with the subgenual cingulate. However, the novelty of this research and the differences in outcomes with the literature in adult population indicates that reanalysing this association is necessary.
- ItemOpen AccessEngaging people with lived experience in the grant review process(2019-12-16) Rittenbach, Katherine; Horne, Candice G; O’Riordan, Terence; Bichel, Allison; Mitchell, Nicholas; Fernandez Parra, Adriana M; MacMaster, Frank PAbstract People with lived experience are individuals who have first-hand experience of the medical condition(s) being considered. The value of including the viewpoints of people with lived experience in health policy, health care, and health care and systems research has been recognized at many levels, including by funding agencies. However, there is little guidance or established best practices on how to include non-academic reviewers in the grant review process. Here we describe our approach to the inclusion of people with lived experience in every stage of the grant review process. After a budget was created for a specific call, a steering committee was created. This group included researchers, people with lived experience, and health systems administrators. This group developed and issued the call. After receiving proposals, stage one was scientific review by researchers. Grants were ranked by this score and a short list then reviewed by people with lived experience as stage two. Finally, for stage three, the Steering Committee convened and achieved consensus based on information drawn from stages one and two. Our approach to engage people with lived experience in the grant review process was positively reviewed by everyone involved, as it allowed for patient perspectives to be truly integrated. However, it does lengthen the review process. The proposed model offers further practical insight into including people with lived experience in the review process.
- ItemOpen AccessExploring the experience of boarded psychiatric patients in adult emergency departments(2021-09-27) Major, Daniel; Rittenbach, Katherine; MacMaster, Frank; Walia, Hina; VandenBerg, Stephanie D.Abstract Background This study quantifies the frequency of adverse events (AEs) experienced by psychiatric patients while boarded in the emergency department (ED) and describes those events over a broad range of categories. Methods A retrospective chart review (RCR) of adult psychiatric patients aged 18–55 presenting to one of four Calgary EDs (Foothills Medical Centre (FMC), the Peter Lougheed Centre (PLC), the Rockyview General Hospital (RGH), and South Health Campus (SHC)) who were subsequently admitted to an inpatient psychiatric unit between January 1, 2019 and May 15, 2019 were eligible for review. A test of association was used to determine the odds of an independent variable being associated with an adverse event. Results During the study time period, 1862 adult patients were admitted from EDs (city wide) to the psychiatry service. Of the 200 charts reviewed, the average boarding time was 23.5 h with an average total ED length of stay of 31 h for all presentations within the sample. Those who experienced an AE while boarded in the ED had a significantly prolonged average boarding time (35 h) compared to those who did not experience one (6.5 h) (p = 0.005). Conclusions The length of time a patient is in the emergency department and the length of time a patient is boarded after admission significantly increases the odds that the patient will experience an AE while in the ED. Other significant factors associated with AEs include the type of admission and the hospital the patient was admitted from.
- ItemOpen AccessFirst Nations emergency care in Alberta: descriptive results of a retrospective cohort study(2021-05-04) McLane, Patrick; Barnabe, Cheryl; Holroyd, Brian R; Colquhoun, Amy; Bill, Lea; Fitzpatrick, Kayla M; Rittenbach, Katherine; Healy, Chyloe; Healy, Bonnie; Rosychuk, Rhonda JAbstract Background Worse health outcomes are consistently reported for First Nations people in Canada. Social, political and economic inequities as well as inequities in health care are major contributing factors to these health disparities. Emergency care is an important health services resource for First Nations people. First Nations partners, academic researchers, and health authority staff are collaborating to examine emergency care visit characteristics for First Nations and non-First Nations people in the province of Alberta. Methods We conducted a population-based retrospective cohort study examining all Alberta emergency care visits from April 1, 2012 to March 31, 2017 by linking administrative data. Patient demographics and emergency care visit characteristics for status First Nations persons in Alberta, and non-First Nations persons, are reported. Frequencies and percentages (%) describe patients and visits by categorical variables (e.g., Canadian Triage and Acuity Scale). Means, medians, standard deviations and interquartile ranges describe continuous variables (e.g., age). Results The dataset contains 11,686,288 emergency care visits by 3,024,491 unique persons. First Nations people make up 4% of the provincial population and 9.4% of provincial emergency visits. The population rate of emergency visits is nearly 3 times higher for First Nations persons than non-First Nations persons. First Nations women utilize emergency care more than non-First Nations women (54.2% of First Nations visits are by women compared to 50.9% of non-First Nations visits). More First Nations visits end in leaving without completing treatment (6.7% v. 3.6%). Conclusions Further research is needed on the impact of First Nations identity on emergency care drivers and outcomes, and on emergency care for First Nations women.
- ItemOpen AccessImpacts of racism on First Nations patients' emergency care: results of a thematic analysis of healthcare provider interviews in Alberta, Canada(2022-06-21) McLane, Patrick; Mackey, Leslee; Holroyd, Brian R.; Fitzpatrick, Kayla; Healy, Chyloe; Rittenbach, Katherine; Plume, Tessy B.; Bill, Lea; Bird, Anne; Healy, Bonnie; Janvier, Kristopher; Louis, Eunice; Barnabe, CherylAbstract Background First Nations people experience racism in society and in the healthcare system. This study aimed to document emergency care providers’ perspectives on care of First Nations patients. First Nations research partner organizations co-led all aspects of the research. Methods Sixteen semi-structured interviews were conducted with Alberta emergency department (ED) physicians and nurses between November 2019 and March 2020. Results ED providers reported that First Nations patients are exposed to disrespect through tone and body language, experience overt racism, and may be neglected or not taken seriously. They described impacts of racist stereotypes on patient care, and strategies they took as individuals to address patient barriers to care. Recognized barriers to care included communication, resources, access to primary care and the ED environment itself. Conclusions Results may inform the content of anti-racist and anti-colonial pedagogy that is contextually tailored to ED providers, and inform wider systems efforts to counter racism against First Nations members and settler colonialism within healthcare.
- ItemOpen AccessPriority setting for Canadian Take-Home Naloxone best practice guideline development: an adapted online Delphi method(2022-07-02) Ferguson, Max; Medley, Andrea; Rittenbach, Katherine; Brothers, Thomas D.; Strike, Carol; Ng, Justin; Leece, Pamela; Elton-Marshall, Tara; Ali, Farihah; Lorenzetti, Diane L.; Buxton, Jane A.Abstract Background Take-Home Naloxone (THN) is a core intervention aimed at addressing the toxic illicit opioid drug supply crisis. Although THN programs are available in all provinces and territories throughout Canada, there are currently no standardized guidelines for THN programs. The Delphi method is a tool for consensus building often used in policy development that allows for engagement of stakeholders. Methods We used an adapted anonymous online Delphi method to elicit priorities for a Canadian guideline on THN as a means of facilitating meaningful stakeholder engagement. A guideline development group generated a series of key questions that were then brought to a 15-member voting panel. The voting panel was comprised of people with lived and living experience of substance use, academics specializing in harm reduction, and clinicians and public health professionals from across Canada. Two rounds of voting were undertaken to score questions on importance for inclusion in the guideline. Results Nine questions that were identified as most important include what equipment should be in THN kits, whether there are important differences between intramuscular and intranasal naloxone administration, how stigma impacts access to distribution programs, how effective THN programs are at saving lives, what distribution models are most effective and equitable, storage considerations for naloxone in a community setting, the role of CPR and rescue breathing in overdose response, client preference of naloxone distribution program type, and what aftercare should be provided for people who respond to overdoses. Conclusions The Delphi method is an equitable consensus building process that generated priorities to guide guideline development.
- ItemOpen AccessReducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program(2022-03-12) Eboreime, Ejemai; Shalaby, Reham; Mao, Wanying; Owusu, Ernest; Vuong, Wesley; Surood, Shireen; Bales, Kerry; MacMaster, Frank P.; McNeil, Diane; Rittenbach, Katherine; Ohinmaa, Arto; Bremault-Phillips, Suzette; Hilario, Carla; Greiner, Russ; Knox, Michelle; Chafe, Janet; Coulombe, Jeff; Xin-Min, Li; McLean, Carla; Rathwell, Rebecca; Snaterse, Mark; Spurvey, Pamela; Taylor, Valerie H.; McLean, Susan; Urichuk, Liana; Tzeggai, Berhe; McCabe, Christopher; Grauwiler, David; Jordan, Sara; Brown, Ed; Fors, Lindy; Savard, Tyla; Grunau, Mara; Kelton, Frank; Stauffer, Sheila; Cao, Bo; Chue, Pierre; Abba-Aji, Adam; Silverstone, Peter; Nwachukwu, Izu; Greenshaw, Andrew; Agyapong, Vincent I. O.Abstract Background Individuals discharged from inpatient psychiatry units have the highest readmission rates of all hospitalized patients. These readmissions are often due to unmet need for mental health care compounded by limited human resources. Reducing the need for hospital admissions by providing alternative effective care will mitigate the strain on the healthcare system and for people with mental illnesses and their relatives. We propose implementation and evaluation of an innovative program which augments Mental Health Peer Support with an evidence-based supportive text messaging program developed using the principles of cognitive behavioral therapy. Methods A pragmatic stepped-wedge cluster-randomized trial, where daily supportive text messages (Text4Support) and mental health peer support are the interventions, will be employed. We anticipate recruiting 10,000 participants at the point of their discharge from 9 acute care psychiatry sites and day hospitals across four cities in Alberta. The primary outcome measure will be the number of psychiatric readmissions within 30 days of discharge. We will also evaluate implementation outcomes such as reach, acceptability, fidelity, and sustainability. Our study will be guided by the Consolidated Framework for Implementation Research, and the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Data will be extracted from administrative data, surveys, and qualitative methods. Quantitative data will be analysed using machine learning. Qualitative interviews will be transcribed and analyzed thematically using both inductive and deductive approaches. Conclusions To our knowledge, this will be the first large-scale clinical trial to assess the impact of a daily supportive text message program with and without mental health peer support for individuals discharged from acute psychiatric care. We anticipate that the interventions will generate significant cost-savings by reducing readmissions, while improving access to quality community mental healthcare and reducing demand for acute care. It is envisaged that the results will shed light on the effectiveness, as well as contextual barriers and facilitators to implementation of automated supportive text message and mental health peer support interventions to reduce the psychological treatment and support gap for patients who have been discharged from acute psychiatric care. Trial registration clinicaltrials.gov, NCT05133726 . Registered 24 November 2021
- ItemOpen AccessTake-home naloxone programs for suspected opioid overdose in community settings: a scoping umbrella review(2021-03-26) Moustaqim-Barrette, Amina; Dhillon, Damon; Ng, Justin; Sundvick, Kristen; Ali, Farihah; Elton-Marshall, Tara; Leece, Pamela; Rittenbach, Katherine; Ferguson, Max; Buxton, Jane AAbstract Background Opioid related overdoses and overdose deaths continue to constitute an urgent public health crisis. The implementation of naloxone programs, such as ‘take-home naloxone’ (THN), has emerged as a key intervention in reducing opioid overdose deaths. These programs aim to train individuals at risk of witnessing or experiencing an opioid overdose to recognize an opioid overdose and respond with naloxone. Naloxone effectively reverses opioid overdoses on a physiological level; however, there are outstanding questions on community THN program effectiveness (adverse events, dosing requirements, dose-response between routes of administration) and implementation (accessibility, availability, and affordability). The objective of this scoping review is to identify existing systematic reviews and best practice guidelines relevant to clinical and operational guidance on the distribution of THN. Methods Using the Arksey & O’Malley framework for scoping reviews, we searched both academic literature and grey literature databases using keywords (Naloxone) AND (Overdose) AND (Guideline OR Review OR Recommendation OR Toolkit). Only documents which had a structured review of evidence and/or provided summaries or recommendations based on evidence were included (systematic reviews, meta-analyses, scoping reviews, short-cut or rapid reviews, practice/clinical guidelines, and reports). Data were extracted from selected evidence in two key areas: (1) study identifiers; and (2) methodological characteristics. Results A total of 47 articles met inclusion criteria: 20 systematic reviews; 10 grey literature articles; 8 short-cut or rapid reviews; 4 scoping reviews; and 5 other review types (e.g. mapping review and comprehensive reviews). The most common subject themes were: naloxone effectiveness, safety, provision feasibility/acceptability of naloxone distribution, dosing and routes of administration, overdose response after naloxone administration, cost-effectiveness, naloxone training and education, and recommendations for policy, practice and gaps in knowledge. Conclusions Several recent systematic reviews address the effectiveness of take-home naloxone programs, naloxone dosing/route of administration, and naloxone provision models. Gaps remain in the evidence around evaluating cost-effectiveness, training parameters and strategies, and adverse events following naloxone administration. As THN programs continue to expand in response to opioid overdose deaths, this review will contribute to understanding the evidence base for policy and THN program development and expansion.
- ItemOpen AccessThe Alberta Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) program: protocol for a stepped wedge cluster randomized trial of a hospital-level Neonatal Abstinence Syndrome rooming-in intervention(2023-05-06) Wine, Osnat; McNeil, Deborah; Kromm, Seija K.; Foss, Karen; Caine, Vera; Clarke, Denise; Day, Nathaniel; Johnson, David W.; Rittenbach, Katherine; Wood, Stephen; Hicks, MattAbstract Background Neonatal Abstinence Syndrome (NAS), a problem common in newborns exposed to substances in-utero, is an emerging health concern. In traditional models of care, infants with NAS are routinely separated from their mothers and admitted to the Neonatal Intensive Care Unit (NICU) with long, expensive length of stay (LOS). Research shows a rooming-in approach (keeping mothers and infants together in hospital) with referral support is a safe and effective model of care in managing NAS. The model’s key components are facilitating 24-h care by mothers on post-partum or pediatric units with support for breastfeeding, transition home, and access to Opioid Dependency Programs (ODP). This study will implement the rooming-in approach at eight hospitals across one Canadian Province; support practice and culture shift; identify and test the essential elements for effective implementation; and assess the implementation’s impact/outcomes. Methods A stepped wedge cluster randomized trial will be used to evaluate the implementation of an evidence-based rooming-in approach in the postpartum period for infants born to mothers who report opioid use during pregnancy. Baseline data will be collected and compared to post-implementation data. Six-month assessment of maternal and child health and an economic evaluation of cost savings will be conducted. Additionally, barriers and facilitators of the rooming-in model of care within the unique context of each site and across sites will be explored pre-, during, and post-implementation using theory-informed surveys, interviews, and focus groups with care teams and parents. A formative evaluation will examine the complex contextual factors and conditions that influence readiness and sustainability and inform the design of tailored interventions to facilitate capacity building for effective implementation. Discussion The primary expected outcome is reduced NICU LOS. Secondary expected outcomes include decreased rates of pharmacological management of NAS and child apprehension, increased maternal ODP participation, and improved 6-month outcomes for mothers and infants. Moreover, the NASCENT program will generate the detailed, multi-site evidence needed to accelerate the uptake, scale, and spread of this evidence-based intervention throughout Alberta, leading to more appropriate and effective care and use of healthcare resources. Trial registration ClinicalTrials.gov, NCT0522662. Registered February 4th, 2022.