Engaging healthcare teams to increase access to medications for opioid use disorder.

Sep 09, 2024

Experts: Rebecca S Oberman,Alexis K Huynh,Kelsey Cummings,Adam Resnick,Stephanie L Taylor,Alicia A Bergman,Evelyn T Chang

To assess the effectiveness of evidence-based quality improvement (EBQI) as an implementation strategy to expand the use of medications for opioid use disorder (MOUD) within nonspecialty settings.
We studied eight facilities in one Veteran Health Administration (VHA) region from October 2015 to September 2022 using administrative data.
Initially a pilot, we sequentially engaged seven of eight facilities from April 2018 to September 2022 using EBQI, consisting of multilevel stakeholder engagement, technical support, practice facilitation, and data feedback. We established facility-level interdisciplinary quality improvement (QI) teams and a regional-level cross-facility collaborative. We used a nonrandomized stepped wedge design with repeated cross sections to accommodate the phased implementation. Using aggregate facility-level data from October 2015 to September 2022, we analyzed changes in patients receiving MOUD using hierarchical multiple logistic regression.
Eligible patients had an opioid use disorder (OUD) diagnosis from an outpatient or inpatient visit in the previous year. Receiving MOUD was defined as having been prescribed an opioid agonist or antagonist treatment or a visit to an opioid substitution clinic.
The probability of patients with OUD receiving MOUD improved significantly over time for all eight facilities (average marginal effect [AME]: 0.0057, 95% CI: 0.0044, 0.0070) due to ongoing VHA initiatives, with the probability of receiving MOUD increasing by 0.577 percentage points, on average, each quarter, totaling 16 percentage points during the evaluation period. The seven facilities engaging in EBQI experienced, on average, an additional 5.25 percentage point increase in the probability of receiving MOUD (AME: 0.0525, 95%CI: 0.0280, 0.0769). EBQI duration was not associated with changes.
EBQI was effective for expanding access to MOUD in nonspecialty settings, resulting in increases in patients receiving MOUD exceeding those associated with temporal trends. Additional research is needed due to recent MOUD expansion legislation.

Published 2024. This article is a U.S. Government work and is in the public domain in the USA.

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ABOUT THE EXPERTS

Rebecca S Oberman,Alexis K Huynh,Kelsey Cummings,Adam Resnick,Stephanie L Taylor,Alicia A Bergman,Evelyn T Chang

Rebecca S Oberman

VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California, USA.

Alexis K Huynh

VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California, USA.

Kelsey Cummings

VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California, USA.

Adam Resnick

VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California, USA.

Stephanie L Taylor

VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California, USA.

Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.

Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA.

Alicia A Bergman

VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California, USA.

Evelyn T Chang

VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California, USA.

Division of General Internal Medicine, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.