QUERI – Quality Enhancement Research Initiative

Increasing Access to Medication-Assisted Treatment in VISN 22

Greater Los Angeles Healthcare System, Los Angeles, CA

Overview:

In collaboration with VISN 22 Leadership, this VISN PII start-up project aims to undertake quality improvement efforts to address the opioid crisis by increasing access to Medication-Assisted Treatment (MAT) and Complimentary and Integrative Health (CIH) therapies among patients with Opioid Use Disorder (OUD), a healthcare priority goal selected by the Veteran Integrated Service Networks (VISN) leadership and National Leadership Council. This project will facilitate and evaluate local evidence-based quality improvement activities that increase access to MAT and CIH among patients with OUD, with the overall aim of reducing opioid overdoses and healthcare costs among patients with OUD.

The goal is to improve access to medication-assisted treatment and complimentary and integrative health for patients with OUD by engaging primary care with support from addiction psychiatry and pain clinic specialists at two pilot sites (Southern Arizona VA Health Care System, Tucson, AZ, and the Phoenix VA Health Care System) to increase:

• The number of providers with X-waivers who prescribe buprenorphine,
• Referrals to obtain MAT in Veterans with OUD,
• Referrals to CIH therapies in Veterans with OUD, and
• The number of Veterans with OUD who obtain MAT or who access a CIH therapy.

This will allow Veterans to obtain treatment for OUD at various settings depending on their preference. Investigators will use evidence-based quality improvement (EBQI) implementation strategies, including technical support, practice facilitation, top-down and bottom-up stakeholder engagement, and routine data feedback.

Aims

Specific objectives of the VISN PII start-up phase include:

• Assembling data from literature, administrative data sources, and key stakeholders to inform VISN and Steering Committee of critical decision points to develop a “Quality Improvement Roadmap”
• Engaging primary care providers in adapting evidence-based models of MAT delivery from non-substance use disorder settings based on the “QI Roadmap.”
• Collecting and refining tools developed and tested by sites for engaging primary care providers to increase access to MAT and CIH therapies.

Expected Impacts

Through the engagement of key stakeholders, this project will develop site-tested tools (i.e., educational materials and templates) that engage primary care providers to increase access to MAT and CIH. These tools will assist other facilities and VISNs to increase access to MAT and CIH in primary care settings, allowing VA patients to obtain treatment for OUD at various settings depending on their preference.

Principal Investigator: Evelyn Chang, MD, MSHS (Evelyn.Chang@va.gov); VISN 22 Project Lead: Araceli Revote, MD, MPH (Araceli.Revote2@va.gov).

Operations Partner(s): VISN 22/Desert Pacific Healthcare Network Leadership Team, and the Phoenix and Southern Arizona VA Healthcare Systems.