QUERI – Quality Enhancement Research Initiative

Facilitation of the Stepped-Care Model and Medication Treatment for Opioid Use Disorder

Salt Lake City, UT

Overview:

Among Veterans receiving VA healthcare, there has been a sharp rise in the number of patients diagnosed with opioid use disorder (OUD): from 25,031 in 2003 to 69,142 in 2017. As the largest provider of substance use disorder treatment in the nation, VA continues to be proactive in increasing access to medications indicated for OUD, an essential component of evidence-based care. However, as a recent HSR&D-funded study suggests, substantial challenges persist, such as the underuse of medications, a wide variability in prescribing rates, and the capacity to supply methadone, which all requires further research.¹

The QUERI Facilitation of the Stepped-Care Model and Medication Treatment for Opioid Use Disorder

Partnered Evaluation Initiative will focus on implementing a comprehensive plan to train interdisciplinary teams in primary care, general mental health, pain clinics, and Substance Use Disorder (SUD) Specialty Care clinics to deliver a stepped-model of medication treatment for opioid use disorder to provide treatment services for Veterans with opioid use disorder at his/her preferred point-of-care. Additional aims for investigators will be to:

• Develop, implement, deliver, produce and sustain SCOUTT (Stepped Care for Opioid Use Disorder Train the Trainer) strategies and products across all VISNs.
• Facilitate, train, and mentor VISN-wide SCOUTT Pilot Team members through face-to-face meetings and community of practice webinars.

1. Wyse J, Gordon A, Dobscha S, et al. Medications for opioid use disorder in the Department of Veterans Affairs (VA) healthcare system: Historical perspective, lessons learned, and next steps. Substance Abuse. 2018;39(2):139-144.

Methodology:

SCOUTT consists of both VISN- and facility-level teams, which include: VISN mental health lead, VISN Substance Use Disorder (SUD) lead, VISN pain lead, VISN primary care lead, and two clinical champions. These teams will ensure the stepped-care model of care for opioid use disorder treatment is implemented within their VA facility.

QUERI facilitation will support VISN teams by providing operations and administrative functions – and is composed of implementation scientists who will oversee onsite training and mentoring. QUERI investigators also will conduct program evaluation and process improvement to streamline SCOUTT.

Potential Impacts:

VA/DoD clinical practice guidelines recommend medication-assisted treatment (MAT) as the primary treatment for opioid use disorder; psychosocial interventions alone are not recommended. This QUERI Partnered Evaluation Initiative will facilitate MAT for opioid use disorder in non-addiction specialty settings, where Veterans with OUD are most likely to present, thereby improving patient outcomes.

Principal Investigators: Adam Gordon, MD, MPH, is a former HSR&D Career Development Awardee, and is Chief of Addiction Medicine at the VA Salt Lake City Health Care System.

Operational Partners: Substance Use Disorders, Office of Mental Health and Suicide Prevention