Project: Although rates of pharmacologic treatment of opioid use disorders (OUD) are increasing, less than 40% of patients with OUD receive such treatment, with substantial variation across VA facilities and patient characteristics. One initiative to address timely access to OUD care and suicide prevention, two of the top five VA national priorities, is the national implementation of the Stepped Care for Opioid Use Disorder Train-the- Trainer (SCOUTT) program across primary care, pain management and mental health clinic settings. Given its national scope, range of implementation settings, and train-the-trainer approach, the roll-out of the SCOUTT program presents a unique opportunity to evaluate the implementation of this program in the VA, with the goal of yielding actionable findings to inform not only the current effort but also future implementation efforts to spread similar programs across the VA. This project proposes to evaluate the SCOUTT program implementation at 18 VA facilities using quantitative and qualitative methods. Project Objectives: Guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE- AIM) framework, the specific aims of this evaluation project include to: 1) estimate the number and describe characteristics of patients receiving OUD care at participating sites (Reach); 2) among patients with OUD, assess the trends in the proportion of patients receiving pharmacologic treatment for OUD, acute care utilization, and all-cause mortality in the year before and after SCOUTT's launch, relative to control facilities (Effectiveness); 3) report the number of providers obtaining buprenorphine waivers and providers prescribing OUD medications at implementation clinics; survey and interview providers and clinic leadership regarding their perspectives on providing OUD treatment, organizational climate and barriers and facilitators to delivering OUD care (Adoption); 4) assess patient retention in and compliance with SCOUTT; interview providers/leaders to identify barriers and facilitators to implementing OUD care (Implementation); and 5) assess changes in number of waivered and prescribing providers, retention in and compliance with stepped care; identify barriers and facilitators to maintaining OUD care in original clinics across Years 1 and 2 and spreading OUD care to other clinics in Year 3 (Maintenance). Project Methods: Data sources for this project include VA administrative data, electronic surveys, and semi- structured interviews. The summative evaluation will consist of summarizing and examining involvement in stepped care at the patient- and provider-level and change over time in pharmacy, utilization, and mortality metrics for participating clinics from the year before and year following the SCOUTT rollout. For the formative evaluation, we will recruit clinic leaders and providers to complete brief electronic surveys at baseline and one year after the rollout to assess receptivity to delivering stepped OUD care, as well as perceptions of SCOUTT and local organizational climate. Further, we will complete three waves of semi-structured interviews, recruiting clinic leaders and providers in Year 1 and 2 and VISN leaders and clinical leaders responsible for spreading SCOUTT to new clinics in Year 3. The initial two waves of semi-structured interviews will be administered to obtain leaders and providers? perspectives on barriers and facilitators to implementing (Year 1) and sustaining (Year 2) OUD stepped care in the original implementation clinics. Interviews in Year 3 will be completed with implementation team members responsible for training others in SCOUTT to assess barriers and facilitators to spreading SCOUTT to other clinics in the VISN. Project Impact: Working closely with the VA Office of Mental Health and Suicide Prevention (OMHSP), the project?s findings present an opportunity to inform current as well as future efforts to improve access to stepped care for OUD and potentially reduce harms associated with opioids.
The dramatic rise in opioid prescribing has been accompanied by parallel increases in overdose deaths and opioid use disorders (OUD). One initiative to address this problem in the Veteran Affairs (VA) healthcare system is the Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) program, a model that aims to improve access to OUD treatment and decrease harms associated with opioids. Working closely with the VA Office of Mental Health and Suicide Prevention, the implementer of SCOUTT, this prospective mixed-methods project proposes to obtain complementary quantitative and qualitative information to assess whether the SCOUTT program improves access to OUD care and to identify barriers that inhibit and facilitators that promote its success. These data will provide actionable innovative strategies that will inform the current implementation effort, as well as future efforts to spread similar train-the-trainer models across the VA.