Performance measure can be used to improve quality of care at the patient, provider, and systems level of care. Some performance measures exist for substance use disorder (SUD) and opioid use disorder (OUD), but they are focused on access to care, process of care, and short-term outcomes. Patient-reported outcome measures (PROMs) offer an efficient way to monitor recovery as the ultimate outcome for SUD treatment and quality of care. PROMs are fundamental to the principles of patient-centered care, encouraging self-efficacy and shared decision-making, and if collected at multiple time points, capture of the course of chronic disease. However, SUD PROMs may bring administrative burden and feasibility issues to the clinical setting, and have not yet been tested in clinical trials. We propose a two-phase study, of people with OUD who are receiving OUD treatment medication in an office-based model, that brings a patient-centered approach to quality measure development and testing: First, refine a preliminary Recovery PROM, and assess its implementation, feasibility and usefulness to patients and clinicians, incorporating their perspectives at each stage. Second, conduct an RCT to rigorously assess implementation and effectiveness in a clinical setting. Specifically, the R61 is a pilot study of the preliminary Recovery PROM, in which we will: (1) Work with a clinical partner to assess and refine the Recovery PROM, and examine feasibility and implementation (e.g., workflow, data transfer issues) related to its use in a clinical setting. (2) Determine its initial effectiveness for improving patient outcomes (self-efficacy, health-related quality of life, patient-provider relationship, social determinants of health, substance use) and facilitating self-directed care and patient-centered shared decision- making. (3) Evaluate and update (if needed) the Recovery PROM in terms of recovery while on OUD medication treatment, patient characteristics, and clinical workflow, and finalize the R33 RCT PROM and processes. The R33 is an RCT of the Recovery PROM in community health centers, in which we will: (1) Assess its implementation in the context of OUD medication treatment, in community health centers that offer office-based OUD pharmacotherapy. (2) Determine if the Recovery PROM has improved patient outcomes and patient-centered care for patients who use the Recovery PROM in the clinical setting compared to patients who do not. (3) Define meaningfully important differences (MIDs) to establish thresholds associated with types of recovery outcomes, to enhance shared decision-making and development into a performance measure. The proposed research will help to confirm the value of a Recovery PROM, determine the feasibility of its implementation in the clinical setting, and, more generally, contribute to a dearth of research about the feasibility of using PROMs. The Recovery PROM will be improved through patient and clinician input during this study. In addition, the study will help to establish whether meaningful thresholds can be established for the PROM, which would support future development of additional SUD measures of performance and quality.
Performance measure can improve quality of care at the patient, provider, and systems level of care, and patient-reported outcome measures bring a needed patient-centered focus. Recovery has been difficult to measure for people with substance use disorders, and is more challenging in the context of opioid use disorders and treatment medications. This study will examine a recovery patient-reported outcome measure to determine if patients and clinicians find it useful and acceptable in the clinical context, and if it leads to improved outcomes.
