Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 7;16(1):5.
doi: 10.1186/s13012-020-01076-x.

A facilitation model for implementing quality improvement practices to enhance outpatient substance use disorder treatment outcomes: a stepped-wedge randomized controlled trial study protocol

Megan A O'Grady  1 , Patricia Lincourt  2 , Belinda Greenfield  3 , Marc W Manseau  3 , Shazia Hussain  2 , Kamala Greene Genece  4 , Charles J Neighbors  5   6
Affiliations

A facilitation model for implementing quality improvement practices to enhance outpatient substance use disorder treatment outcomes: a stepped-wedge randomized controlled trial study protocol

Megan A O'Grady et al. Implement Sci. .

Abstract

Background: The misuse of and addiction to opioids is a national crisis that affects public health as well as social and economic welfare. There is an urgent need for strategies to improve opioid use disorder treatment quality (e.g., 6-month retention). Substance use disorder treatment programs are challenged by limited resources and a workforce that does not have the requisite experience or education in quality improvement methods. The purpose of this study is to test a multicomponent clinic-level intervention designed to aid substance use disorder treatment clinics in implementing quality improvement processes to improve high-priority indicators of treatment quality for opioid use disorder.

Methods: A stepped-wedge randomized controlled trial with 30 outpatient treatment clinics serving approximately 2000 clients with opioid use disorder each year will test whether a clinic-level measurement-driven, quality improvement intervention, called Coaching for Addiction Recovery Enhancement (CARE), improves (a) treatment process quality measures (use of medications for opioid use disorder, in-treatment symptom and therapeutic progress, treatment retention) and (b) recovery outcomes (substance use, health, and healthcare utilization). The CARE intervention will have the following components: (1) staff clinical training and tools, (2) quality improvement and change management training, (3) external facilitation to support implementation and sustainability of quality improvement processes, and (4) an electronic client-reported treatment progress tool to support data-driven decision making and clinic-level quality measurement. The study will utilize multiple sources of data to test study aims, including state administrative data, client-reported survey and treatment progress data, and staff interview and survey data.

Discussion: This study will provide the field with a strong test of a multicomponent intervention to improve providers' capacity to make systematic changes tied to quality metrics. The study will also result in training and materials that can be shared widely to increase quality improvement implementation and enhance clinical practice in the substance use disorder treatment system.

Trial registration: Trial # NCT04632238NCT04632238 registered at clinicaltrials.gov on 17 November 2020.

Keywords: External facilitation; Implementation; Opioid use disorder; Quality improvement; Quality metrics; Stepped-wedge trial.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Intervention conceptual method
Fig. 2
Fig. 2
Stepped-wedge design
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. SAMHSA. Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health Rockville, MD: Center for Behavioral Statistics and Qaulity, Substance Abuse and Mental Health Services Administration 2019. Report No.: HHS Publication No. PEP19-5068, NSDUH Series H-54.
    1. AHRQ. HCUP Fast Stats-Opioid Related Hospital Use 2020 [Available from: https://www.hcup-us.ahrq.gov/faststats/OpioidUseServlet?radio-3=on&locat....
    1. SAMHSA. Treatment Episode Data Set (TEDS) 2017: Admissions and Discharges from Publicly-Funded Substance Use Treatment Rockville, MD 2019.
    1. Czeisler M, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1049–1057. doi: 10.15585/mmwr.mm6932a1. - DOI - PMC - PubMed
    1. Volkow ND. Collision of the COVID-19 and addiction epidemics. Annals of Internal Medicine. 2020;173(1):61–62. doi: 10.7326/M20-1212. - DOI - PMC - PubMed

Publication types

Substances

Associated data