Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment

阿片类药物使用障碍（OUD）是退伍军人发病和死亡的主要原因， 退伍军人健康管理局（VHA）的质量改进目标。治疗OUD的有效药物 （MOUD）可用，但在VHA中，它们的使用情况差异很大。此外，VHA一直在 在美国的前列，在促进替代疗法的疼痛，但这些并不一致， 非常需要它们的退伍军人：那些患有慢性疼痛和有害阿片类药物使用的人。VHA，通过其办公室， 心理健康和自杀预防，使所有退伍军人谁需要它的系统范围内获得MOUD 要务然而，成功实施面临无数障碍的复杂护理流程需要 专家小组密切合作，有意识地、有条理地、循证地开展实施工作 与当地领导。 因此，该项目的总体目标-传播和理解联盟 阿片类药物使用障碍治疗（CONDUIT）的实施-是将五个相互关联的VISN/QUERI试点项目联合起来 合作实施倡议项目，共同努力改善退伍军人获得MOUD的机会 OUD和获得替代疗法的疼痛在57 VHA网站跨越六个VISN。导管将跨越 OUD连续护理中的四种重症护理环境：初级护理;专科护理;急性护理（住院 急诊科;远程医疗。这些努力将由退伍军人参与， 实施和量化/经济核心，将帮助CONDUIT团队协调指标， 过程和结果。还将设立一个战略咨询小组， 退伍军人，这将有助于导管保持最大限度地与VHA和退伍军人的优先事项。导管将 还为研究中心提供实施新的循证实践的机会（即， 在项目的后半段， 每个CONDUIT团队部署的方法将是相似的：专家“外部促进”团队 在一个名为“实施促进“的过程中， - 一套由多个组成部分组成的工具，旨在帮助各网站有效地采用循证实践。五 项目在第一阶段试行并系统地修改了综合框架战略，现在建议传播这些战略， 在未来三年内，在全国范围内加强战略，包括两个新的VISN和几十个 其他网站。在评估方面，CONDUIT将使用完善的形成性评估方法， 评估综合框架战略的有效性并推动其改进。此外，CONDUIT将使用 先进的定量方法，以评估工作对重要临床目标的影响，并评估 从成本与收益的角度来衡量工作的价值。在整个项目期间，团队将开发和完善 产品，如患者和提供者的教育材料，处方和沟通指南，以及诊所 操作手册。这些评估和产品开发工作将为成功扩大规模和 在整个VHA的传播工作。

Opioid use disorder (OUD) is a major cause of morbidity and mortality among Veterans and a high-priority target for quality improvement in the Veterans Health Administration (VHA). Effective medications for OUD (MOUD) are available but uptake of them has been highly variable across VHA. Additionally, VHA has been at the forefront in the U.S. in promoting alternative therapies for pain, but these are not consistently available to Veterans in great need of them: those with chronic pain and harmful opioid use. VHA, through its Office of Mental Health and Suicide Prevention, has made access to MOUD for all Veterans who need it a system-wide priority. However, successful implementation of complex care processes that face myriad barriers requires intentional, structured, evidence-based implementation efforts carried out by expert teams in close partnership with local leadership. As such, the overarching goal of this project – the Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment (CONDUIT) -- is to unite five inter-related VISN/QUERI pilot Partnered Implementation Initiative projects in a concerted effort to improve access to MOUD among Veterans with OUD and access to alternative therapies for pain in 57 VHA sites spanning six VISNs. CONDUIT will span four critical care settings in the OUD continuum of care: Primary Care; Specialty Care; Acute Care (inpatient and Emergency Department); and Telehealth. These efforts will be connected by Veteran Engagement, Implementation, and Quantitative/Economic Cores that will help CONDUIT teams harmonize on metrics, processes and outcomes. There will also be a Strategic Advisory Group composed of Operations leaders and Veterans that will help CONDUIT remain maximally aligned with VHA and Veteran priorities. CONDUIT will also offer sites the opportunity to implement new evidence-based practices (i.e. ones that were not part of initial launch) in the latter half of the project period. The methods deployed by each of the CONDUIT teams will be similar: expert “external facilitation” teams will lead partnered “internal facilitation” teams at local sites in a process called “Implementation Facilitation (IF)” – a multi-component suite of tools aimed to help the sites effectively adopt evidence-based practices. The five projects piloted and systematically modified IF strategies in Phase 1 and now propose to disseminate those sharpened strategies on a national scale over the next three years, including two new VISNs and dozens of additional sites. In terms of evaluation, CONDUIT will use well-established formative evaluation methods to assess the effectiveness of and to drive refinements to the IF strategies. Additionally, CONDUIT will use cutting edge quantitative methods to assess the impact the work on important clinical targets and to assess the value of the work in terms of costs vs. benefits. Throughout the project period, teams will develop and refine products such as patient and provider educational materials, prescribing and communication guides, and clinic operations manuals. These evaluation and product development efforts will prime successful scale-up and dissemination efforts throughout VHA.