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，也是一个高度优先的问题 退伍军人健康管理局(VHA)的质量改进目标。治疗尿毒症的有效药物 (Moud)是可用的，但在VHA中对它们的吸收一直存在很大差异。此外，VHA一直在 在美国推广替代疼痛疗法方面走在了前列，但这些疗法并不总是适用于 退伍军人非常需要他们：那些患有慢性疼痛和有害的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，使所有需要的退伍军人都能接触到Moud 优先考虑。然而，成功实施面临无数障碍的复杂护理流程需要 由专家团队密切合作开展的有目的、有结构、以证据为基础的实施工作 有地方领导的。 因此，该项目的首要目标--传播和理解 实施阿片类药物使用障碍治疗(管道)--联合五个相互关联的VISN/QUERI试点 与执行倡议项目合作，共同努力改善退伍军人获得穆德的机会 在跨越六个VISN的57个VHA站点使用OUD和获得疼痛替代疗法。导管将跨越 OUD连续护理中的四个危重护理环境：初级护理；专科护理；急性护理(住院患者 和急诊部)；以及远程保健。这些努力将通过资深人士的参与联系在一起， 实施，以及将帮助管道团队协调指标的量化/经济核心， 过程和结果。还将设立一个战略咨询小组，由运营领导和 退伍军人将帮助管道保持最大限度地与VHA和退伍军人优先事项保持一致。管道会 还为网站提供了实施新的基于证据的做法的机会(即不属于 初步启动)在项目期的后半部分。 每个管道团队部署的方法将是相似的：专家“外部促进”团队 将在当地站点领导合作的“内部促进”团队，在称为“实施促进(IF)”的过程中 -一套多组成部分的工具，旨在帮助各网站有效采用循证做法。五人组 项目在第一阶段试行并系统地修改了综合框架战略，现在提议传播这些战略 在未来三年内在全国范围内加强战略，包括两个新的VISN和数十个 其他站点。在评估方面，Conduit将采用成熟的形成性评估方法 评估IF策略的有效性并推动其改进。此外，Conduit将使用 先进的量化方法来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，团队将开发和改进 产品，如患者和提供者教育材料、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推动成功的规模扩大和 在整个VHA范围内的传播努力。

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.