Evaluating the Implementation of the VA Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) Program

项目：虽然阿片类药物使用障碍（OUD）的药物治疗率正在增加，但低于 40%的OUD患者接受此类治疗，VA机构和患者之间存在显著差异 特色一项旨在解决及时获得OUD护理和预防自杀问题的举措，这是前五项举措中的两项 VA国家优先事项，是国家实施阿片类药物使用障碍阶梯式护理培训， 培训师（SCOUTT）计划横跨初级保健，疼痛管理和心理健康诊所设置。鉴于其 国家范围、实施环境的范围和培训培训员的方法，SCOUTT的展开 该计划提供了一个独特的机会，以评估该计划在弗吉尼亚州的实施，目标是 提出可采取行动的调查结果，不仅为当前的工作提供信息，而且为今后的执行工作提供信息， 在弗吉尼亚州推广类似的项目本项目旨在评估SCOUTT计划 使用定量和定性方法在18个VA设施实施。 项目目标：以达到，有效性，采用，实施和维护（RE- AIM）框架，本评估项目的具体目标包括：1）估计数量并描述 在参与研究中心接受OUD护理的患者的特征（Reach）; 2）在OUD患者中， 评估OUD接受药物治疗的患者比例的趋势， 在SCOUTT发射前和发射后的一年中，相对于控制设施的利用率和全因死亡率 （有效性）; 3）报告获得丁丙诺啡豁免的提供者数量和开处方的提供者数量 实施诊所的OUD药物;调查和采访提供者和诊所领导， 他们对提供OUD治疗的看法，组织气氛和障碍以及提供的促进者 OUD护理（收养）; 4）评估患者对SCOUTT的保留和依从性;采访提供者/领导者 确定实施OUD护理的障碍和促进因素（实施）;以及5）评估 放弃和开处方的提供者的数量，保留和遵守阶梯式护理;确定障碍 和促进者，以维持OUD护理在原来的诊所在第1年和第2年，并传播OUD护理， 第三年（维护）。 项目方法：本项目的数据来源包括VA行政数据、电子调查和半定量分析。 结构化面试总结性评估将包括总结和检查参与 患者和提供者层面的分级护理，以及药房、利用率和死亡率随时间的变化 SCOUTT推出前一年和推出后一年参与诊所的指标。对于形成 评估，我们将招募诊所领导人和供应商完成简短的电子调查，在基线和一个 推出一年后，评估对提供阶梯式OUD护理的接受度以及对SCOUTT的看法 当地的组织氛围。此外，我们将完成三波半结构化面试，招聘 第1年和第2年的临床领导者和提供者以及负责传播的VISN领导者和临床领导者 斯科特在第三年的新诊所。最初的两波半结构化面试将进行， 获得领导者和提供者对实施（第1年）和维持的障碍和促进因素的看法 (Year 2）OUD在最初实施的诊所进行阶梯式护理。第三年的面试将完成， 执行小组成员，负责培训SCOUTT的其他成员，以评估 将斯科特推广到VISN的其他诊所 项目影响：与退伍军人事务部心理健康和自杀预防办公室（OMHSP）密切合作， 该项目的研究结果提供了一个机会，为当前和未来的努力提供信息， 治疗OUD并可能减少与阿片类药物相关的危害。

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.