Measurement-Based Care as an Implementation Strategy for Long-Acting Injectable Medications for Opioid Use Disorders in CCBHCs - Project Summary Almost 6 million individuals in the US have an opioid use disorder (OUD). Medications to treat OUD (MOUD) are considered the gold standard; however, most people with OUD do not receive them. Integrated care settings, such as Certified Community Behavioral Health Clinics (CCBHC), are promising settings to focus provision of MOUD. However, MOUD, particularly newer long-acting injectable formulations that may significantly improve patient outcomes, remain highly underutilized in CCBHCs. Implementation strategies to address barriers at the patient, provider, and organizational levels need to be developed and tested to improve uptake of long-acting injectable MOUD in CCBHC settings. Adopting measurement-based care (MBC) holds promise as an implementation strategy to optimize treatment delivery in patients with OUD, especially for medications. Doing so may create a learning health system model that improves clinical practice and patient outcomes. However, this proposition remains largely untested, particularly in CCBHCs. More research is needed to understand the potential benefits of implementing MBC systems to address implementation outcomes for MOUD. For example, it is not known whether adding MBC to other common implementation strategies (e.g., practice facilitation) confers additional implementation and patient outcome benefits. This two- phased R34 project proposes to develop and test implementation strategies to support long-acting injectable MOUD implementation in CCBHCs. It brings together an interdisciplinary team of implementation science researchers and CCBHC providers. During the first phase, we will develop an MBC-based multi-level implementation approach to support long-acting injectable buprenorphine implementation in CCBHCs using an iterative user-centered, participatory, co-design process with CCBHC patients and staff/providers. We will create MBC protocols and EHR systems, educational/shared decision-making tools for long-acting buprenorphine, and quality-improvement driven tailored implementation supports for long-acting buprenorphine and MBC (e.g., practice facilitation). In the second phase, a mixed-methods pilot cluster-RCT in 6 CCBHC sites serving approximately 1,000 OUD patients per year will test the multi-level MBC implementation approach vs. non-MBC based approach on implementation and patient clinical outcomes. Specifically, staff/provider implementation (adoption, acceptability, and feasibility), patient implementation (patient penetration, acceptability), and patient clinical (retention in treatment and on long-acting injectable MOUD) and functional outcomes will be compared between the two conditions. We will also examine implementation context. Results of this R34 will provide an initial test of MBC-based implementation strategies for long-acting injectable MOUD in CCBHCs and will set the stage for a larger R01-level hybrid implementation-effectiveness trial. This work will address critical gaps in knowledge about how to efficiently implement long-acting injectable MOUD in CCBHCs in the context of a learning health system model with the goal of improving treatment quality and outcomes.
