• Hildi J Hagedorn, Allison M Gustavson, Princess E Ackland, Ann Bangerter, Mark Bounthavong, Barbara Clothier, HarrisAlex H SAHSCenter for Innovation To Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, 94025, USA.Department of Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA., Marie E Kenny, Siamak Noorbaloochi, Hope A Salameh, and Adam J Gordon.
• Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Mil Code #152, Minneapolis, MN, 55417, USA. hildi.hagedorn@va.gov.
• J Gen Intern Med. 2022 Nov 1; 37 (14): 359436023594-3602.

BackgroundIdentifying effective strategies to improve access to medication treatments for opioid use disorder (MOUD) is imperative. Within the Veterans Health Administration (VHA), provision of MOUD varies significantly, requiring development and testing of implementation strategies that target facilities with low provision of MOUD.ObjectiveDetermine the effectiveness of external facilitation in increasing the provision of MOUD among VHA facilities with low baseline provision of MOUD compared to matched controls.DesignPre-post, block randomized study designed to compare facility-level outcomes in a stratified sample of eligible facilities. Four blocks (two intervention facilities in each) were defined by median splits of both the ratio of patients with OUD receiving MOUD and number of patients with OUD not currently receiving MOUD (i.e., number of actionable patients). Intervention facilities participated in a 12-month implementation intervention.ParticipantsVHA facilities in the lowest quartile of MOUD provision (35 facilities), eight of which were randomly assigned to participate in the intervention (two per block) with twenty-seven serving as matched controls by block.InterventionExternal facilitation included assessment of local barriers/facilitators, formation of a local implementation team, a site visit for action planning and training/education, cross-facility quarterly calls, monthly coaching calls, and consultation.Main MeasuresPre- to post-change in the facility-level ratio of patients with an OUD diagnosis receiving MOUD compared to control facilities.Key ResultsIntervention facilities significantly increased the ratio of patients with OUD receiving MOUD from an average of 18% at baseline to 30% 1 year later, with an absolute difference of 12% (95% confidence interval [CI]: 6.6%, 17.0%). The difference in differences between intervention and control facilities was 3.0% (95% CI: - 0.2%. 6.7%). The impact of the intervention varied by block, with smaller, less complex facilities more likely to outperform matched controls.ConclusionsIntensive external facilitation improved the adoption of MOUD in most low-performing facilities and may enhance adoption beyond other interventions less tailored to individual facility contexts.© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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