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This page contains information about a research study conducted through the Department of Veterans Affairs. Please scroll down to learn more.

Background

Evidence-based treatment for opioid use disorder (OUD) reduces mortality by ~50%,1 yet fewer than half of Veterans with opioid use disorder (OUD) receive it, and up to half who initiate treatment do not remain in treatment after 12 months. A major factor is that few Veterans engage in care (i.e., seek care, pursue treatment, adhere to treatment plan, follow up with a provider). Patient-centered care is a tenet of care quality that can improve patient engagement but has not been measured for OUD care. Gaps identified in patient-centered care for OUD could represent targets for quality improvement interventions that increase patient engagement, improve treatment delivery, and reduce mortality.

Our Objectives

Aim 1: Assess performance of VA OUD providers on measures of patient-centered care and the association of patient-centered care performance with patient engagement

Aim 2: Identify preferences, needs, and values of Veterans with OUD that impact their willingness to engage in care

Aim 3: Develop and implement a provider performance audit and feedback intervention based on patient-centered measures of OUD care quality

Introduction

Opioid use disorder (OUD), or opioid addiction, affects more than 2 million Americans, including thousands of Veterans, and is a primary driver of >100,000 overdose deaths per year in the United States.2,3 Medication treatment for OUD (MOUD) reduces mortality by up to 50%,1 yet surprisingly few (<50% in VA4) receive it. Lack of engagement in care (i.e., seeking care, pursuing treatment, adhering to treatment plan, following up with a provider) is a major contributor to low rates of MOUD initiation and retention,5,6 yet why levels of engagement remain low is not well understood. However, there is evidence that low levels of patient-centered care negatively affect patients with OUD7 and could drive low levels of engagement.

Patient-centered care is described by the National Academy of Medicine as a core tenet of quality that is respectful of and responsive to individual patient preferences and needs and ensures patient values guide all clinical decisions.8 Despite its central importance, patient-centered care as a measure of quality for OUD is not well studied, which is likely attributable to the inherent difficulty in measuring patient-centered care with conventional data (e.g., chart review, patient surveys).9,10  More reliable measurement approaches could enable the incorporation of patient-centered care into quality measurement and quality improvement frameworks for OUD—all of which as the potential to increase patient engagement improve outcomes.

KelleyCDA

Benefits

OUD is a serious problem among Veterans, and the quality of OUD care has significant implications on quality of life, morbidity, and mortality for those affected by it. Prior research has clearly shown that aspects of quality associated with the patient-provider interaction, such as shared decision-making and stigma, play a role in patient willingness to engage in care. The knowledge gained in this study—a better understanding of Veteran preferences for OUD care and OUD-specific, patient-centered quality measure targets—will lay a foundation for designing and evaluating OUD care around Veteran needs and preferences and will be expected to improve quality of life, reduce morbidity, and decrease mortality.

While risks and direct benefits to the research subjects are minimal, study participation could have a significant impact on OUD care quality within VA. Providers who participate in the study may also benefit from the summary performance reports and individual reports (should they choose to receive individual-level feedback for themselves). Studies of similar design have shown that feedback on clinical performance has led to greater provider satisfaction and improved performance.

Recruitment and Participation

All recruitment, consent, and coordination for the Stakeholder Panel will be overseen by the PI and/or Project Coordinator at VASLC. Stakeholder panel participants will be identified as VAP members or OUD providers; or recognized local or national leaders. Since these individuals will have been identified in previous portions of the study, no additional chart review or review of other protected health information will be required. Prospective panel participants will be recruited by email and/or letter, then by phone. Each individual contacted will receive an informational packet about the panel that includes an overview of the study purpose and objectives, anticipated benefits, and potential risks. Informed consent and authorization will be required for participation in the stakeholder panel.

Research within the Veteran Affairs

This research study is funded through the Department of Veterans Affairs and is part of the VA Salt Lake City Health Care System. For questions, please contact @Alan.Kelley@hsc.utah.edu.

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