Systems Improvement for Opioid Use Disorder

(SAIA-MOUD Trial)

Overseen By Principal Investigator

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Washington

Must be taking: MOUD

Disqualifiers: Not on Medicaid, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

165 Participants Needed

Trial Summary

What is the purpose of this trial?

This study evaluates the effectiveness of a health systems strategy (the Systems Analysis and Improvement Approach - SAIA) that packages systems engineering tools (including cascade analysis, flow mapping, and continuous quality improvement) to optimize the management of opioid use disorder (MOUD) care cascade and improve linkages between jails and clinical referral sites. The investigators will 1. study the effectiveness of SAIA on MOUD care cascade quality and continuity for patients receiving care in jail and exiting to referral clinics 2. explore determinants of adoption, implementation, and sustainment of SAIA-MOUD across implementation clinics, and 3. estimate the cost and cost-effectiveness of SAIA-MOUD

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Systems Analysis and Improvement Approach (SAIA) for opioid use disorder?

The research highlights the importance of using quality improvement methods and systems thinking to enhance treatment outcomes for opioid use disorder. Similar approaches, like the Network for the Improvement of Addiction Treatment model, have shown success in improving client engagement and retention in treatment, suggesting that SAIA could be effective in a similar way. ^{1 2 3 4 5}

How does this treatment differ from other treatments for opioid use disorder?

This treatment is unique because it focuses on systems improvement and quality enhancement in outpatient substance use disorder clinics, using a multicomponent intervention to implement quality improvement processes, which is different from traditional medication-based treatments. ^{1 4 5 6 7}

Research Team

Sarah Odell Gimbel-Sherr

Principal Investigator

University of Washington

Eligibility Criteria

This trial is for adults over 18 who are on Medicaid, have been treated for opioid use disorder while in King County Jails (WA), and will be released to the community. They must currently be patients at a SAIA clinic with jail involvement within the last year.

Inclusion Criteria

I have agreed to participate in the study's follow-up procedures.

I am treated by staff at JHS, OBOT, Pathways, or Sound clinics.

I have been involved with the jail system in the past year and am currently a patient at a SAIA clinic.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intensive Implementation

Implementation of the Systems Analysis and Improvement Approach (SAIA) in jail and referral clinics to optimize MOUD care

2 years

Sustainment

Sustainment of SAIA implementation to ensure continued optimization of MOUD care

1 year

Follow-up

Participants are monitored for linkage to MOUD care and retention in care post-release from jail

30 days

Treatment Details

Interventions

• Systems Analysis and Improvement Approach (SAIA)

Trial Overview The study tests a health systems strategy called SAIA, which uses tools like cascade analysis and flow mapping to improve opioid addiction care after release from jail. It aims to enhance quality and continuity of care between jails and clinics.

Participant Groups

Group I: SAIA MOUD clinics in Jail Health Services Experimental Treatment 1 Intervention

MOUD clinics within Jail Health Services implementing the Systems Analysis and Improvement Approach (SAIA)

Who Is Running the Clinical Trial?

University of Washington

Lead Sponsor

Trials

1,858

Recruited

2,023,000+

National Institute of Nursing Research (NINR)

Collaborator

Trials

623

Recruited

10,400,000+

Findings from Research

The demonstration project involved 30 Change Teams from 12 treatment agencies in Los Angeles County, focusing on rapid-cycle changes to improve substance abuse treatment processes, such as reducing wait times and no-shows.

The project highlighted that a clear methodology, peer interaction, and ongoing technical support are crucial for successfully implementing evidence-based improvements in addiction treatment services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving client engagement and retention in treatment: the Los Angeles County experience. Rutkowski, BA., Gallon, S., Rawson, RA., et al.[2010]

There is a critical need for better dissemination and implementation strategies for evidence-based practices to combat the opioid crisis, as current addiction journals often overlook practical quality improvement projects.

The special issue aims to showcase implementation and quality improvement projects that can provide real-world guidance on translating research into effective practices for treating opioid use disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Applying and advancing best practices in opioid use disorder and addiction treatment: Introduction to the special issue on implementation science and quality improvement scholarship. Gordon, AJ., Oliva, EM.[2019]

The HEAL Prevention Cooperative (HPC) is focused on implementing and testing effective interventions to prevent opioid misuse among youth and young adults, addressing the urgent need due to rising overdose rates in the USA.

This study will analyze the implementation experiences of nine research projects to identify best practices and adaptable components of prevention interventions, ultimately creating resources to aid in the effective adoption and implementation of these strategies in real-world settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Accelerating Solutions for the Overdose Crisis: an Effectiveness-Implementation Hybrid Protocol for the HEAL Prevention Cooperative. Patel, SV., Cance, JD., Bonar, EE., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

A facilitation model for implementing quality improvement practices to enhance outpatient substance use disorder treatment outcomes: a stepped-wedge randomized controlled trial study protocol. [2021]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Validation and endorsement of health system performance measures for opioid use disorder in British Columbia, Canada: A Delphi panel study. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Improving client engagement and retention in treatment: the Los Angeles County experience. [2010]

4. United States pubmed.ncbi.nlm.nih.gov

Applying and advancing best practices in opioid use disorder and addiction treatment: Introduction to the special issue on implementation science and quality improvement scholarship. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Engineering Approaches for Addressing Opioid Use Disorder in the Community. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Accelerating Solutions for the Overdose Crisis: an Effectiveness-Implementation Hybrid Protocol for the HEAL Prevention Cooperative. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

West Virginia's model of buprenorphine expansion: Preliminary results. [2021]