Coaching Performance Driven Practice Change in the Context of Value Based Purchasing Under New York Medicaid

Study Overview
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Brief Summary
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This project will develop and test quality measures for and a facilitation model to help addictions treatment clinics increase use of medicines for opioid use disorders, retain clients longer in care, and help more people move into successful recovery. At the end of the project, we will have developed specific training and coaching protocols as well as electronic clinical support tools to guide quality improvement that can be disseminated within New York and the rest of the country. The study will test a clinic-level intervention that uses external facilitators to provide guidance to addictions clinics and contain three key components: 1) training on data driven management; 2) training and guidance on patient-centered care and OUD medication; and 3) electronic tools for shared decision making and patient progress monitoring.

Detailed Description
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There will be 4 sources of data examined in this study: 3 at the patient level and 1 at the staff level. The sources of patient data include: 1) State administrative data from all clients receiving treatment at the enrolled clinics ( 7,950); 2) a subsample (1,200) who will be recruited directly from the clinics to complete patient-reported outcome assessments, and 3) treatment progress data for clients will also be collected. For our administrative source of data, a final study population of approximately 7,950 individuals who are receiving treatment in the 30 enrolled outpatient treatment clinics for OUD is anticipated. Clinics will be located in the New York City metropolitan region (including Nassau, Westchester, and Rockland counties) and the Capital Region (including Albany, Rensselaer, Saratoga, Montgomery, Schenectady, and Schoharie counties). Staff at each enrolled clinic will also be interviewed and surveyed.

Official Title
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Coaching Performance Driven Practice Change in the Context of Value Based Purchasing Under New York Medicaid

Conditions
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Opioid-use Disorder, Substance Use Disorders

Intervention / Treatment
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* Behavioral: Metrics-driven quality improvement (MDQI)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Substance use disorder clinics in the regions surrounding New York City and the New York Capital Region with annual census of 50 or greater. All staff and patients from participating clinics will be eligible to participate in the study. Inclusion in the analyses using administrative data will be limited to those enrolled in Medicaid and not co-insured with Medicare (individuals ages greater than 64 and those with Federally determined disability). Exclusion Criteria: Patients who are not working/being treated at substance use disorder clinics with less than 50 clients per year.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: Stepped Wedge Cluster Randomized Trial (SW-RCT)
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br> | |
| Experimental: Metrics-driven quality improvement (MDQI) intervention<br> | Behavioral: Metrics-driven quality improvement (MDQI)<br>* The intervention broadly consists of training and coaching to clinic staff and leadership on 1) clinical quality measure monitoring; 2) clinical practice process change management; and 3) use of tools for shared decision making and patient treatment progress monitoring.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in clinic-level rates of initiation to OUD medications |  | Assessed from commencement of the trial in Year 1 of the study to the conclusion of the trial in Year 4 of the study. | 
| Change in clinic-level rates of adherence to OUD medications |  | Assessed from commencement of the trial in Year 1 of the study to the conclusion of the trial in Year 4 of the study. | 
| Retention in Care | Clinic rates of 6-month client retention in care | Assessed from commencement of the trial in Year 1 of the study to the conclusion of the trial in Year 4 of the study. | 
| Change in Incidence of Overdoses |  | Assessed from commencement of the trial in Year 1 of the study to the conclusion of the trial in Year 4 of the study. | 
| Change in Incidence of Substance Use-Related Hepatitis C Infection |  | Assessed from commencement of the trial in Year 1 of the study to the conclusion of the trial in Year 4 of the study. | 
| Change in Number of Emergency Room Visits |  | Assessed from commencement of the trial in Year 1 of the study to the conclusion of the trial in Year 4 of the study. | 
| Change in Health Status | Change in health status is measured by the first item of the SF-12 Health Survey: In general, would you say your health is: 1 - excellent, 2 - very good, 3 - good, 4 - fair, 5 - poor. Scores range from 1-5, with a higher score indicating worse health. | Assessed from the start of each clinic in the intervention to 1 year post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cost of treatment | Cost of the intervention to the clinic | Assessed from commencement of the intervention at each clinic to 1 year post-intervention | 
| Change in clinic-level rates of clients with Severe OUD | As indicated by daily use and/or injection drug use as indicated in state administrative admission data | Assessed from commencement of the intervention at each clinic to 1 year post-intervention | 
| Change in clinic level-rates of clients identified as homeless | As indicated in state administrative admission data | Assessed from commencement of the intervention at each clinic to 1 year post-intervention | 
| Change in clinic-rates of clients with co-existing psychiatric disorder as indicated in state administrative admission data |  | Assessed from commencement of the intervention at each clinic to 1 year post-intervention |