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| ID | Type | Description | Link |
|---|---|---|---|
| R01DA041067 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute on Drug Abuse (NIDA) | NIH |
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Tobacco, alcohol and opioid use disorders threaten the health of HIV-infected patients. What if evidence-based counseling and medication treatments for tobacco, alcohol and opioid use disorders (herein refered to as addiction treatments) were routinely provided in HIV clinics? Implementation Facilitation is an established strategy to increase the uptake of evidence-based treatments. Our goal is to evaluate the impact of Implementation Facilitation on the use of addiction treatments in four large HIV clinics.
The purpose of the WHAT-IF study is:
Aim 1. Among key stakeholders, to use quantitative and qualitative (mixed) methods to identify the site-specific evidence, context and facilitation-related barriers and facilitators to the integration of addiction treatments to help tailor an Implementation Facilitation for each clinic.
Aim 2. To evaluate the impact of Implementation Facilitation on:
2a: Organizational readiness to deliver addiction treatments 2b: Provider readiness to deliver addiction treatments 2c: Provision of addiction treatments 2d: Changes in organizational models of care used to deliver addiction treatments
Aim 3. To evaluate the impact of Implementation Facilitation on antiretroviral therapy receipt, HIV viral suppression, VACS Index, and retention in HIV care among patients eligible for addiction treatment.
The Working with HIV clinics to adopt Addiction Treatments using Implementation Facilitation (WHAT IF?) study will evaluate the impact of Implementation Facilitation on the adoption of addiction treatment services in four HIV clinics. We will use a stepped wedge design . The primary comparison is of the change that occurs from the pre-implementation period to two post-implementation periods, the initial six months (evaluation) and the following six months (maintenance). This proposal will consist of three main components in each of four clinics: 1) formative evaluation with key stakeholders at each site to guide and refine the Implementation Facilitation, 2) conduct of the Implementation Facilitation and 3) an evaluation of the impact of the Implementation Facilitation on organization and provider-level readiness, provision of addiction treatments, and HIV outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Usual Care- Control | No Intervention | We will use a stepped wedge design to evaluate the effect of the Implementation Facilitation on the outcomes. The first phase for all clinics is a control phase where clinic staff and patients engage in usual care. The time to implementation is randomly assigned. Each clinic is then followed prospectively to determine their outcome status. | |
| Implementation Facilitation | Experimental | We will use a stepped wedge design to evaluate the effect of the Implementation Facilitation on the outcomes. The time to implementation in a stepped wedge design is randomly assigned. Clinics are then followed prospectively to determine their outcome status.. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Implementation Facilitation | Behavioral | Implementation Facilitation is an evidence-based strategy tailored to the specific needs of the clinic, designed to increase uptake of evidence based treatments for tobacco, alcohol and opioid use disorders. Will include provider education and academic detailing.
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in Provision of Addiction Treatments | Study team will use the electronic health record (EHR) to identify prescriptions for each of the target medications in the surveillance period. Study team will use CPT codes to determine whether specific counseling therapies were provided. Patients diagnosed with Opioid Use Disorder and/or Alcohol Use Disorder and/or Tobacco Use Disorder were identified and then assessed in the EHR to determine if medication assisted therapy was provided by a provider during the 6 month Intervention period. | Baseline, 6 months |
| Change in Provision of Addiction Treatments | Study team will use the electronic medical record to identify prescriptions for each of the target medications in the surveillance period. Study team will use CPT codes to determine whether specific counseling therapies were provided. Patients diagnosed with Opioid Use Disorder and/or Alcohol Use Disorder and/or Tobacco Use Disorder were identified and then assessed in the EHR to determine if medication assisted therapy was provided by a provider during the 12 month Evaluation period. | Baseline, 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Antiretroviral Therapy (ART) Receipt | ART receipt will be defined as at least 180 days of three concurrent antiretroviral agents in the 6-month interval based on prescriptions in the electronic medical record. | 6 months |
| Antiretroviral Therapy (ART) Receipt |
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Inclusion Criteria:
Patient inclusion criteria:
Staff inclusion criteria:
Payer/health insurance provider inclusion criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| David Fiellin, MD | Yale University | Principal Investigator |
| Jennifer Edelmen, MD | Yale University | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hartford Hospital's HIV Clinic | Hartford | Connecticut | 06115 | United States | ||
| Haelen Center at Yale New Haven Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32976995 | Background | Edelman EJ, Dziura J, Esserman D, Porter E, Becker WC, Chan PA, Cornman DH, Rebick G, Yager J, Morford K, Muvvala SB, Fiellin DA. Working with HIV clinics to adopt addiction treatment using implementation facilitation (WHAT-IF?): Rationale and design for a hybrid type 3 effectiveness-implementation study. Contemp Clin Trials. 2020 Nov;98:106156. doi: 10.1016/j.cct.2020.106156. Epub 2020 Sep 23. | |
| 33675619 | Result | Edelman EJ, Gan G, Dziura J, Esserman D, Morford KL, Porter E, Chan PA, Cornman DH, Oldfield BJ, Yager JE, Muvvala SB, Fiellin DA. Readiness to Provide Medications for Addiction Treatment in HIV Clinics: A Multisite Mixed-Methods Formative Evaluation. J Acquir Immune Defic Syndr. 2021 Jul 1;87(3):959-970. doi: 10.1097/QAI.0000000000002666. |
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At each of the 6 month assessment stages, the numbers fluctuate based on the number of patients identified in the electronic health record (EHR) and the number of clinicians and staff that completed each survey. The numbers at each stage are part of a sliding cohort where direct follow up with patients and clinicians longitudinally is not part of the design. Assessment of patients using EHR began 6 months prior to the assessment of clinicians and staff using surveys.
| ID | Title | Description |
|---|---|---|
| FG000 | Patient Characteristics | Patients from 4 clinics at each phase in the implementation facilitation design. |
| FG001 | Clinician/Staff Characteristics | Clinician/staff participants from 4 clinics at each phase phase in the implementation facilitation design. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
These are counts of the participants (patients and clinician/staff) that were assessed at the end of the control stage (stage 1 in the participant flow).
| ID | Title | Description |
|---|---|---|
| BG000 | Patient Characteristics | Presented are the characteristics of patients across 4 clinics in the control (baseline) phase in the implementation facilitation design. |
| BG001 | Clinician/Staff Characteristics |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Change in Provision of Addiction Treatments | Study team will use the electronic health record (EHR) to identify prescriptions for each of the target medications in the surveillance period. Study team will use CPT codes to determine whether specific counseling therapies were provided. Patients diagnosed with Opioid Use Disorder and/or Alcohol Use Disorder and/or Tobacco Use Disorder were identified and then assessed in the EHR to determine if medication assisted therapy was provided by a provider during the 6 month Intervention period. | Unduplicate count of participants from control stage to intervention stage. | Posted | Count of Participants | Participants | Baseline, 6 months |
|
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Adverse events were not collected as part of this study. The total 3759 is the largest number of patients assessed during the time period for the patient specific outcomes.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Patients | Patients from 4 clinics across all phases in the implementation facilitation design. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| David Fiellin, MD | Yale School of Medicine | (203) 688-5555 | david.fiellin@yale.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jun 22, 2020 | Feb 13, 2023 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D019966 | Substance-Related Disorders |
| ID | Term |
|---|---|
| D064419 | Chemically-Induced Disorders |
| D001523 | Mental Disorders |
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|
ART receipt will be defined as at least 180 days of three concurrent antiretroviral agents in the 6-month interval based on prescriptions in the electronic medical record. |
| 12 months |
| Viral Suppression | Viral suppression, will be defined as HIV RNA <200 copies/mL at last test closest to the time of data extraction, consistent with Department of Health and Human Services (DHHS) guidelines. Although current limits of detection are lower, this cutoff allows for low-level "blips" that have no clinical significance. | 6 months |
| Viral Suppression | Viral suppression, will be defined as HIV RNA <200 copies/mL at last test closest to the time of data extraction, consistent with Department of Health and Human Services (DHHS) guidelines. Although current limits of detection are lower, this cutoff allows for low-level "blips" that have no clinical significance. | 12 months |
| VACS Index | The Veterans Aging Cohort Study Index (VACS Index) creates a score by summing pre-assigned points for age, routinely monitored indicators of HIV disease (CD4 count and HIV-1 RNA), and general indicators of organ system injury including hemoglobin, platelets, aspartate and alanine transaminase (AST and ALT), creatinine, and viral hepatitis C infection (HCV). This score is weighted to indicate increasing risk of all-cause mortality with increasing score. The score can be used to estimate risk of all-cause mortality using a conversion factor. The VACS Index will be evaluated based on most recent values at the time of data extraction. VACS Index score will be treated as a continuous variable. VACS Index: minimum value: 0; maximum value: 164- a higher score means a worse outcome. | 6 months |
| VACS Index | The Veterans Aging Cohort Study Index (VACS Index) creates a score by summing pre-assigned points for age, routinely monitored indicators of HIV disease (CD4 count and HIV-1 RNA), and general indicators of organ system injury including hemoglobin, platelets, aspartate and alanine transaminase (AST and ALT), creatinine, and viral hepatitis C infection (HCV). This score is weighted to indicate increasing risk of all-cause mortality with increasing score. The score can be used to estimate risk of all-cause mortality using a conversion factor. The VACS Index will be evaluated based on most recent values at the time of data extraction. VACS Index score will be treated as a continuous variable. VACS Index: minimum value: 0; maximum value: 164- a higher score means a worse outcome. | 12 months |
| Retention in HIV Care | Retention in HIV care, per DHHS guidelines uses a 24-month measurement period. It is defined as at least one HIV medical care visit in each 6-month period, with a minimum of 60 days between the first medical visit in the prior 6-month period and the last medical visit in the subsequent 6-month period. This measure has good agreement with the Institute of Medicine indicator for retention in care and is an independent predictor of mortality. We will evaluate whether patients have had at least 1 visit in the 6-month period prior to time of data extraction. | 6 months |
| Retention in HIV Care | Retention in HIV care, per DHHS guidelines uses a 24-month measurement period. It is defined as at least one HIV medical care visit in each 6-month period, with a minimum of 60 days between the first medical visit in the prior 6-month period and the last medical visit in the subsequent 6-month period. This measure has good agreement with the Institute of Medicine indicator for retention in care and is an independent predictor of mortality. We will evaluate whether patients have had at least 1 visit in the 6-month period prior to time of data extraction. | 12 months |
| Organizational Readiness | Investigators will use the ORCA to measure factors impacting the provision of addiction treatments. This 15-minute survey is based on the PARiHS framework and asks the respondent to rate local factors related to evidence, context and facilitation on a 5-point Likert scale from strongly disagree to strongly agree. Facilitation questions will be omitted from the pre-implementation assessment since this part of the intervention and will not have taken place. The score has a range from 1 to 5 where a higher score indicates higher readiness. | 6 months |
| Organizational Readiness | Investigators will use the ORCA to measure factors impacting the provision of addiction treatments. This 15-minute survey is based on the PARiHS framework and asks the respondent to rate local factors related to evidence, context and facilitation on a 5-point Likert scale from strongly disagree to strongly agree. Facilitation questions will be omitted from the pre-implementation assessment since this part of the intervention and will not have taken place. The score has a range from 1 to 5 where a higher score indicates higher readiness. | 12 months |
| Provider Readiness | Investigators will use change rulers, among appropriate providers, for each of the medications and counseling to assess readiness to provide each medication and counseling intervention. The change rulers will independently assess, on a 0-10 scale each provider's: 1) confidence to prescribe/provide the intervention, 2) readiness to prescribe/provide the intervention and 3) commitment to prescribe/provide the intervention. Presented is the score that indicates readiness to prescribe medication. The score has a range from 1 to 10 where a higher score indicates increased readiness. | 6 months |
| Provider Readiness: | Investigators will use change rulers, among appropriate providers, for each of the medications and counseling to assess readiness to provide each medication and counseling intervention.185 The change rulers will independently assess, on a 0-10 scale each provider's: 1) confidence to prescribe/provide the intervention, 2) readiness to prescribe/provide the intervention and 3) commitment to prescribe/provide the intervention. Presented is the score that indicates readiness to prescribe medication. The score has a range from 1 to 10 where a higher score indicates increased readiness. | 12 months |
| New Haven |
| Connecticut |
| 06511 |
| United States |
| SUNY Downstate Medical Center | Brooklyn | New York | 11203 | United States |
| Immunology Center at Miriam Hospital | Providence | Rhode Island | 02906 | United States |
| 35341613 | Result | Morford KL, Muvvala SB, Chan PA, Cornman DH, Doernberg M, Porter E, Virata M, Yager JE, Fiellin DA, Edelman EJ. Patients' perspectives of medications for addiction treatment in HIV clinics: A qualitative study. J Subst Abuse Treat. 2022 Aug;139:108767. doi: 10.1016/j.jsat.2022.108767. Epub 2022 Mar 18. |
| 36251291 | Result | Edelman EJ, Gan G, Dziura J, Esserman D, Porter E, Becker WC, Chan PA, Cornman DH, Helfrich CD, Reynolds J, Yager JE, Morford KL, Muvvala SB, Fiellin DA. Effect of Implementation Facilitation to Promote Adoption of Medications for Addiction Treatment in US HIV Clinics: A Randomized Clinical Trial. JAMA Netw Open. 2022 Oct 3;5(10):e2236904. doi: 10.1001/jamanetworkopen.2022.36904. |
Presented are the characteristics of clinician/staff participants across 4 clinics in the control (baseline) phase in the implementation facilitation design.
| BG002 | Total | Total of all reporting groups |
| Clinics |
|
| years |
| Participants |
|
|
| Sex: Female, Male | Count of Participants | Participants | Participants |
|
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants | Participants |
|
|
| Race/Ethnicity, Customized | Count of Participants | Participants | Participants |
|
|
| Region of Enrollment | Number | participants | Participants |
|
|
| Public insurance | Patient Specific Measure | Count of Participants | Participants | Participants |
|
|
| Self-Pay | Patient Specific Measure: Self Paying Patient | Patient Specific Measure | Count of Participants | Participants | Participants |
|
|
| Private or commercial insurance | Patient Specific Measure: Insurance Type | Patient Specific Measure | Count of Participants | Participants | Participants |
|
|
| Completed Visits at Baseline | Patient Specific Measure | Median | Full Range | Clinic Visits | Participants |
|
|
| Prescribed Antiretroviral Therapy | Patients prescribed antiretroviral therapy at baseline. | Patient Specific Measure | Count of Participants | Participants | Participants |
|
|
| Detectable HIV viral load (>200 copies/mL) | Patients with detectable HIV viral load (>200 copies/mL). | Patient Specific Measure | Count of Participants | Participants | Participants |
|
|
| Hepatitis C virus infection | Patients with hepatitis C virus infection. | Patient Specific Measure | Count of Participants | Participants | Participants |
|
|
| CD4 cell count categorized (cells/μL) | Patients CD4 cell count (cells/μL) | Patient Specific Measure | Count of Participants | Participants | Participants |
|
|
| Clinician (physicians, physician assistant, nurse practitioner) | Clinician (physicians, physician assistant, nurse practitioner) yes or no | Clinician and Staff Participant Specific Measure | Count of Participants | Participants | Participants |
|
|
| Time working at clinic | Clinician and Staff Participant Specific Measure | Mean | Standard Deviation | years | Participants |
|
|
| Time per week spent working at HIV clinic | Clinician and Staff Participant Specific Measure | Median | Full Range | hours | Participants |
|
|
| Ever prescribed medications to treat tobacco use disorder | Clinician and Staff Participant Specific Measure | Count of Participants | Participants | Participants |
|
|
| Ever provided counseling to treat tobacco use disorder | Clinician and Staff Participant Specific Measure | Count of Participants | Participants | Participants |
|
|
| Ever prescribed medications to treat unhealthy alcohol use | Clinician and Staff Participant Specific Measure | Count of Participants | Participants | Participants |
|
|
| Ever provided counseling to treat unhealthy alcohol use | Clinician and Staff Participant Specific Measure | Count of Participants | Participants | Participants |
|
|
| Ever provided counseling to treat opioid use disorder | Clinician and Staff Participant Specific Measure | Count of Participants | Participants | Participants |
|
|
| Hold a waiver that allows buprenorphine (eg, Suboxone) prescribing | Clinician and Staff Participant Specific Measure | Count of Participants | Participants | Participants |
|
|
| Ever prescribed oral or injectable (eg, Vivitrol) naltrexone to treat opioid use disorder | Clinician and Staff Participant Specific Measure | Count of Participants | Participants | Participants |
|
|
| Alcohol Use Disorder Patients |
Patients diagnosed with Alcohol Use Disorder (AUD). |
| OG002 | Tobacco Use Disorder | Patients diagnosed with Tobacco Use Disorder |
|
|
|
| Primary | Change in Provision of Addiction Treatments | Study team will use the electronic medical record to identify prescriptions for each of the target medications in the surveillance period. Study team will use CPT codes to determine whether specific counseling therapies were provided. Patients diagnosed with Opioid Use Disorder and/or Alcohol Use Disorder and/or Tobacco Use Disorder were identified and then assessed in the EHR to determine if medication assisted therapy was provided by a provider during the 12 month Evaluation period. | Unique patients assessed across the two time points by disorder type. | Posted | Count of Participants | Participants | Baseline, 12 months |
|
|
|
|
| Secondary | Antiretroviral Therapy (ART) Receipt | ART receipt will be defined as at least 180 days of three concurrent antiretroviral agents in the 6-month interval based on prescriptions in the electronic medical record. | All those included in the multiple control and intervention phases across sites. | Posted | Count of Participants | Participants | 6 months |
|
|
|
| Secondary | Antiretroviral Therapy (ART) Receipt | ART receipt will be defined as at least 180 days of three concurrent antiretroviral agents in the 6-month interval based on prescriptions in the electronic medical record. | All patients monitored across all (multiple) control and evaluation periods. | Posted | Count of Participants | Participants | 12 months |
|
|
|
| Secondary | Viral Suppression | Viral suppression, will be defined as HIV RNA <200 copies/mL at last test closest to the time of data extraction, consistent with Department of Health and Human Services (DHHS) guidelines. Although current limits of detection are lower, this cutoff allows for low-level "blips" that have no clinical significance. | All patients monitored across all control (multiple) and intervention periods. | Posted | Count of Participants | Participants | 6 months |
|
|
|
| Secondary | Viral Suppression | Viral suppression, will be defined as HIV RNA <200 copies/mL at last test closest to the time of data extraction, consistent with Department of Health and Human Services (DHHS) guidelines. Although current limits of detection are lower, this cutoff allows for low-level "blips" that have no clinical significance. | All patients monitored across all control (multiple) and evaluation periods. | Posted | Count of Participants | Participants | 12 months |
|
|
|
| Secondary | VACS Index | The Veterans Aging Cohort Study Index (VACS Index) creates a score by summing pre-assigned points for age, routinely monitored indicators of HIV disease (CD4 count and HIV-1 RNA), and general indicators of organ system injury including hemoglobin, platelets, aspartate and alanine transaminase (AST and ALT), creatinine, and viral hepatitis C infection (HCV). This score is weighted to indicate increasing risk of all-cause mortality with increasing score. The score can be used to estimate risk of all-cause mortality using a conversion factor. The VACS Index will be evaluated based on most recent values at the time of data extraction. VACS Index score will be treated as a continuous variable. VACS Index: minimum value: 0; maximum value: 164- a higher score means a worse outcome. | Unduplicated count of survey respondents at each administration. | Posted | Mean | 95% Confidence Interval | units on a scale | 6 months |
|
|
|
| Secondary | VACS Index | The Veterans Aging Cohort Study Index (VACS Index) creates a score by summing pre-assigned points for age, routinely monitored indicators of HIV disease (CD4 count and HIV-1 RNA), and general indicators of organ system injury including hemoglobin, platelets, aspartate and alanine transaminase (AST and ALT), creatinine, and viral hepatitis C infection (HCV). This score is weighted to indicate increasing risk of all-cause mortality with increasing score. The score can be used to estimate risk of all-cause mortality using a conversion factor. The VACS Index will be evaluated based on most recent values at the time of data extraction. VACS Index score will be treated as a continuous variable. VACS Index: minimum value: 0; maximum value: 164- a higher score means a worse outcome. | Unduplicated count of survey respondents at each administration. | Posted | Mean | 95% Confidence Interval | units on a scale | 12 months |
|
|
|
| Secondary | Retention in HIV Care | Retention in HIV care, per DHHS guidelines uses a 24-month measurement period. It is defined as at least one HIV medical care visit in each 6-month period, with a minimum of 60 days between the first medical visit in the prior 6-month period and the last medical visit in the subsequent 6-month period. This measure has good agreement with the Institute of Medicine indicator for retention in care and is an independent predictor of mortality. We will evaluate whether patients have had at least 1 visit in the 6-month period prior to time of data extraction. | Patients identified at the control period to follow up with at the end of the intervention period. | Posted | Count of Participants | Participants | 6 months |
|
|
|
| Secondary | Retention in HIV Care | Retention in HIV care, per DHHS guidelines uses a 24-month measurement period. It is defined as at least one HIV medical care visit in each 6-month period, with a minimum of 60 days between the first medical visit in the prior 6-month period and the last medical visit in the subsequent 6-month period. This measure has good agreement with the Institute of Medicine indicator for retention in care and is an independent predictor of mortality. We will evaluate whether patients have had at least 1 visit in the 6-month period prior to time of data extraction. | Patients identified at the control period to follow up with at the end of the evaluation period. | Posted | Count of Participants | Participants | 12 months |
|
|
|
| Secondary | Organizational Readiness | Investigators will use the ORCA to measure factors impacting the provision of addiction treatments. This 15-minute survey is based on the PARiHS framework and asks the respondent to rate local factors related to evidence, context and facilitation on a 5-point Likert scale from strongly disagree to strongly agree. Facilitation questions will be omitted from the pre-implementation assessment since this part of the intervention and will not have taken place. The score has a range from 1 to 5 where a higher score indicates higher readiness. | Unduplicated count of survey respondents for the intervention period. | Posted | Mean | 95% Confidence Interval | units on a scale | 6 months |
|
|
|
| Secondary | Organizational Readiness | Investigators will use the ORCA to measure factors impacting the provision of addiction treatments. This 15-minute survey is based on the PARiHS framework and asks the respondent to rate local factors related to evidence, context and facilitation on a 5-point Likert scale from strongly disagree to strongly agree. Facilitation questions will be omitted from the pre-implementation assessment since this part of the intervention and will not have taken place. The score has a range from 1 to 5 where a higher score indicates higher readiness. | Unduplicated count of survey respondents for the maintenance period. | Posted | Mean | 95% Confidence Interval | units on a scale | 12 months |
|
|
|
| Secondary | Provider Readiness | Investigators will use change rulers, among appropriate providers, for each of the medications and counseling to assess readiness to provide each medication and counseling intervention. The change rulers will independently assess, on a 0-10 scale each provider's: 1) confidence to prescribe/provide the intervention, 2) readiness to prescribe/provide the intervention and 3) commitment to prescribe/provide the intervention. Presented is the score that indicates readiness to prescribe medication. The score has a range from 1 to 10 where a higher score indicates increased readiness. | Unduplicated count of survey respondents for the intervention period. | Posted | Mean | 95% Confidence Interval | units on a scale | 6 months |
|
|
|
| Secondary | Provider Readiness: | Investigators will use change rulers, among appropriate providers, for each of the medications and counseling to assess readiness to provide each medication and counseling intervention.185 The change rulers will independently assess, on a 0-10 scale each provider's: 1) confidence to prescribe/provide the intervention, 2) readiness to prescribe/provide the intervention and 3) commitment to prescribe/provide the intervention. Presented is the score that indicates readiness to prescribe medication. The score has a range from 1 to 10 where a higher score indicates increased readiness. | Unduplicated count of survey respondents for the maintenance period. | Posted | Mean | 95% Confidence Interval | units on a scale | 12 months |
|
|
|
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
Not provided
Not provided
Not provided
| Unknown or Not Reported |
|
| White |
|
| Other |
|
| Missing |
|
| Missing |
|
| Missing |
|
| Missing |
|
| Missing |
|
| Missing |
|
| 100-199 |
|
| 200-349 |
|
| 350-499 |
|
| >500 |
|
| Missing |
|
| Evaluation (12 months) |
|
|
| Odds Ratio (OR) |
| 1.77 |
| 2-Sided |
| 95 |
| 0.88 |
| 3.55 |
| Superiority |
| Generalized Estimating Equation | 0.005 | Odds Ratio (OR) | 1.35 | 2-Sided | 95 | 1.09 | 1.66 | Superiority |