Abstract

BACKGROUND: Delivery of evidence-based treatment for opioid use disorder (OUD)—especially medication treatment (MOUD)—reduces morbidity and mortality and is the bedrock of OUD care. Yet fewer than half of Veterans with OUD receive MOUD, and up to half who initiate treatment do not remain in treatment after 12 months. Access to treatment is a barrier that many interventions have addressed in recent years; however, there is also evidence that many Veterans with access to treatment may not 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. My study objective is to develop and implement a quality measurement and quality improvement strategy that will improve patient-centered care for Veterans with OUD. My long-term goal is to become an independent VA clinician-investigator with a focus on improving healthcare access and quality for Veterans with OUD and other substance use disorders (SUDs). SIGNIFICANCE/IMPACT: OUD prevalence, morbidity, and mortality among Veterans are disproportionate to the general US population. To address this disparity, VA has expanded treatment access, but overall engagement among affected Veterans remains low. The extent to which patient engagement is affected by the quality of patient-centered care is not established because there are few quality measures for OUD, and most are not patient-centric. Instead, current measures may disincentivize patient-centered care by measuring aspects of care outside the full control of the provider (e.g., treatment initiation, adherence, and retention) and favor treating patients already committed to recommended care over those who are not. VA has a track record as a leader in both patient-centered care and SUD care that spans decades, making this study optimal for VA. INNOVATION: This CDA-2 will measure the quality of patient-centered care through audio-recorded patient visits (patient-collected audio). It will also incorporate the patient voice in defining a provider feedback intervention to improve patient-centered care, through direct elicitation of patient preferences and partnership with a Veteran Advisory Panel. SPECIFIC AIMS: There are three aims in this study: (1) To assess performance of VA OUD providers on measures of patient-centered care and the association of patient-centered care performance with patient engagement; (2) To identify preferences, needs, and values of Veterans with OUD that impact their willingness to engage in care; and (3) To develop and implement a provider performance audit and feedback intervention based on patient-centered measures of OUD care quality. METHODOLOGY: I will use patient-collected audio recordings of 300 OUD-related clinical visits to assess provider performance on five validated measures of patient-centered care at two VA facilities, followed by chart review to compare the extent of patient-centered care received to six measures of engagement six months after initial assessment. Next, I will (a) interview Veterans with OUD regarding their preferences, needs, and values related to OUD care and (b) survey Veterans with OUD using best-worst scaling to identify preference- ordered themes that are perceived as likely to increase engagement in care. I will then bring together VA stakeholders (patients, providers, leaders) using a nominal group technique to (a) review provider performance and patient preferences related to patient-centered care and patient engagement and (b) develop and implement a provider feedback intervention to improve patient-centered care for OUD at one VA. NEXT STEPS/IMPLEMENTATION: I will work with key stakeholders, including Veterans, clinicians, and VA operational partners, to expand this quality measurement and implementation strategy across VA.

NIH Reporter Project Information: https://reporter.nih.gov/project-details/10748271


PUBLICATIONS:
None at this time.