Medicaid finances nearly half of treatment for opioid use disorder (OUD) in the United States, yet few states have adopted a comprehensive approach to measuring the quality of OUD treatment. Moreover, a lack of provider-level measures and limited integration of patient-reported outcomes impedes OUD quality measurement and improvement efforts. To address this gap, we conducted listening sessions and a ranking exercise to assess stakeholder perceptions of the acceptability, feasibility, and usefulness of several OUD quality measures for Medicaid patients, providers, and payers. We sought input from four stakeholder groups: lived experience panelists, OUD treatment providers, Medicaid managed care organizations’ Chief Medical Officers (MCO CMOs), and Medicaid Medical Directors (MMDs). Listening sessions, held with lived experience panelists and MMDs, solicited input on (1) OUD treatment provider roles and responsibilities, (2) perceptions of what constitutes high-quality care, and (3) OUD treatment experiences. Qualitative methods followed the Consolidated Criteria for Reporting Qualitative Research guidelines. Treatment providers, MCO CMOs, and MMDs participated in the modified Delphi process to add, edit, and rank 16 provider-level OUD quality measures based on 5 criteria: (1) provider influence, (2) acceptability, (3) feasibility, (4) patient choice of provider, and (5) use for performance assessment. Analyses of listening session data with lived experience panelists and MMDs (n = 20) identified five themes: (1) empathic and respectful OUD treatment settings; (2) provider stigma hindering effective OUD treatment; (3) insufficient provider and treatment choices (i.e., medication types and peer support) for individuals with OUD; (4) importance of structured peer support; and (5) whole-person, team-based care for individuals receiving OUD treatment. The participants in the modified Delphi activity (n = 30) ranked the following measures highest on all 5 criteria: “proportion of the provider’s patients with OUD receiving MOUD,” and “proportion of provider’s patients with a residential treatment episode for OUD that have an outpatient visit within 30 days after discharge.” Patient-reported outcome measures (“proportion of patients treated with respect”) ranked highly on value for patient choice and provider influence but lower on other criteria, such as feasibility. Stakeholders emphasized empathy and person-centered care as core tenets of high-quality OUD care. Only select provider-level quality measures were ranked highly across all criteria. Claims-based quality measures were ranked highly on more criteria, even though patient-reported outcomes ranked highly for determining patient choice. (Not applicable).
Background Injection drug use among nonurban people has fueled sharp rises in Hepatitis C (HCV) infections. Innovative treatment models are needed that circumvent healthcare system barriers for people who use drugs (PWUD), particularly in rural areas. The Oregon HOPE TeleHCV study randomized PWUD living with HCV in rural Oregon to peer-facilitated and streamlined telemedicine HCV treatment (Peer TeleHCV) versus enhanced usual care (EUC) and assessed sustained virologic response at 12 weeks post treatment (SVR12). Peer Support Specialists (peers) conducted HCV screening in the community, facilitated pretreatment evaluation and linkage to telemedicine HCV treatment clinicians, and supported participants in HCV medication adherence. A qualitative investigation queried patients about their experiences with the implementation of the model.Methods This qualitative study explored patient experiences with the Peer TeleHCV model in rural Oregon. We conducted semi-structured interviews with 34 participants purposively sampled from a larger randomized trial comparing Peer TeleHCV with enhanced usual care. The qualitative team analyzed transcripts using a thematic analysis framework combining inductive and deductive coding.Results. Participants described the model as accessible, supportive, and low barrier. We identified three major themes: 1) Staff approach and values facilitated engagement in care; 2) Convenience and flexibility made care accessible, and 3) Support addressing needs helped overcome barriers to care.Conclusion Findings highlight how community-based peers, integrated telemedicine, and flexible model design together reduce structural barriers to HCV care for rural PWUD. Adapting peer-facilitated telemedicine models can inform broader implementation of low-threshold, equitable approaches for substance use disorders and infectious disease treatment.
Regular alcohol and cannabis (AC) use during adolescence is associated with significant life-long consequences including psychosocial, health, financial, and emotional problems. Although primary care (PC) settings offer unique opportunities for screening and brief interventions (BI), there is often not enough time and/or training. In addition, significant disparities exist in delivery of these services, particularly for racially and ethnically diverse young people and sexual and gender diverse (SGD) adolescents. This paper describes the protocol for a randomized controlled trial (RCT) evaluating the effectiveness of CHAT (a brief motivational interviewing intervention) delivered by behavioral health staff in the health care setting compared to enhanced usual care (EUC) among diverse adolescents in PC settings. This is a two-arm, parallel-group RCT that will recruit 500 adolescents aged 12–19 from PC organizations in Southern California and Pittsburgh. Participants who screen positive on the CRAFFT screener for AC use risk will be randomized in blocks of 10, with 5 assigned to CHAT (a 15-minute MI-based intervention) and 5 to EUC (educational brochure) within each block. The study employs an advanced mixed-methods design with qualitative data collection to ensure patient-centeredness and stakeholder engagement. Primary outcomes include alcohol use, cannabis use, and alcohol and cannabis consequences measured at baseline, 3-, 6-, and 12-months post-randomization. This study addresses critical gaps in the literature regarding BI effectiveness for diverse adolescent populations in PC settings when delivered by staff in the health care system. The patient-centered approach, involving teens, parents, and providers throughout the research process will provide essential information about implementation feasibility, acceptability, and sustainability of brief interventions in real-world clinical settings. ClinicalTrials.gov Identifier: NCT06699251; 11/18/24 November 2023 1.0
Opioid poisoning is a leading cause of preventable mortality in North America. Emergency departments are open 24/7 and frequently provide care to people who use illicit opioids. While emergency departments offer critical opportunities to reverse drug toxicity, mitigate harm, and initiate longer-term treatment, there is limited high-quality evidence to guide emergency care for people presenting with opioid poisoning and/or use disorder. Our objective is to establish a national registry of patients presenting to emergency departments with opioid poisoning and produce timely evidence to inform clinical care, public health surveillance and policy. We will use the Canadian Emergency Department Research Network (CEDRN) data sharing and membership agreements, infrastructure and expertise to create the CEDRN Opioid Registry to collect data on consecutive patients of all ages presenting to participating emergency departments with suspected opioid poisoning. A waiver of informed consent for registry inclusion will ensure absence of volunteer bias. We will automate screening and data extraction from electronic health records. We will capture data from emergency medical services, emergency departments, and in-hospital care, including demographics (e.g., age, sex at birth, housing), presentation characteristics (e.g., vital signs, chief complaint), investigations (e.g., urine toxicology), treatments (e.g., medications), harm-reduction interventions (e.g., take-home naloxone), and consultations (e.g., physician, social work, peer support). We will collect short-term outcomes (e.g., disposition) and link data with administrative sources to ascertain retention on opioid agonist therapy, revisits, admissions and mortality. We will verify data quality and validate definitions by comparing automatically extracted electronic health record data with manually extracted data. We will measure the inter-rater reliability of data elements and the diagnostic performance of discharge diagnoses. We anticipate using mixed-effects models with splines to examine associations between treatments and outcomes, and regression models, internal bootstrap validation, and nomograms to derive clinical decision rules to predict mortality. Our data can also be used for public health surveillance. The CEDRN Opioid Registry will capture harmonized clinical data describing emergency care for patients presenting with opioid poisoning and allow us to create real-world timely evidence to inform clinical care, public health surveillance and policy. NCT07466784 (20 February 2026).
Opioid agonist treatment (OAT) remains the standard of care for people with opioid use disorder in Canada and the United States. Despite rising rates of overdose among youth (aged 16–24), OAT continues to be underutilized in this population. To reduce these gaps, we gathered experts’ recommendations on the development and implementation of youth-centred models of care for OAT. This qualitative research study was conducted between March 2024 and March 2025 in British Columbia (BC, Canada), where overdose is one of the leading causes of accidental death among youth. The study involved semi-structured expert interviews, conducted with four participant groups with expertise on the development and implementation of OAT for youth, including youth (aged 16–24) with experience accessing OAT, caregivers of youth with such experience, service providers, and decision-makers. Participants were recruited purposefully through youth mental health and substance use services across BC. A directed content analysis was performed on transcribed interviews to synthesize and describe experts’ recommendations for improving the delivery of OAT to youth. A total of 17 experts participated, including n = 6 youth, n = 4 caregivers, n = 5 service providers, and n = 2 decision-makers. The analysis led to the identification of eight recommendations: (1) establishing and maintaining trusting relationships with youth; (2) regularly checking in with youth about their goals, benefits, and challenges with OAT; (3) presenting all medication options and their benefits and challenges; (4) collaboratively developing OAT induction plans; (5) delivering OAT as part of a comprehensive approach; (6) delivering OAT in low barrier and non-judgmental settings; (7) collaboratively developing tapering processes; and (8) empowering and supporting caregivers. Recommendations were grounded in four foundational pillars, which emphasized positive youth–service provider relationships, flexible treatment plans, and service delivery settings that are low-barrier and holistic. This study outlines experts’ recommendations for youth-centred models of care for OAT. Future research is needed to examine the implementation of youth-centred models of care for OAT, with specific attention to how these models address the diverse needs of youth across different communities, age ranges, genders, and clinical, social, and cultural contexts.
