NIH – HEAL Initiative: Research to Foster an Opioid Use Disorder Treatment System Patients Can Count On (RM1 – Clinical Trial Optional)

July 15, 2022 by dld5dt@virginia.edu

Purpose:

Specifically, NIDA seeks applications for multi-project RM1 Opioid Use Disorder Quality Measurement and Management Research Centers (OUD-QM2RCs). OUD-QM2RCs will involve researchers and a partner with a deployed or in-development quality measurement strategy for opioid use disorder treatment that rigorous, scientific research could substantially advance. The ultimate goal is the creation of feasible, efficient quality measurement systems that provide meaningful information to help patients, families, and payors fairly compare and select providers and to help clinicians and providers improve patient outcomes. OUD-QM2RCs should 1. identify key aspects of the partner’s strategy that require additional research, 2. conduct the research, and 3. test or prepare to test the resulting system to determine if implementing it improves patient outcomes. Activities should also support the acceptability of the quality measurement and management system to patients, clinicians, and providers; the feasibility, scalability, and sustainability of the system; and equity in clinician/provider selection and treatment delivery.

Background:

Individuals with opioid use disorder (OUD), families, and payors report needing credible information to help them find and select effective opioid use disorder treatment providers. At the same time, evidence-based practices such as medications for opioid use disorder (MOUDs) are not routinely provided to patients nor taken for what is considered a sufficient duration. Efficacious, innovative approaches such as injectables are adopted slowly, and other practices often remain entrenched long after they have been demonstrated to be ineffective. Individuals who could benefit from interventions, their families, payors, providers, health care systems and the public at large often have an incomplete understanding of the effectiveness of specific interventions or the components of effective treatment.

Long recognizing these issues, the substance use disorder (SUD) treatment field, and increasingly the OUD treatment field, have developed and promulgated measures meant to indicate quality care. Quality measures may assess structural characteristics of providers, such as staff qualifications or the availability of evidence-based interventions; clinical processes such as the percent of patients receiving specific evidence-based interventions; or patient outcomes such as reductions in drug use. Existing and in-development quality measurement strategies are supported by federal, state, and local governments, private non-profit quality improvement organizations, private insurers, professional organizations, and others. Some examples include the Addiction Medicine Practice-Based Research Network, The American Society of Addiction Medicine’s Standards of Care and Performance Measures, Shatterproof’s ATLAS(R) Platform, The Substance Abuse and Mental Health Administration’s National Outcome Measures, The Center for Medicare and Medicaid Services Quality Measures, The National Association of Addiction Treatment (FoRSE) Addiction Treatment Outcomes Program, and the North Carolina Treatment Outcome Treatment Outcomes and Program Performance System (NC-TOPPS). Though some of these efforts have been in place for decades, improvement in quality as measured has been slower than hoped.

Ideally, quality measures would identify both areas of excellence and areas that need improvement. They would convey information that helps clinicians and providers improve their treatments and processes, and, most importantly, patient outcomes. Measures would be meaningful to patients and families who could use them to fairly compare and select the most appropriate and effective care and providers, and to payors or health plans who could use them to contract with effective providers. Measures would exist as part of a system that routinely collects, analyzes, and reports the measures and, crucially, acts on them to promote improvements in patient outcomes.

Rigorous research could advance the field toward the ideal by informing the development and assessing the effects of quality measurement and management systems based on existing quality measurement strategies to improve OUD treatment. Relevant research areas would depend on the specific quality measurement strategy, but examples may include, but are not limited to, the following:

  • Examining the measures used in the quality strategy to determine opportunities for improvement and whether improvements in measured performance lead to improvements in patient outcomes.
  • Developing and implementing evidence-based benchmark levels for the quality measures that promote improvement and/or signify high-quality treatment.
  • Developing, testing, and implementing a casemix measurement system that addresses differences in patient severity to enable fair comparisons of providers and clinicians.
  • Identifying potentially relevant predictors of response (e.g., social determinants of health, scores on symptom checklists, combinations of factors, biomarkers) to inform casemix development and/or patient outcome measurement and developing feasible measurement and reporting protocols.
  • Developing, testing, and implementing approaches for clinicians to use to improve their performance on specific quality measures.
  • Developing and pilot testing efficient systems relying on the latest technologies and advances in our understanding of addiction for routinely, timely, and objectively collecting, reporting, and acting upon measures.
  • Determining unintended negative effects of implementing a quality measurement and management system and testing approaches to mitigate those effects.
  • Testing the effects on patient outcomes of implementing the quality management and measurement system resulting from the resaerch.

To enhance impact, research should be informed by and disseminated to appropriate stakeholders to support the acceptability of the quality measurement and management system to patients, clinicians, and providers; the feasibility, scalability, and sustainability of the system; and equity in clinician/provider selection and treatment delivery.

Key Dates:

Open Date (Earliest Submission Date): January 02, 2023
Letter of Intent Due Date(s): January 2, 2023
Applications Due: February 2, 2023

URL for more information:

https://grants.nih.gov/grants/guide/rfa-files/RFA-DA-23-046.html

Filed Under: Funding Opportunities