The STop UNhealthy (STUN) Substance Use Now Trial (STUN II) is a multisite trial aiming to evaluate the comparative effectiveness of the following strategies for improving the implementation of screening and interventions for substance use disorders in primary care: practice facilitation (PF), PF plus a learning collaborative (LC), PF plus performance incentives (PI), and PF+LC+PI. We plan to enroll 144 clinic staff participants from 48 primary care practices
The STop UNhealthy (STUN) Substance Use Now Trial (STUN II) is a multisite trial aiming to evaluate the comparative effectiveness of the following strategies for improving the implementation of screening and interventions for substance use disorders in primary care: practice facilitation (PF), PF plus a learning collaborative (LC), PF plus performance incentives (PI), and PF+LC+PI. We plan to enroll 144 clinic staff participants from 48 primary care practices Specific aim 1 (primary aim) will compare the effect of learning collaborative (LC) participation, performance incentives (PI), or their combination, with practice facilitation (PF) only, on implementation of evidence-based screening for SUDs. Specific aim 2 (secondary aim) will compare the effect of LC participation, PI, or their combination, with PF only, on implementation of evidence-based interventions for SUDs, including (a) brief counseling, (b) medications (e.g., buprenorphine, naltrexone) and adherence to them, and (c) referral to specialty care. Specific aims 1 and 2 will produce fundamentally important evidence about the comparative effectiveness of PF, PF+LC, PF+PI, and PF+LC+PI strategies on uptake of evidence-based screening and interventions for SUD when delivered to primary care practices. Specific aim 3 (exploratory aim) will use a longitudinal mixed-methods evaluation to assess the association between implementation effectiveness and putative moderators (e.g., organizational readiness for change) and mediators (e.g., implementation climate). Aim 3 will generate scientific knowledge about mechanisms of change (why and how the various strategies work) in primary care settings.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
144
Practices will meet with practice facilitators monthly and apply tests of change using a Plan-Do-Study-Act approach, guided by the PF team. Facilitators will confirm that practices have established workflows for substance use disorder (SUD) screening and interventions and perform checks periodically to ensure progression. PF will entail: implementing protocols/algorithms for evidence-based screening and interventions, promoting decision support tools and templates to support practice workflow, optimizing electronic health record (EHR) use to pull clinical data monthly to guide the improvement process, developing patient registries (e.g., for those with SUD) to identify needed care and optimize delivery of evidence-based interventions, encouraging proactive, team-based care with assigned roles and responsibilities, and enhancing the understanding of evidence-based SUD interventions, including counseling and referral resources to ensure practices have appropriate intervention options.
Virtual LC sessions will be held monthly and will include participants presenting anonymized cases to clinical experts, targeted brief didactics related to the content of the cases, and time for open discussion and Q\&A. Participant-generated ideas for topics to be covered during virtual LC sessions will be encouraged. Some specific topics will include optimal SUD screening approaches; prescribing medications for opioid use disorder (OUD) in primary care; pragmatic issues around integrated SUD care within primary care such as compliance with state and federal requirements, note templates/visit frequency, and when/how to escalate care for patients with severe or worsening SUD; medications for alcohol use disorder (AUD); and motivational interviewing.
We will work closely with key stakeholders and the Steering Committee to co-design the PI strategy, refining the specific performance metrics to ensure that they align with other ongoing efforts in our partnering organizations. We plan to base the incentive on achieving a threshold target for the percentage of eligible adult patients screened for SUD, or the percentage improvement in screening, for quarters 1 and 2. For quarters 3 and 4, after practices have had time to implement and improve their processes for screening for SUD, the incentives will evolve to become a composite of (1) patients screened for SUD (the same as used in quarters 1 and 2) and (2) achieving a threshold target for the percentage of persons with SUD who received evidence-based interventions.
Bon Secours Mercy Health
Cincinnati, Ohio, United States
RECRUITINGThe Ohio State University Wexner Medical Center
Columbus, Ohio, United States
RECRUITINGOhio Association of Community Health Centers
Columbus, Ohio, United States
RECRUITINGNumber of adults screened for substance use disorder
Number of people aged 18 and older who are screened for substance use disorder using a validated screening tool
Time frame: 12 months
Percent of adults screened for substance use disorder
Percent of people aged 18 and older who are screened for substance use disorder using a validated screening tool
Time frame: 12 months
Number of adults with a positive screen for substance use disorder
Of those aged 18 and older who were screened for substance use disorder, number who had a positive screening result
Time frame: 12 months
Number of adults with a positive screen for substance use disorder
Of those aged 18 and older who were screened for substance use disorder, number who had a positive screening result
Time frame: 24 months
Percent of adults with a positive screen for substance use disorder
Of those aged 18 and older who were screened for substance use disorder, percentage who had a positive screening result
Time frame: 12 months
Percent of adults with a positive screen for substance use disorder
Of those aged 18 and older who were screened for substance use disorder, percentage who had a positive screening result
Time frame: 24 months
Number of adults who received any evidence-based intervention for substance use disorder
Of those aged 18 or older who were identified as having substance use disorder and/or alcohol use disorder, number who received brief counseling, medication, or referral to specialty care
Time frame: 12 months
Number of adults who received any evidence-based intervention for substance use disorder
Of those aged 18 or older who were identified as having substance use disorder and/or alcohol use disorder, number who received brief counseling, medication, or referral to specialty care
Time frame: 24 months
Percentage of adults who received any evidence-based intervention for substance use disorder
Of those aged 18 or older who were identified as having substance use disorder and/or alcohol use disorder, percentage that received brief counseling, medication, or referral to specialty care
Time frame: 24 months
Percentage of adults who received any evidence-based intervention for substance use disorder
Of those aged 18 or older who were identified as having substance use disorder and/or alcohol use disorder, percentage that received brief counseling, medication, or referral to specialty care
Time frame: 12 months
Number of adults who received brief counseling for substance use disorder
Of people aged 18 or older who screened positive for substance use disorder and/or alcohol use disorder, number who received brief counseling
Time frame: 12 months
Number of adults who received brief counseling for substance use disorder
Of people aged 18 or older who screened positive for substance use disorder and/or alcohol use disorder, number who received brief counseling
Time frame: 24 months
Percentage of adults who received brief counseling for substance use disorder
Of people aged 18 or older who screened positive for substance use disorder and/or alcohol use disorder, percentage who received brief counseling
Time frame: 24 months
Percentage of adults who received brief counseling for substance use disorder
Of people aged 18 or older who screened positive for substance use disorder and/or alcohol use disorder, percentage who received brief counseling
Time frame: 12 months
Number of adults who received medication for substance use disorder
Of people aged 18 or older who screened positive for substance use disorder and/or alcohol use disorder, number who received medication
Time frame: 12 months
Number of adults who received medication for substance use disorder
Of people aged 18 or older who screened positive for substance use disorder and/or alcohol use disorder, number who received medication
Time frame: 24 months
Percentage of adults who received medication for substance use disorder
Of people aged 18 or older who screened positive for substance use disorder and/or alcohol use disorder, percentage who received medication
Time frame: 24 months
Percentage of adults who received medication for substance use disorder, including alcohol use disorder
Of people aged 18 or older who screened positive for substance use disorder and/or alcohol use disorder, percentage who received medication
Time frame: 12 months
Number of adults who received medication for substance use disorder, including alcohol use disorder, and adhered to 6 months of treatment
Of those aged 18 or older who received medication for substance use disorder and/or alcohol use disorder, number who adhered to treatment for 6 months
Time frame: 12 months
Number of adults who received medication for substance use disorder, including alcohol use disorder, and adhered to 6 months of treatment
Of those aged 18 or older who received medication for substance use disorder and/or alcohol use disorder, number who adhered to treatment for 6 months
Time frame: 24 months
Percentage of adults who received medication for substance use disorder, including alcohol use disorder, and adhered to 6 months of treatment
Of those aged 18 or older who received medication for substance use disorder and/or alcohol use disorder, percentage who adhered to treatment for 6 months
Time frame: 24 months
Percentage of adults who received medication for substance use disorder, including alcohol use disorder, and adhered to 6 months of treatment
Of those aged 18 or older who received medication for substance use disorder and/or alcohol use disorder, percentage who adhered to treatment for 6 months
Time frame: 12 months
Number of adults referred to specialty care for substance use disorder and/or alcohol use disorder
Of those aged 18 or older who were identified as having substance use disorder and/or alcohol use disorder, number who were referred to specialty care (psychiatry, 12-step programs, counseling, etc.)
Time frame: 12 months
Number of adults referred to specialty care for substance use disorder and/or alcohol use disorder
Of those aged 18 or older who were identified as having substance use disorder and/or alcohol use disorder, number who were referred to specialty care (psychiatry, 12-step programs, counseling, etc.)
Time frame: 24 months
Percentage of adults referred to specialty care for substance use disorder and/or alcohol use disorder
Of those aged 18 or older who were identified as having substance use disorder and/or alcohol use disorder, percentage who were referred to specialty care (psychiatry, 12-step programs, counseling, etc.)
Time frame: 24 months
Percentage of adults referred to specialty care for substance use disorder and/or alcohol use disorder
Of those aged 18 or older who were identified as having substance use disorder and/or alcohol use disorder, percentage who were referred to specialty care (psychiatry, 12-step programs, counseling, etc.)
Time frame: 12 months
Number of adults with alcohol use disorder
Of those aged 18 or older who were screened for substance use disorder, number who had alcohol use disorder
Time frame: 12 months
Number of adults with alcohol use disorder
Of those aged 18 or older who were screened for substance use disorder, number who had alcohol use disorder
Time frame: 24 months
Percentage of adults with alcohol use disorder
Of those aged 18 or older who were screened for substance use disorder, percentage who had alcohol use disorder
Time frame: 24 months
Percentage of adults with alcohol use disorder
Of those aged 18 or older who were screened for substance use disorder, percentage who had alcohol use disorder
Time frame: 12 months
Number of adults who received any evidence-based intervention for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, number who received any evidence-based intervention (brief counseling, medication, referral to specialty care)
Time frame: 12 months
Number of adults who received any evidence-based intervention for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, number who received any evidence-based intervention (brief counseling, medication, referral to specialty care)
Time frame: 24 months
Percentage of adults who received any evidence-based intervention for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, percentage who received any evidence-based intervention (brief counseling, medication, referral to specialty care)
Time frame: 24 months
Percentage of adults who received any evidence-based intervention for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, percentage who received any evidence-based intervention (brief counseling, medication, referral to specialty care)
Time frame: 12 months
Number of adults who received brief counseling for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, number who received brief counseling
Time frame: 12 months
Number of adults who received brief counseling for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, number who received brief counseling
Time frame: 24 months
Percentage of adults who received brief counseling for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, percentage who received brief counseling
Time frame: 24 months
Percentage of adults who received brief counseling for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, percentage who received brief counseling
Time frame: 12 months
Number of adults who received medication for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, number who received medication
Time frame: 12 months
Number of adults who received medication for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, number who received medication
Time frame: 24 months
Percentage of adults who received medication for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, percentage who received medication
Time frame: 24 months
Percentage of adults who received medication for alcohol use disorder
Of those aged 18 or older identified as having alcohol use disorder, percentage who received medication
Time frame: 12 months
Number of adults who received medication for alcohol use disorder and adhered to 6 months of treatment
Of those aged 18 or older who received medication for alcohol use disorder, number who adhered to treatment for 6 months
Time frame: 12 months
Number of adults who received medication for alcohol use disorder and adhered to 6 months of treatment
Of those aged 18 or older who received medication for alcohol use disorder, number who adhered to treatment for 6 months
Time frame: 24 months
Percentage of adults who received medication for alcohol use disorder and adhered to 6 months of treatment
Of those aged 18 or older who received medication for alcohol use disorder, percentage who adhered to treatment for 6 months
Time frame: 24 months
Percentage of adults who received medication for alcohol use disorder and adhered to 6 months of treatment
Of those aged 18 or older who received medication for alcohol use disorder, percentage who adhered to treatment for 6 months
Time frame: 12 months
Number of adults referred to specialty care for alcohol use disorder
Of those aged 18 or older who were identified as having alcohol use disorder, number who were referred to specialty care (psychiatry, 12-step programs, counseling, etc.)
Time frame: 12 months
Number of adults referred to specialty care for alcohol use disorder
Of those aged 18 or older who were identified as having alcohol use disorder, number who were referred to specialty care (psychiatry, 12-step programs, counseling, etc.)
Time frame: 24 months
Percentage of adults referred to specialty care for alcohol use disorder
Of those aged 18 or older who were identified as having alcohol use disorder, percentage who were referred to specialty care (psychiatry, 12-step programs, counseling, etc.)
Time frame: 24 months
Percentage of adults referred to specialty care for alcohol use disorder
Of those aged 18 or older who were identified as having alcohol use disorder, percentage who were referred to specialty care (psychiatry, 12-step programs, counseling, etc.)
Time frame: 12 months
Number of adults screened for substance use disorder
Number of people aged 18 and older who are screened for substance use disorder using a validated screening tool
Time frame: 24 months
Percent of adults screened for substance use disorder
Percent of people aged 18 and older who are screened for substance use disorder using a validated screening tool
Time frame: 24 months
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