Partnering with a large health system to study the effectiveness of an innovative clinical program to improve care for hospital patients with substance use disorders:  Pragmatic trial of the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in 6 New York City public hospitals

Jennifer McNeely, MD
NYU Grossman School of Medicine

ABSTRACT:
Individuals with substance use disorders (SUD) have high rates of hospitalization, and frequently have poor health outcomes and low rates of addiction treatment.  Hospital-based addiction consult services have the potential to improve inpatient and post-discharge care for patients with substance use disorders (SUD), and can be an important component of strategies to reduce opioid-related overdose.  Beginning in 2017, with special funds from the NYC Mayor’s Office to address the opioid crisis, the New York City Health + Hospitals (H+H) system began the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in 6 hospitals.  We partnered with H+H to design the program model and conduct a NIDA-funded pragmatic trial of the CATCH program focused on patients with opioid use disorder (OUD).  A hybrid effectiveness-implementation study (Type 1) studied the effectiveness of CATCH for increasing post-discharge initiation and engagement in OUD treatment, while studying the process of implementing this large new program in public hospital settings to inform its adoption and sustainability.  A stepped-wedge cluster randomized trial design compared treatment outcomes for patients hospitalized during the CATCH versus treatment as usual periods.  A mixed methods approach primarily utilized Medicaid claims data to measure outcomes, while electronic health records data and interviews with staff and patients provided additional information on implementation fidelity and barriers.  Our study involved active ongoing collaboration with the H+H system, including through the first year of the COVID-19 pandemic, which presented unprecedented challenges to the City’s public hospitals.  This talk will reflect on the process of partnering with a large health system to study a new program, present findings on the program’s effectiveness, and discuss the implementation process and outcomes.

From single to multiple behaviour change approaches in implementation science

Justin Presseau, PhD
University of Ottawa

ABSTRACT:
Behaviour change theory-informed implementation intervention development and evaluation often focuses on improving sub-optimally performed clinical practice, redressing variations in care, or de-implementing lower-value care. In many instances, such approaches focus on a given clinical action as the target for change. However, the professional context of those delivering healthcare and the lived experience of those receiving healthcare are characterised by navigating contexts involving engaging in multiple behaviours; where engaging in a given action may impact on other competing demands and/or the actions of others. Predominant methodological approaches and theoretical lenses used in implementation science may not yet be accounting for this system of multiple behaviours. This talk will explore the challenges and opportunities of shifting from a single behaviour to a multiple behaviour approach in implementation science. With examples of implementation research across a variety of chronic disease topic areas, this talk will explore the implications and opportunities for shifting to a multiple behaviour change approach for: identifying gaps in care and selecting focal behaviour(s), identifying theory-informed barriers/enablers to change, selecting intervention strategies and change techniques, and evaluating implementation strategies.

The Stanford Lightning Report: An Implementation Science Rapid Qualitative Approach for Formative Evaluation

Catherine Brown Johnson, PhD
Stanford School of Medicine

Steve Asch, MD, MPH
Stanford School of Medicine

ABSTRACT:
The Stanford Lightning Report is a structured but flexible rapid qualitative approach used to increase the pace of learning in healthcare implementation. Supporting Learning Health System goals as well as large-scale research agendas, it can be applied across settings, from quality improvement and to randomized trials, ensuring more successful implementation. This talk includes examples of Lightning Report use in addiction settings (e-cigarettes and opioid use), step-by-step instructions on how to employ the approach, and hands-on just-in-time consultation on how to incorporate the Lightning Report into your projects.

Implementing Collaborative Care for Co-Occurring Disorders in low-resourced settings

Katherine Watkins, MD, MSHS
RAND Corporation

ABSTRACT:
Untreated co-occurring opioid use disorders and mental illness are prevalent and can have devastating consequences for the individual, their families, and the community. The Collaborative Care Model (CoCM) improves outcomes by addressing problems in access and quality for primary care patients with common behavioral health conditions but has not been implemented and tested for co-occurring disorders. This presentation will describe the development and implementation of a CoCM program for co-occurring opioid and mental health disorders in 17 primary care clinics in New Mexico and California. Using Proctor et al.’s 2011/2022 taxonomy of implementation outcomes and data from an ongoing clinical trial, we present the methods used to assess implementation outcomes and results of implementation efforts on model reach and fidelity. We compare the characteristics of individuals who received an initial session with a care coordinator with those whom the care coordinator was unable to engage. Understanding who does and does not receive CC may aid in developing implementation strategies to increase reach and fidelity

Assessing Implementation Strategies for the Uptake of Bundled Interventions to Improve Culturally Relevant Care for Black women with HIV

Andrea Dakin, PhD, MA
AIDS Foundation Chicago

Serena Rajabiun, PhD
University of Massachusetts Lowell

Alicia Downes, LMSW
AIDS United

Corliss Heath, PhD
US Department of Health and Human Services

ABSTRACT:
The Health Resources and Services Administration (HRSA), HIV/AIDS Bureau(HAB), Ryan White HIV/AIDS Program (RWHAP), Part F- Special Projects of National Significance initiative entitled Improving Care and Treatment Coordination for Black women with HIV funded 12 clinical and community-based organizations and one evaluation center to adapt, implement, and assess the uptake of evidence based/informed (EB/EI) bundled interventions to improve health outcomes and well-being for Black women with HIV. This study examines the successes, challenges, and adaptations to implementation strategies to support intervention uptake and cultural responsiveness for Black women with HIV.

Guided by the Expert Recommendations for Implementing Change (ERIC) compilation, the Evaluation and Technical Assistance Center working in partnership with the demonstration sites selected five implementation strategies for intervention uptake: tailoring interventions to local context; train/educate stakeholders; evaluation and iterative strategies; engaging consumers; and changing infrastructure. Tracking implementation strategies and adaptations across sites required multiple approaches to data collection, as each of the twelve sites bundled two-four EB/EIs. Modifications to strategies during the pre-implementation and implementation phases were documented using FRAME-IS core modules gathered through monthly coaching calls with sites and annual site visits with evaluation center coaches and site implementation teams. This presentation will outline the data collection and analysis methods employed by the evaluation center, as well as present a case study from one of the demonstration sites.

It takes a village: Implementing a pragmatic trial to evaluate a group telehealth intervention for family members affected by opioid use disorder

Karen Osilla, PhD
Stanford University School of Medicine

ABSTRACT:
Opioid use disorder (OUD) has devastating effects on individuals, families, and communities. This presentation describes eINSPIRE (INtegrating Support Persons Into REcovery), a pragmatic randomized trial that tests the Community Reinforcement Approach and Family Training (CRAFT) intervention delivered via group telehealth therapy compared to usual care. CRAFT is an evidence-based approach for the family members or close friends (referred to as Support Persons; SPs) of individuals with a substance use disorder. Patients and SP dyads were recruited across five community health systems in Southern and Northern California that provide buprenorphine treatment and mental health services. This presentation will describe our dyadic recruitment and implementation insights on the adoption, reach, and feasibility of intervening with SPs in these settings.

Eight characteristics of rigorous multilevel implementation research: a step-by-step guide.

Rebecca Lengnick-Hall, PhD, MSW, MPA
Washington University in St. Louis

Gregory Aarons, PhD
University of California, San Diego

ABSTRACT:
Although healthcare is delivered in inherently multilevel contexts, implementation science has no widely endorsed methodological standards defining the characteristics of rigorous, multilevel implementation research. Presenters will identify and describe eight characteristics of high-quality, multilevel implementation research to encourage discussion, spur debate, and guide decision-making around study design and methodological issues. These eight characteristics provide benchmarks for evaluating the quality and replicability of multilevel implementation research and promote a common language and reference points. This, in turn, facilitates knowledge generation across diverse multilevel settings and ensures that implementation research is consistent with (and appropriately leverages) what has already been learned in allied multilevel sciences. When a shared and integrated description of what constitutes rigor is defined and broadly communicated, implementation science is better positioned to innovate both methodologically and theoretically.

Four Ways to Conceptualize and Study Policy in Implementation Science Research

Jonathan Purtle, DrPH, MSc
New York University

ABSTRACT:
This presentation will offer a typology of four ways to conceptualize policy in implementation science research: 1) Policy as something to adopt, 2) Policy as something to implement, 3) Policy as context to understand, and 4) Policy as strategy to use. Examples will be provided of studies that have conceptualized policy in these different ways in the area of behavioral health.

Designing for Dissemination and Sustainability: Methods, Frameworks, Tools, and a Diabetes Case Example

Bethany M. Kwan, PhD, MSPH, FSBM
University of Colorado School of Medicine

ABSTRACT:
Designing for dissemination and sustainability (D4DS) refers to the process of ensuring that the products of research are likely to be adopted, implemented, and sustained in the context of intended use. D4DS involves use of methods such as participatory co-design, active dissemination planning, and pragmatic trial designs to develop evidence that “fits the context” and can be readily adopted in real-world settings. This presentation will provide an overview of the rationale, principles, methods, and frameworks for D4DS. The Fit to Context Framework for D4DS is a novel process framework to guide planning, conduct, and dissemination of research, based on a narrative review of the literature on D4DS. Tools to support application of the Fit to Context Framework, including https://dicemethods.org/ and https://app.d4dsplanner.com/, will be demonstrated. A case example will describe D4DS applications in the Invested in Diabetes study, a pragmatic, type II hybrid implementation-effectiveness trial of two models of diabetes shared medical appointments.

Prevention science and methodology: Considerations for working with Indigenous populations

Donald Warne, MD, MPH
Johns Hopkins Bloomberg School of Public Health

ABSTRACT:
American Indians and Alaska Natives (AI/ANs) endure some of the worst health disparities in the nation. The history of marginalization and exclusion of Indigenous voices from setting the research agenda, determining priorities, and conducting research will be explored. We will also define American Indian, Alaska Native, Native American, and Indigenous populations in the US; and we will describe the impact of preventable conditions on Indigenous health equity. We will also explore and identify opportunities to promote prevention science, methods, and implementation in AI/AN populations to improve outcomes.   

Beyond Jacobson & Truax: Modern Methods for Estimating Clinically Significant Change

Antonio Morgan-Lopez, PhD
RTI International

ABSTRACT:
In the majority of randomized controlled trials (RCTs) the focus is on differences in the average change over time on outcomes across intervention conditions, with variation in individual trajectories often treated as nuisance. In contrast, a primary focus on inferences regarding the improvement (or worsening) of individual participants is best represented by clinical significance or clinically significant change (CSC). One of the primary tools in the assessment of CSC is Jacobson and Truax (1991’s) Reliable Change Index (RCI). The RCI is still very popular, as evidenced by 12,000 total citations and over 300 citations in 2023 alone. However, three specific limitations have been identified with the RCI: a) the RCI estimate is based on a pre-post difference score, b) the scores upon which the RCI estimate is based (typically total scores) often contain both measurement bias and measurement error and c) the RCI standard error of measurement (SEM) is erroneously assumed to be constant across participants and time. We present an approach that addresses all three limitations simultaneously: a) scale score and SEM estimation using moderated nonlinear factor analysis and b) RCI estimation using a modification of a three-level multilevel model with modeling of observation-specific measurement uncertainty. We focus on two illustrations: one from a treatment trial targeting comorbid PTSD/alcohol use disorder among OEF/OIF Veterans and second from a school-based selective preventive intervention trial targeting conduct problems in late elementary through high school. We also provide sample SAS code for implementation that is easily accessible to those with experience with conventional multilevel models.

Peer-delivered Intervention to Improve Retention and Polysubstance Use in Mobile Telemedicine in Rural Maryland

Jessica Magidson, PhD
University of Maryland

Sarah Kattakuzhy, MD, MPH
University of Maryland

ABSTRACT:
There is a severe shortage of providers to treat opioid use disorder (OUD), which is further exacerbated in rural areas. Similar to the shortage of prescribers, there is also a severe shortage of trained behavioral health providers to meet the needs of patients with OUD. This talk will provide an overview of a newly launched NIDA-funded R01 trial “Peer Recovery to Improve Polysubstance Use and Mobile Telemedicine Retention” (PRISM)--a randomized Type 1 hybrid effectiveness-implementation trial (n=180) to examine a peer recovery specialist-delivered behavioral intervention to improve retention and polysubstance use on a mobile telemedicine treatment unit in rural Maryland. We will describe a novel telemedicine mobile treatment unit approach to expand access to OUD treatment in hard hit rural areas, as well as how our team is integrating an evidence-based, peer-delivered behavioral activation intervention to support retention and polysubstance use outcomes.

Adapting to the Fentanyl Epidemic: Implications for translation of a multi-component intervention and RCT in the Emergency Department and real world lessons from an implementation practitioner 

Lauren K. Whiteside, MD, MS
University of Washington

ABSTRACT:
The opioid epidemic is rapidly evolving with the proliferation of nonpharmaceutical fentanyl. Simultaneously, researchers, public health officials, and clinicians are working to develop and implement interventions to improve clinical care for patients with opioid use disorder (OUD). The Emergency Department Longitudinal Integrated Care (ED-LINC) randomized clinical trial harnesses the Collaborative Care model to reduce illicit opioid use and improve initiation and retention of evidence-based medications for opioid use disorder (MOUD) for patients that visit the ED with OUD. The original ED-LINC intervention was developed and pilot-tested prior to the overwhelming availability of fentanyl in our community.  We present information on a systematic rapid qualitative approach leveraging real-time clinical observations related to fentanyl use among the initial n=30 ED-LINC intervention participants.  This method was used to systematically produce and document protocol modifications and intervention adaptations required to ensure successful implementation of an intervention that is relevant to the target population amidst the rapidly intensifying fentanyl epidemic. As an implementation practitioner, there is an unavoidable urgency in treating patients with OUD due to fentanyl now and it is crucial that research does not lag behind the current state given the rapidly evolving epidemic. 

Understanding and Reducing Inequities in Substance Use Treatment Access and Utilization

Lesia Ruglass, PhD
City College of New York

ABSTRACT:
Data from the United States National Survey on Drug Use and Health (NSDUH, 2021) indicate that while certain racial/ethnic minoritized populations may have equivalent or lower rates of substance use disorders (SUD) compared to White people, evidence suggests that once developed, and given structural inequities and barriers, racial/ethnic minoritized people may suffer more deleterious consequences (i.e., health, criminal justice system involvement etc.) related to SUD than their White counterparts. In tandem, racial/ethnic minoritized people are less likely to access, utilize, and receive quality evidence-based SUD treatment than their White counterparts, which may further contribute to worsening of their SUD over time. This presentation will review research findings on some of the key factors (individual, interpersonal, community, and social) associated with inequities in treatment access and outcomes for racial/ethnic minoritized populations. Recommendations for research, clinical, and community/societal changes to advance health equity for racial/ethnic minoritized populations with SUD will be discussed.

Adjunctive Interventions in Implementation Research:​ One “thing”? Two things? Old thing? New thing?

Nanette Benbow, MA
Northwestern University

Dennis Li, MPH, PhD
Northwestern University

James Merle, PhD
University of Utah

ABSTRACT:
Implementation science currently groups change methods into two categories: (1) clinical, behavioral, or biomedical interventions targeting recipients’ health outcomes, and (2) implementation strategies—actions taken to improve system-level delivery of an intervention. Differentiating interventions from strategies based on their intended functions is critical to accurately attributing the effects of each change method on its respective health or implementation outcomes. However, in our work coordinating 200+ HIV implementation research projects and conducting systematic reviews of HIV intervention implementation, we identified change methods that had characteristics of both interventions and strategies and were inconsistently classified. To alleviate confusion and improve change method specification, we propose that implementation science should adopt the term adjunctive interventions to classify change methods that fall into this gray area. Adjunctive interventions are distinguished from other change methods by their intended targets, desired outcomes, and theory of action and causal processes. Whereas health interventions target recipients and have a direct, causal effect on the health outcome, adjunctive interventions enhance recipients’ motivation, self-efficacy, or capacity for initiating, adhering to, or engaging with the health intervention and thus have an indirect causal link to the health outcome via increasing the probability of recipients’ utilization of the health intervention. Adjunctive interventions are incapable of directly producing the health outcome and require additional implementation strategies to deliver alongside the health intervention. We will discuss case examples, logic modeling, and considerations for adjunctive intervention research. Conceptualizing adjunctive interventions as a separate type of change method will advance implementation research by improving tests of effectiveness and the specification of mechanisms and outcomes, which will accelerate research evidence to achieve public health impact.

Proposing and Applying the Observational-Implementation Hybrid Approach

Justin Knox, PhD, MPH
Columbia University

ABSTRACT:
We recently proposed the observational-implementation hybrid approach, or the incorporation of implementation science elements into observational studies in order to collect information that will allow for anticipation, estimation, and/or inference about the effects of interventions and implementation strategies. We describe this approach, including examples of how we are applying it to an ongoing observational study among n=600 Black sexual minority (SMM) men in order to collect relevant implementation data regarding the use of evidence-based practices to support drinking reductions. An initial step for employing an observational-implementation hybrid approach is knowing about the state of the research on relevant interventions or policies that aim to address the modifiable constructs relevant to the research questions of the study, including their implementation. Evidence-based practices that have been shown to help individuals reduce their alcohol use that we will focus on include: electronic screening and brief intervention, motivational interviewing, HealthCall (an mHealth intervention for people living with HIV), and naltrexone. We will employ various approaches to collect information on how to deliver these alcohol interventions to Black SMM. We are using survey measures to collect factors related to transportability of the alcohol interventions that we selected (e.g., access to a primary care physician, insurance status, treatment-seeking). We are conducting a discrete choice experiment among n=240 participants who report heavy drinking (AUDIT-C score >4) in order to collect preference data on the delivery of the alcohol interventions. Among a HIV-status neutral sub-sample of participants who report heavy drinking (n=30), we are using a human-centered design approach to collect journey maps of their experiences accessing HIV prevention and care service in clinical settings that will identify opportunities for co-delivery of alcohol interventions in these settings. Lastly, we are conducting in-depth interviews with n=10 HIV prevention and care service providers to collect input on implementation factors related to co-locating alcohol interventions into HIV prevention and care services. Applying this observational-implementation hybrid approach provides an opportunity to conduct observational research in ways that will allow it to achieve more rapid translational gains in terms of understanding how to deliver evidence-based practices to support reductions in alcohol use among Black SMM.

Developing Metrics to Improve Equitable Implementation of HIV Prevention

Moira McNulty, MD
University of Chicago

Maria Pyra, MEd, MPH, PhD
Northwestern University

ABSTRACT:
A daily pill, PrEP, has changed HIV prevention and could help end the HIV epidemic in the U.S. Thus far, use of PrEP has not been evenly or effectively distributed. Much of the focus to date on PrEP delivery has been on linkage and initiation of PrEP. We know that effectiveness of PrEP depends not only on initiation, but also on adherence, which typically requires retention in care for ongoing monitoring and prescriptions per the CDC guidelines; i.e., persistence on PrEP. While the annual number of PrEP users has been increasing, improvement in retention and adherence has lagged, with many individuals who initiate PrEP no longer adherent or retained at 6 months, despite the likelihood that risk of exposure to HIV continues. Furthermore, some of the most vulnerable populations such as young Black MSM are more likely to fall out of PrEP care than their non-Black peers. Yet, measuring persistence has been challenging, particularly in a way that is standardized and can be used across patient populations and PrEP programs. Dr. Moira McNulty, from the University of Chicago, and Dr. Maria Pyra, from Northwestern University, will present their work on PrEP metrics, particularly around persistence, and how these metrics can improve equitable implementation of PrEP.

Innovating Substance Use Disorder Treatment at Scale

Jeff DeFlavio, MD
Groups: Recover Together

ABSTRACT:
Across medicine clinical innovations take years to disseminate widely into practice, while some best practices in addiction medicine fail to ever gain widespread adoption. This presentation describes two private medical practices (Groups Recover Together and Affect Therapeutics) which have brought underutilized and evidence-based interventions to scale across the United States. The presentation will focus on the clinical models, patient outcomes, workforce considerations, revenue models and capital formation which was required to scale these effective care programs.

Supercharging implementation science with insights from behavioral economics

Rinad Beidas, MA, PhD
Northwestern University

ABSTRACT:
This presentation will describe efforts to apply the tools and insights from behavioral economics to improve upon implementation of evidence-based practices.

Design Considerations in Embedded Pragmatic Trials: Separating Rigor from Idolatry

Gregory E. Simon, MD, MPH
Kaiser Permanente Washington Health Research Institute

ABSTRACT:
This presentation will consider specific considerations in the design and implementation of embedded pragmatic trials, including: eligibility criteria, unit of allocation, method of allocation, standardization of “active” interventions, standardization of “control” interventions, blinding, and analytic strategy. For each of these design decisions, investigators must focus on the specific study question and consider scientific rigor, practical constraints, and ethical obligations to potential study participants.

Charting an Interdisciplinary Course to Advance Policy D&I and Reduce the Research to Policy Gap

Erika Crable, PhD
University of California San Diego

ABSTRACT:
The ‘research to policy gap’ describes the failure to translate research findings into real-world, evidence-informed policies. This gap is dangerous to health systems and population health, but dissemination and implementation science (D&I) is poised to address this pervasive problem by designing effective strategies that promote evidence-informed policy and policy implementation success. To be most efficient while advancing science, policy D&I efforts must meaningfully draw from lessons learned in other fields. This presentation will discuss: (1) how different social science disciplines have studied the research to policy gap, (2) how those theories and methods can be incorporated into policy D&I efforts, and (3) highlight an example of a current policy dissemination study at this multidisciplinary intersection. We hope to foster a discussion about challenges in studying policy and policy-level factors, and practical multidisciplinary research approaches to advance policy D&I.

The Economics of Efficiency in Implementation Science

Todd Wagner, PhD
Stanford University

ABSTRACT:
Efficiency is upheld as a cornerstone of high-quality care. Unfortunately, the term efficiency is used in different contexts, creating substantial confusion about what it means. In this talk, I define efficiency as it relates to the delivery of health care. I then review different frameworks for measuring it and common strategies that can be used to improve it.

Development of an integrated implementation determinant framework for shared learning to promote health equity

Lilian Perez, PhD
RAND Corporation

James Merle, PhD
University of Utah

ABSTRACT:
As evidence-based innovations (EBIs) are translated into clinical and community settings, implementation determinant frameworks can help understand the factors that impede or facilitate implementation outcomes. Use of different frameworks across implementation initiatives can impede shared learning. To develop a framework for shared learning in the DECIPHeR Alliance (www.decipheralliance.org), we conducted a crosswalk of three determinant frameworks used in the Alliance: 1) Exploration, Preparation, Implementation, and Sustainment (EPIS); 2) Practical, Robust Implementation and Sustainability Model (PRISM); and 3) Consolidated Framework for Implementation Research (updated CFIR). To operationalize health justice and equity considerations, we also incorporated elements of the Health Equity Implementation Framework (HEIF).  In this talk, we will discuss the process for developing the integrated framework, called “IM4Equity,” and describe our user-centered feedback process to improve the framework’s understandability and usefulness across the Alliance. IM4Equity can help guide evaluations of EBIs and implementation outcomes across diverse contexts. Compared to any single framework, it has the potential to better identify the myriad of implementation determinants with a focus on health equity considerations. It can also aid in common data elements and cross-project synthesis.

Bridging policy research and implementation science

Beth McGinty, PhD, MS
Weill Cornell Medicine

ABSTRACT:
Policy implementation is a key but often-ignored aspect of policy effectiveness. Public policy research typically considers the effects of having versus not having a policy on outcomes, without considering whether and how the policy was implemented – even though the effects of policies on their intended outcome depend upon degree of implementation. Experimental approaches to studying policy dissemination and implementation are challenging, given that policies are difficult to randomly assign, but not impossible. Natural experiments in policy implementation abound, as states, localities, and organizations consider, adopt, and implement – with varying degrees of implementation success, and intensity – a range of policies over time. Rigorous nonexperimental methods for studying policy dissemination and implementation in these types of natural experiments are critical, but methodological advances are needed. This presentation will motivate the importance of studying policy implementation, provide examples of current approaches, and discuss promising future directions.

Prosocial Behaviors as a Marker of Health and Enhancer of Well Being

Gustavo Carlo, PhD
University of California, Irvine

Silvia Koller, PhD
North West University

ABSTRACT:
Drawing upon a strengths-based, cultural assets perspective, I will present evidence on the growth properties of prosocial behaviors and assert the need to incorporate prosocial behaviors as a marker of health and well being. The presentation will focus on risk and protective correlates and consequences of prosocial behaviors in U.S. Latine youth. Implications for prevention and intervention research and programs will be briefly discussed.

A cost-effectiveness analysis of telemedicine and mobile health interventions to support continuing care for patients receiving treatment for alcohol use disorder

Andrew Quanbeck, PhD
University of Wisconsin-Madison

ABSTRACT:
This presentation reports the cost-effectiveness analysis from a fully powered randomized clinical trial that featured a head-to-head comparison between telemedicine and digital health interventions for providing continuing care for patients with alcohol use disorder. A telemedicine intervention (telephone monitoring and counseling: TMC) and a mobile health intervention (Alcohol Comprehensive Health Enhancement Support System: A-CHESS) were examined in a 2x2 factorial randomized trial that enrolled 262 participants from two Philadelphia area intensive outpatient programs. Intervention costs and effectiveness (in terms of number of risky drinking days) were assessed for each group with respect to the control group.

The effectiveness of reduced days heavy drinking for all 3 treatment groups (TMC, A-CHESS, and TMC+A-CHESS) were statistically significant compared to the control group. However, no treatment group was more effective than the others in terms of statistical significance. Compared to the control group, where participants averaged 43.75 days of heavy drinking over 12 months, participants in the treatment groups had significantly fewer average heavy drinking days over the 12-month intervention (TMC: 15.78 days heavy drinking, P<.001; A-CHESS: 17.83 days heavy drinking, P=.001; TMC+A-CHESS: 16.54 days heavy drinking, P<.001). Participants in the TMC, A-CHESS, and TMC+A-CHESS groups had an average of 31.62, 40.60, and 32.89 fewer days heavy drinking over the 12-month intervention compared to the control group, respectively, when adjusting for baseline rates of heavy drinking at the individual level. A-CHESS was slightly more expensive than TMC at a cost of $479 per patient vs. $434 for TMC; A-CHESS was also slightly more effective than TMC, and incremental cost-effectiveness ratios were comparable between the two interventions. In summary, using either A-CHESS or TMC both represented cost-effective intervention choices for providing continuing care to patients with alcohol use disorder. There was no clear evidence supporting the use of one intervention vs. the other. Rather, the decision about whether to use TMC or CHESS will depend (in part) on policymakers’ overall willingness to pay for reducing risky drinking in the populations they serve; further, pragmatic factors related to organizational context (including the socio-economic status of the patient population and overall size of the population served) may bear heavily on decision-makers’ preference for implementing TMC vs. A-CHESS.

The present study is the first to directly compare the cost-effectiveness of evidence-based mHealth and telemedicine approaches for the treatment of alcohol use treatment, and among the first studies in any domain of healthcare to feature a direct comparison between mHealth and telehealth modalities for chronic disease management.Results of this study may inform healthcare policymakers and decision makers on the costs and effects of telehealth and mHealth systems for reducing alcohol use and provide guidance on the most cost-effective approaches to incorporating technology-supported treatment into health care delivery systems for chronic disease management.

Swimming Downstream to Catch Upstream Prevention

Lisa Saldana, PhD
Oregon Social Learning Center

ABSTRACT:
FAIR (Families Actively Improving Relationships) is an evidence-based practice for parents referred to the child welfare system. Treatment addresses substance use (primarily opioids and/or methamphetamine), mental health, parenting, and ancillary needs. FAIR is community-based and relies on collaboration with service and community partners.  

As part of the NIH Helping to End Addiction Long-term (HEAL) initiative, FAIR was adapted for upstream prevention to be evaluated for clinical effectiveness in a Hybrid Type 2 trial in four rural counties. Counties were selected in collaboration with state leadership. A clearly defined implementation process was followed at the county, clinic, and provider levels. Challenges and opportunities related to the outer context of a staggering increase in opioid and methamphetamine use in the participating regions and the COVID-19 pandemic will be highlighted. Implementation process (using the Stage of Implementation Completion) and the resources used to complete it (measured using the Cost of Implementing New Strategies) will be presented in relation to these different contexts. 

How to embed equity perspective in implementation studies – reflections from a learner

Ana Baumann, PhD
Washington University

ABSTRACT:
Equity continues to garner attention in the field of implementation science. Coming from a learner perspective, this presentation will offer some recommendations and suggestions as to how to embed equity in implementation studies, with a focus on processes and outcomes.

The Systems Analysis and Improvement Approach for Mental Health Systems Optimization in Mozambique (SAIA-MH)

Brad Wagenaar, PhD
University of Washington

ABSTRACT:
Significant investments are being made to close the mental health (MH) treatment gap, which often exceeds 90% in many low- and middle-income countries (LMICs). However, limited attention has been paid to patient quality of care in nascent and evolving LMIC MH systems. In system assessments across sub-Saharan Africa, MH loss-to-follow-up often exceeds 50% and sub-optimal medication adherence often exceeds 60%. This talk will summarize our work on adapting, implementing, and now testing the effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH) implementation strategy to optimize the primary mental healthcare treatment cascade in government health facilities in Mozambique.

Does evidence-based practice have any meaning for implementation science?  Rethinking the nature of evidence and purpose of research through an examination of sustainment and spread.

Brian Mittman, PhD
Kaiser Permanente

ABSTRACT:
Full realization of the societal benefits of our work in implementation science requires high levels of successful sustainment (maintenance) and scale-up/spread of our implementation strategies and the effective practices we strive to implement.  This presentation offers a series of questions we should ask, and recommendations for actions we can – and should – take, to enhance our societal contributions as implementation scientists.