The University of Pittsburgh School of Pharmacy’s Program Evaluation and Research Unit (PERU) has received a five-year $7.9 million grant from the National Institute on Drug Abuse to improve quality of care for patients with opioid use disorder across Pennsylvania.
The project will establish the Helping to End Addiction Long-term (HEALing) Measures Center at Pitt, which will focus on developing and implementing measurement-based care into 20 community opioid treatment programs across Pennsylvania with the goal of enhancing treatment access, promoting recovery and reducing fatal overdoses across the commonwealth.
“Improving the quality of patient care requires full system-wide implementation support, system-wide capacity to focus on patient and provider needs, and empowering providers with clinically useful data,” said principal investigator Renee Cloutier, Ph.D., research scientist at PERU in the Pitt School of Pharmacy. “Successful results will set the stage for broader implementation and dissemination that has the potential to transform patient care across Pennsylvania and the country.”
Although opioid overdose deaths in Pennsylvania decreased from 2021 to 2022, opioid use disorder (OUD) and other substance use disorders remain a major public health issue in the commonwealth and across the country. Medications, including buprenorphine, methadone, and naltrexone, are an important pillar of treatment for OUD, but about 20% of patients discontinue treatment within the first month and up to 50% within the first three months.
Reducing discontinuation rates of medications for OUD by even a few percentage points could translate into thousands of lives saved, according to the researchers.
“The key to reducing the impact of opioids is getting patients the right treatment at the right time, and then making sure that the quality of treatment is high enough that they can move into stable recovery,” said Cloutier. “Randomized clinical trials that demonstrate the impact of interventions have very controlled conditions, so often when we translate those findings into practice, we see a reduction in effectiveness because people are complicated. We need better data to figure out what is and isn’t working for patients.”
To address this gap and enhance the quality of data that is collected and used in a more systematic way, PERU will expand on an existing partnership with the PA Department of Human Services’ Centers of Excellence for Opioid Use Disorder to integrate measurement-based care into existing treatment practices and workflows.
Measurement-based care, which is common in physical and mental health care settings but hasn’t previously been applied to opioid treatment programs, is a model where clinicians systematically evaluate patients’ symptoms on a regular basis to measure how they change over the course of their treatment and use that information to guide care on a personalized level.
“Measurement-based care is about addressing what the patient is experiencing, including symptoms from other conditions or diseases beyond OUD,” said Cloutier. “It’s about getting information to ask what a patient needs and how clinicians can respond to that need or identifying barriers to why they can’t meet that need.”
The project will examine implementation effectiveness, cost-effectiveness and clinical effectiveness, including reduction in patient symptoms and treatment retention. These data will inform ways to increase treatment efficiency and effectiveness, while also providing a roadmap for sustainable ways to scale measurement-based care to new opioid treatment sites.
Other principal investigators on the project are Kelli Scott, Ph.D., of the New England Addiction Technology Transfer Center, and Arni Aldridge, Ph.D., of Research Triangle Institute (RTI) International. Co-investigators are Erh-Hsuan (Reina) Wang, Ph.D., and Debra Moore, Ph.D., both of PERU.
The HEALing Measures Center will also include collaborations between researchers at Northwestern University Feinberg School of Medicine and (RTI) International, and community partners at the PA Department of Human Services, UPMC, and the Community Care Behavioral Health Organization.