Project Summary In 2021, the number of drug overdoses in New York continued to rise, with 4,946 deaths involving opioids. Synthetic opioids are driving the rise as these are mixed with other substances taken by people who use drugs (PWUD). Alarmingly, the rates of overdose deaths are rising faster for Black and Latinx individuals, exacerbating health inequities. The New York State agency that regulates addictions treatment—the Office of Addiction Services and Supports (OASAS)—oversees a system that annually serves 350,000 individuals with substance use disorders (SUD). Within the system, outpatient clinics provide the majority of treatment services for individuals with opioid use disorders (OUD). In response to the continuing opioid crisis, OASAS is calling for new approaches that embrace person-centered care, evidence-based practices, equitable treatment, and harm reduction principles. OASAS envisions a revised treatment system that better retains clients in treatment, mitigates adverse healthcare events, and reduces deaths. To drive change, OASAS will invest in a quality measurement and management (QM2) strategy that provides performance feedback to activate leadership and staff of clinics to improve practice as well as publicizes quality measures to ensure public accountability. Using the Donabedian framework as a guide, the OASAS QM2 strategy will include a suite of structural (e.g., client/counselor ratios), process (e.g., use of medications for OUD), and outcome (e.g., hospitalization for detoxification) quality measures. In support of the strategy, OASAS will also provide funding to ensure all clinics have electronic health records (EHR) that have capacity to capture and report on quality measures. The OASAS strategy will address common barriers to QM2 efforts, including: inadequate technological capacity at clinics, dearth of validated quality measures for SUD treatment, limited data literacy in the workforce, insufficient expertise in change management among staff, and clinic leadership resistance due to concerns about fairness in accounting for the clinical complexity of their clients. In addition, OASAS recognizes that gathering data directly from patients is essential to assessing whether their goals and needs are addressed in a person-centered system of care. OASAS will work with academic partners to develop measures and provide support to clinics to address these barriers. This QM2 research center (QM2-RC) proposal comes from an academic-government partnership that has a longstanding history of collaborating on studies to improve treatment for SUD. The broad aim is to build then test a science-based QM2 strategy for person-centered treatment. The project will leverage OASAS's investment in its new QM2 strategy and policy leadership. The academic partners will offer expertise in statistical methods for measurement validation, risk adjustment, and causal inference that will address some obstacles to QM2 as well as build the evidence base for the benefits of the strategy. The team will also assess how clinics and other stakeholders—e.g., patients, payers—incorporate the QM2 strategy into practice improvement, contract negotiations, and choosing clinics.

Narrative The number of drug overdoses in New York continues to rise, with 4,946 deaths involving opioids in 2021. In response, the New York State Office of Addiction Services and Supports (OASAS) is promoting new approaches that embrace person-centered care, evidence-based practices, equitable treatment, and harm reduction principles. OASAS and New York University will build a quality measurement and management (QM2) research center that provides performance feedback to activate leadership and staff of clinics to improve practice as well as publicizes quality measures to ensure public accountability.