Abstract Opioid use disorder (OUD) remains a critical public health crisis in Pennsylvania. The Pennsylvania Centers of Excellence have been charged with providing opioid treatment, including medication for opioid use disorder (MOUD), to enhance treatment access, promote recovery, and reduce the impact of fatal overdose throughout the state. Despite efforts to improve access to evidence-based treatments for OUD such as medications and integrated behavioral health services, national OUD and opioid involved overdose death rates remain alarmingly high. Current MOUD interventions primarily targeting reduction in OUD symptoms have significant dropout rates (20-50%) and result in remission of OUD for ~36 percent of individuals. The patients with co- occurring substance use and mental health disorders are at greater risk for poor outcomes, often because they have more complex treatment needs that are hard to identify, track, and respond to in real time. To potentially improve OUD intervention outcomes, the overarching goal of the HEALing Measures Center at University of Pittsburgh is to enhance the measurement, quality, and equity of care delivered in community opioid treatment programs (OTPs) through sustained implementation of measurement-based care (MBC). Specifically, the three proposed projects were designed to address the immediate concerns expressed by our partners while simultaneously meeting critical research gaps. Research Plan 1 will develop an MBC Implementation Blueprint including technical assistance, learning networks, and paperwork reduction strategies. Research Plan 2 will demonstrate the fidelity and effectiveness of implementing enhanced MBC implementation (MBC+) versus measurement as usual (MAU) via a stepped-wedge, hybrid type II effectiveness-implementation trial. Research Plan 3 will demonstrate the clinical effectiveness of MBC+ relative to MAU for patients with co-occurring OUD and mental health diagnoses. The proposed study will provide critical preliminary evidence regarding the role and significance of capitalizing on MBC in OUD interventions, enhanced implementation of a sustainable, equitable, and effective MBC intervention via implementation strategies that are co-designed with stakeholders (policymaker, payer, and OTP), and alternative avenues to potentially enhance symptom-related outcomes and treatment retention of OUD interventions with downstream societal, psychological, and public health benefits.

Project Narrative The proposed RM1 grant will enhance the measurement, quality, and equity of care delivered in 20 community opioid treatment programs (OTPs) by co-designing and implementing measurement-based care (MBC) tools and systems. Using a Hybrid Implementation Effectiveness Type II trial with a stepped-wedge design, we will simultaneously evaluate MBC implementation (e.g., fidelity) and clinical (e.g., patient retention, improved quality of life) effectiveness. This significant and innovative study will provide: (1) critical preliminary evidence regarding the role and significance of capitalizing on MBC in opioid use disorder (OUD) interventions (including evidence on potential mechanisms underlying MBC’s effects); (2) enhanced implementation of a sustainable, equitable, and effective MBC intervention via implementation strategies that are co-designed with stakeholders (policymaker, payer, and OTP), including paperwork reduction strategies as a means to enhance capacity; and (3) alternative avenues to potentially enhance symptom-related outcomes and treatment retention of OUD interventions with downstream societal, psychological, and public health benefits.