The opioid crisis continues to be one of the most pressing public health issues of our time, with national opioid-related overdose death rates continuing to increase. Treatment with medication such as buprenorphine is an evidence-based approach for treating opioid use disorder (OUD) that reduces illicit opioid use. Many healthcare organizations are implementing or expanding medication-assisted treatment (MAT) programs along with new patient outreach and engagement strategies, and there is a growing need for corresponding monitoring and evaluation systems.
At ICH, we are evaluating RIZE Massachusetts’ Saving Lives, Improving Health grant initiative, which is funding four community-based OUD treatment programs to improve access to MAT for the populations at highest risk of overdose and death. The grantees are doing amazing work with vulnerable populations such as homeless and recently incarcerated individuals, and are implementing a range of strategies to reduce barriers to care and engage people in treatment.
Our evaluation uses the cascade of care model as a framework – this model was originally developed for HIV/AIDS treatment, and tracks the stages from initial screening and diagnosis to long-term viral suppression. The cascade of care model can be easily translated to OUD , with the following key stages: 1) diagnosis, 2) linkage to care, 3) medication initiation, 4) retention on medication, and 5) recovery (abstinence from non-prescribed opioids).
Conceptually, it may seem straightforward to apply the cascade of care model to OUD. However, the reality of operationalizing this model for evaluation and creating the necessary measurement systems is very challenging. For example, consider the concept of ‘retention on medication’ – how long does a patient need to be on medication to be counted as retained? 3 months? 6 months? 12 months? Do we measure retention by looking at prescription continuity, and if so, how much of a gap in prescriptions do we allow? Do programs have data telling them whether patients filled their prescriptions, or can they only assess whether prescriptions have been written? How are prescriptions documented and do the programs follow similar protocols for prescription length and refills?
These are just a few of the many questions we have been grappling with as part of the RIZE Saving Lives evaluation. We have been working collaboratively with RIZE and with the funded programs to work through these questions and develop cascade of care measure definitions and reporting systems that are meaningful, rigorous, and feasible. I am so excited about this project – it is a privilege to be able to partner with programs that are doing such exceptional work, and I love the challenge of designing an evaluation that fits within each program’s context and will produce useful, actionable data. I believe that our cascade of care evaluation framework has the potential to help the RIZE grantees save more lives by facilitating data-informed decision-making about how to improve, scale up, and replicate their work. The grantees recently finished their first data reports, and I am really looking forward to seeing what we will learn over the rest of the evaluation period – stay tuned for an update next year!