Relationship of hub and treatment characteristics with client outcomes in the initial Washington State hub and spoke cohort.

Introduction: Washington State's Hub and Spoke (HS) approach aims to improve availability of opioid use disorder (OUD) treatment. Washington initially funded six hubs with expertise in medications for opioid use disorder (MOUD) that built care networks with referral and treatment partners (spokes). We assessed outcomes for the initial HS cohort, considering the role of HS and treatment characteristics.

Disparities in Alcohol Treatment Use at the Intersection of Race, Ethnicity, Gender, and Insurance.

Background: Treatment for alcohol use disorder (AUD) has the potential to improve health and quality of life. Little is known about disparities in AUD treatment utilization at the intersection of race and gender. We examined disparities in AUD treatment utilization among those diagnosed with AUD in a community sample, by race, ethnicity, and gender, and whether disparities varied by insurance.

Expanding access to medication treatment for opioid use disorders: Findings from the Washington State hub and spoke effort.

Background: Opioid use disorder (OUD) is a leading cause of preventable death and injury nationwide. Efforts to increase the use of medication for opioid use disorder (MOUD) are needed. In 2017, Washington State implemented a Hub and Spoke (HS) model of care with the primary goal of expanding access to MOUD.

Quality of Opioid Use Disorder Treatment for Persons With and Without Disabling Conditions.

Importance: Adverse outcomes associated with opioid use disorder (OUD) are disproportionately high among people with disabilities (PWD) compared with those without disability. A gap remains in understanding the quality of OUD treatment for people with physical, sensory, cognitive, and developmental disabilities, specifically regarding medications for OUD (MOUD), a foundation of treatment.

Objective: To examine the use and quality of OUD treatment in adults with diagnosed disabling conditions, compared with adults without these diagnoses.

Evaluating the feasibility and impact of case rate payment for recovery support navigator services: a mixed methods study.

Background: Acute 24-h detoxification services (detox) are necessary but insufficient for many individuals working towards long-term recovery from opiate, alcohol or other drug addiction. Longer engagement in substance use disorder (SUD) treatment can lead to better health outcomes and reductions in overall healthcare costs. Connecting individuals with post-detox SUD treatment and supportive services is a vital next step.

Impact of recovery support navigators on continuity of care after detoxification.

Although evidence points to the benefits of continuity of care after detoxification (detox), especially when continuity of care occurs within a short time after discharge from a detox episode, the rate at which clients engage in continued treatment after detox remains low. The goal of the study was to develop and deploy a specially trained workforce, called recovery support navigators (RSNs), to increase the likelihood of clients continuing onto treatment after detox. Continuity of care is defined as receiving any substance use disorder (SUD) treatment service within 14 days of discharge from the index detox.

Race/Ethnicity, Community of Residence, and DUI Arrest After Beginning Treatment for an Alcohol Use Disorder.

The purpose of this study was to examine whether racial/ethnic disparities in post-treatment arrests for driving under the influence (DUI) exist among clients receiving outpatient treatment for an alcohol use disorder (AUD) and to assess whether community characteristics were associated with this outcome. The sample included adults with an AUD entering publicly funded outpatient treatment in Washington State in 2012. Treatment data were linked with criminal justice and US Census data.

Rural Clients' Continuity Into Follow-Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts.

Purpose: Treatment after discharge from detoxification or residential treatment is associated with improved outcomes. We examined the influence of travel time on continuity into follow-up treatment and whether financial incentives and weekly alerts have a modifying effect.

Methods: For a research intervention during October 2013 to December 2015, detoxification and residential substance use disorder treatment programs in Washington State were randomized into 4 groups: potential financial incentives for meeting performance goals, weekly alerts to providers, both interventions, and control.

Disparities in Criminal Justice Outcomes After Beginning Treatment for Substance Use Disorders: The Influence of Race/Ethnicity and Place.

Objective: This study examined whether racial/ethnic disparities exist in posttreatment arrests and assessed the extent to which community characteristics account for such disparities.

Method: Administrative data on clients (N = 10,529) receiving publicly funded services in Washington State were linked with criminal justice and census data. Multilevel survival models were used for two outcomes measuring time (in days) to any arrest and to any substance-related arrest.

Correction to: Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?

The professional degree of co-author Kevin Campbell is incorrect. It should be "DrPH" and not "PhD".

Impact of Agency Receipt of Incentives and Reminders on Engagement and Continuity of Care for Clients With Co-Occurring Disorders.

Objective: This study examined whether having co-occurring substance use and mental disorders influenced treatment engagement or continuity of care and whether offering financial incentives, client-specific electronic reminders, or a combination to treatment agencies improved treatment engagement and continuity of care among clients with co-occurring disorders.

Methods: The study used a randomized cluster design to assign agencies (N=196) providing publicly funded substance use disorder treatment in Washington State to a research arm: incentives only, reminders only, incentives and reminders, and a control condition. Data were analyzed for 76,044 outpatient, 32,797 residential, and 39,006 detoxification admissions from Washington's treatment data system.

Employment after beginning treatment for substance use disorders: The impact of race/ethnicity and client community of residence.

Employment is an important substance use treatment outcome, frequently used to assess individual progress during and after treatment. This study examined whether racial/ethnic disparities exist in employment after beginning treatment. It also examined the extent to which characteristics of clients' communities account for such disparities.

Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?

This study focused on (1) whether disparities in timely receipt of substance use services can be explained in part by the characteristics of the community in which the clients reside and (2) whether the effect of community characteristics on timely receipt of services was similar across racial/ethnic groups. The sample was composed of adults receiving publicly funded outpatient treatment in Washington State. Treatment data were linked to data from the US census.

Agency-level financial incentives and electronic reminders to improve continuity of care after discharge from residential treatment and detoxification.

Background: Despite the importance of continuity of care after detoxification and residential treatment, many clients do not receive further treatment services after discharged. This study examined whether offering financial incentives and providing client-specific electronic reminders to treatment agencies lead to improved continuity of care after detoxification or residential treatment.

Methods: Residential (N = 33) and detoxification agencies (N = 12) receiving public funding in Washington State were randomized into receiving one, both, or none (control group) of the interventions.

Influencing quality of outpatient SUD care: Implementation of alerts and incentives in Washington State.

Financial incentives for quality improvement and feedback on specific clients are two approaches to improving the quality of treatment for individuals with substance use disorders. We examined the impacts of these interventions in Washington State by randomizing outpatient substance use treatment agencies into intervention and control groups. From October 2013 through December 2015, agencies could earn financial incentives for meeting performance goals incorporating both achievement relative to a benchmark and improvement from agencies' own baselines.

Unsolicited Reporting to Prescribers of Opioid Analgesics by a State Prescription Drug Monitoring Program: An Observational Study with Matched Comparison Group.

Objective: State prescription drug monitoring programs (PDMPs) can help detect individuals with multiple provider episodes (MPEs; also referred to as doctor/pharmacy shopping), an indicator of prescription drug abuse and/or diversion. Although unsolicited reporting by PDMPs to prescribers of opioid analgesics is thought to be an important practice in reducing MPEs and the potential harm associated with them, evidence of its effectiveness is mixed. This exploratory research evaluates the impact of unsolicited reports sent by Massachusetts' PDMP to the prescribers of persons with MPEs.

Implementation of Client Incentives within a Recovery Navigation Program.

Objective: Multiple detoxification admissions among clients with substance use disorders (SUD) are costly to the health care system. This study explored the impact on behavior and cost outcomes of recovery support navigator (RSN) services delivered with and without a contingent incentive intervention.

Methods: New intakes at four detoxification programs were offered RSN-only (N=1116) or RSN plus incentive (RSN+I; N=1551) services.

Testing novel patient financial incentives to increase breast cancer screening.

Objectives: To examine the effects of 3 types of low-cost financial incentives for patients, including a novel "person-centered" approach on breast cancer screening (mammogram) rates.

Study Design: Randomized controlled trial with 4 arms: 3 types of financial incentives ($15 gift card, entry into lottery for $250 gift card, and a person-centered incentive with choice of $15 gift card or lottery) and a control group. Sample included privately insured Tufts Health Plan members in Massachusetts who were women aged 42 to 69 years with no mammogram claim in ≥ 2.

Performance measures and racial/ethnic disparities in the treatment of substance use disorders.

Objective: A limited literature on racial/ethnic disparities in the treatment of substance use disorders suggests that quality of treatment may differ based on client's race/ethnicity. This study examined whether (a) disparities exist in the probability of treatment engagement, a performance measure for substance use disorders, and (b) treatment engagement is associated with similar reductions in likelihood of arrest for Whites, Blacks, Latinos, and American Indians.

Method: Adult clients who began an outpatient treatment episode in 2008 in public sector specialty treatment facilities in Connecticut, New York, Oklahoma, and Washington made up the sample (N = 108,654).

A performance measure for continuity of care after detoxification: relationship with outcomes.

Administrative data from five states were used to examine whether continuity of specialty substance abuse treatment after detoxification predicts outcomes. We examined the influence of a 14-day continuity of care process measure on readmissions. Across multiple states, there was support that clients who received treatment for substance use disorders within 14-days after discharge from detoxification were less likely to be readmitted to detoxification.

Criminal justice outcomes after engagement in outpatient substance abuse treatment.

The relationship between engagement in outpatient treatment facilities in the public sector and subsequent arrest is examined for clients in Connecticut, New York, Oklahoma and Washington. Engagement is defined as receiving another treatment service within 14 days of beginning a new episode of specialty treatment and at least two additional services within the next 30 days. Data are from 2008 and survival analysis modeling is used.

Engagement in outpatient substance abuse treatment and employment outcomes.

This study, a collaboration between an academic research center and Washington State's health, employment, and correction departments, investigates the extent to which treatment engagement, a widely adopted performance measure, is associated with employment, an important outcome for individuals receiving treatment for substance use disorders. Two-stage Heckman probit regressions were conducted using 2008 administrative data for 7,570 adults receiving publicly funded treatment. The first stage predicted employment in the year following the first treatment visit, and three separate second-stage models predicted the number of quarters employed, wages, and hours worked.

Drinking patterns of older adults with chronic medical conditions.

Background: Understanding alcohol consumption patterns of older adults with chronic illness is important given the aging baby boomer generation, the increase in prevalence of chronic conditions and associated medication use, and the potential consequences of excessive drinking in this population.

Objectives: To estimate the prevalence of alcohol consumption patterns, including at-risk drinking, in older adults with at least one of seven common chronic conditions.

Design/methods: This descriptive study used the nationally representative 2005 Medicare Current Beneficiary Survey linked with Medicare claims.

Is Customization in Antidepressant Prescribing Associated with Acute-Phase Treatment Adherence?

OBJECTIVES: The objective was to explore whether prescribing variation is associated with duration of antidepressant use during the acute phase of treatment. Improving quality of care and increasing the extent to which treatment is patient-centered and customized are interrelated goals. Prescribing variation may be considered a marker of customization, and could be associated with better antidepressant treatment adherence.

Racial and ethnic differences in substance abuse treatment initiation and engagement.

This study examined variations by race and ethnicity in initiation and engagement, two performance measures of treatment for substance use disorders that focus on the timely receipt of services during the early stage of substance abuse treatment. Administrative data from the Oklahoma Department of Mental Health and Substance Abuse Services were linked with facility-level information from the National Survey of Substance Abuse Treatment Services. We found that Black clients were least likely to initiate treatment, but no race or ethnic differences in treatment engagement were found when compared by race or ethnicity.