Advancing Pharmacological Treatments for Opioid Use Disorder (ADaPT-OUD): an Implementation Trial in Eight Veterans Health Administration Facilities

Hildi J. Hagedorn, Allison M. Gustavson, Princess E. Ackland, Ann Bangerter, Mark Bounthavong, Barbara Clothier, Alex H.S. Harris, Marie E. Kenny, Siamak Noorbaloochi, Hope A. Salameh, Adam J. Gordon

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Identifying effective strategies to improve access to medication treatments for opioid use disorder (MOUD) is imperative. Within the Veterans Health Administration (VHA), provision of MOUD varies significantly, requiring development and testing of implementation strategies that target facilities with low provision of MOUD. Objective: Determine the effectiveness of external facilitation in increasing the provision of MOUD among VHA facilities with low baseline provision of MOUD compared to matched controls. Design: Pre-post, block randomized study designed to compare facility-level outcomes in a stratified sample of eligible facilities. Four blocks (two intervention facilities in each) were defined by median splits of both the ratio of patients with OUD receiving MOUD and number of patients with OUD not currently receiving MOUD (i.e., number of actionable patients). Intervention facilities participated in a 12-month implementation intervention. Participants: VHA facilities in the lowest quartile of MOUD provision (35 facilities), eight of which were randomly assigned to participate in the intervention (two per block) with twenty-seven serving as matched controls by block. Intervention: External facilitation included assessment of local barriers/facilitators, formation of a local implementation team, a site visit for action planning and training/education, cross-facility quarterly calls, monthly coaching calls, and consultation. Main Measures: Pre- to post-change in the facility-level ratio of patients with an OUD diagnosis receiving MOUD compared to control facilities. Key Results: Intervention facilities significantly increased the ratio of patients with OUD receiving MOUD from an average of 18% at baseline to 30% 1 year later, with an absolute difference of 12% (95% confidence interval [CI]: 6.6%, 17.0%). The difference in differences between intervention and control facilities was 3.0% (95% CI: − 0.2%. 6.7%). The impact of the intervention varied by block, with smaller, less complex facilities more likely to outperform matched controls. Conclusions: Intensive external facilitation improved the adoption of MOUD in most low-performing facilities and may enhance adoption beyond other interventions less tailored to individual facility contexts.

Original languageEnglish (US)
Pages (from-to)3594-3602
Number of pages9
JournalJournal of general internal medicine
Issue number14
StatePublished - Nov 2022

Bibliographical note

Funding Information:
This study was funded by the Veteran Administrations Health Services Research and Development Investigator Initiated Research Project #16–145; Minneapolis Center of Innovation, Center for Care Delivery and Outcomes Research (CIN 13–406); Veteran Administrations Health Services Research and Development Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation (CIN 13–414)[AJG]; and the Veterans Health Administration Office of Academic Affiliations Advanced Fellowship in Clinical and Health Services Research (TPH 67–000). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Publisher Copyright:
© 2021, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.


  • Adoption
  • Evidence-based practice
  • External facilitation
  • Implementation science
  • Medication treatment for opioid use disorder
  • Substance use disorder

PubMed: MeSH publication types

  • Randomized Controlled Trial
  • Journal Article
  • Research Support, U.S. Gov't, Non-P.H.S.


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