Application of an opioid use disorder cascade of care in a large public health system

ABSTRACT

Background: Over the past decade, hospitals and health systems have increasingly adopted interventions to address the needs of patients with substance use disorders. The Opioid Use Disorder (OUD) Cascade of Care provides a framework for organizing and tracking patient health milestones over time and can assist health systems in identifying areas of intervention to maximize the impact of evidence-based services. However, detailed protocols are needed to guide health systems in how to operationalize the OUD Cascade and track outcomes using electronic health records.

Objective: In this paper, we describe the process of operationalizing and applying the OUD Cascade in a large, urban, public hospital system.

Methods: Through this case example, we describe the technical processes around data mining, as well as the decision-making processes, challenges encountered, lessons learned from compiling preliminary patient data and defining stages and outcome measures for the OUD Cascade of Care, and preliminary data

Results: We identified 33,616 (26.17% female) individuals with an OUD diagnosis. Almost half (48%) engaged with addiction services, while only 10.7% initiated medication-based treatment in an outpatient setting, 6.7% had timely follow-up, and 3.5% were retained for a minimum of 6 months.

Conclusion: The current paper serves as a primer for other health systems seeking to implement data-informed approaches to guide more efficient care and improved substance use-related outcomes. An OUD Cascade of Care must be tailored to local systems based on inherent data limitations and services design with an emphasis on early stages wherein drop-off is the greatest.

KEYWORDS:

• buprenorphine
• health systems
• quality measures
• methadone
• medication for opioid use disorder
• opioid use disorder
• OUD Cascade of Care

Disclosure statement

Dr. Williams receives consulting fees, equity, and travel reimbursement from Ophelia Health Inc a telehealth company for the treatment of opioid use disorder. He also receives consulting fees from the National Quality Forum. Dr. Krawczyk receives fees for expert testimony in ongoing opioid litigation.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00952990.2024.2302500

Additional information

Funding

Drs. Williams, Henry, and Krawczyk were funded by the SAMHSA Opioid Response Network (ORN) TI-18-004 Subaward (Subaward PI: Williams). Dr. Krawczyk was supported by NIDA K01DA055758. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.