{
  "abstract": "Objective: To determine whether the Veterans Health Administration's (VHA) Stepped Care for Opioid Use Disorder Train‐the‐Trainer (SCOUTT) initiative increased medication treatment for opioid use disorder (MOUD) among persons experiencing homelessness (PEH).\n\nStudy Setting and Design: We conducted a national retrospective cohort study of MOUD, including buprenorphine, naltrexone, or methadone, in federal fiscal years (FY) 2016–2020. In late FY2018, VHA regional directors nominated facilities to receive SCOUTT implementation support to expand prescribing of MOUD (primarily buprenorphine) in select primary care, pain, and general mental health settings. We used mixed‐effects quasi‐Poisson regression models with entropy balancing to estimate the Average Treatment Effect on the Treated in the years after SCOUTT was implemented (FY2019–2020), controlling for pre‐implementation levels of MOUD. Secondary analyses applied synthetic difference‐in‐differences (DiD) to estimate changes associated with SCOUTT.\n\nData Sources and Analytic Sample: We used yearly pooled cross‐sectional data from VHA electronic health records, FY2016–2020. The sample included annual cohorts of PEH with an opioid use disorder diagnosis and ≥ 1 primary care visit in the pre‐implementation (FY2016–2018, n = 31,354) or post‐implementation (FY2019–2020, n = 20,746) periods.\n\nPrincipal Findings: From FY2016–2020, MOUD receipt increased more in SCOUTT facilities (n = 30, 45.0% to 61.1%) than in non‐SCOUTT facilities (n = 811, 41.9% to 49.7%). In post‐implementation years, PEH in SCOUTT facilities, compared to non‐SCOUTT facilities, were more likely to receive any MOUD (risk difference [RD] = 6.16, 95% CI = 2.33–9.99), including buprenorphine (RD = 7.16, 95% CI = 4.35–9.97). There were no significant differences in methadone (RD = −0.19, 95% CI = −1.03–0.65) or naltrexone (RD = 0.10, 95% CI = −1.85–2.05). Synthetic DiD offered similar results: any MOUD DiD = 7.85, 95% CI = 2.15–13.55; buprenorphine DiD = 9.31, 95% CI = 3.56–15.06.\n\nConclusions: A national initiative to advance a stepped‐care model that encourages MOUD initiation outside specialty addiction settings improved access to buprenorphine among PEH. Similar initiatives could help to close treatment gaps in health care settings serving PEH.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA",
    "Department of Population Health Sciences University of Utah School of Medicine Salt Lake City Utah USA",
    "Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System Salt Lake City Utah USA",
    "Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine University of Utah Salt Lake City Utah USA",
    "Health Systems Research (HSR) Seattle Center of Innovation for Veteran‐Centered and Value‐Driven Care Veterans Affairs (VA) Puget Sound Health Care System Seattle Washington USA",
    "Center of Excellence in Substance Addiction Treatment and Education VA Puget Sound Health Care System Seattle Washington USA",
    "Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA",
    "Center for Care Delivery & Outcomes Research Minneapolis VA Health Care System Minneapolis Minnesota USA",
    "Birmingham VA Health Care System Birmingham Alabama USA",
    "Department of Medicine University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA",
    "Department of Health Behavior University of Alabama at Birmingham School of Public Health Birmingham Alabama USA"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Haojia Li",
      "orcid": "0000-0002-1295-4341"
    },
    {
      "affs": [
        1,
        2,
        3
      ],
      "name": "Jacob D. Baylis",
      "orcid": "0000-0002-8251-4704"
    },
    {
      "affs": [
        1,
        2,
        3
      ],
      "name": "Sophia Huebler",
      "orcid": "0000-0001-9940-9604"
    },
    {
      "affs": [
        0,
        2,
        3
      ],
      "name": "Adam J. Gordon",
      "orcid": "0000-0002-2453-8871"
    },
    {
      "affs": [
        4,
        5,
        6
      ],
      "name": "Eric Hawkins",
      "orcid": "0000-0001-5467-1553"
    },
    {
      "affs": [
        5,
        6,
        7
      ],
      "name": "Hildi J. Hagedorn",
      "orcid": "0000-0002-5118-7624"
    },
    {
      "affs": [
        8,
        9,
        10
      ],
      "name": "Stefan G. Kertesz",
      "orcid": "0000-0001-6101-8421"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Ying Suo"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Yue Zhang"
    },
    {
      "affs": [
        0,
        2,
        3
      ],
      "name": "Audrey L. Jones",
      "orcid": "0000-0003-1533-7469"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6bxh1z574qd6x.bib",
  "cited_by": 0,
  "doi": "10.1111/1475-6773.70171",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661296/?tool=EBI",
  "id": "6bxh1z574qd6x",
  "issns": [
    "0017-9124",
    "1475-6773"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13661296",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research Article"
    ],
    [
      "openalex",
      "2739|Opioid Use Disorder Treatment"
    ]
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  "openalex": "W7221661504",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661296/pdf/?tool=EBI",
  "pmcid": "PMC13661296",
  "pmid": "42869778",
  "published": "2026-10-01",
  "publisher": "Health Research & Educational Trust",
  "ris": "https://research.draconitic.com/paper/6bxh1z574qd6x.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:31Z",
      "native_id": "PMC:PMC13661296",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13661296"
    },
    {
      "first_seen": "2026-11-02T12:23:13Z",
      "native_id": "PMC13661296",
      "source": "pmc",
      "url": "https://doi.org/10.1111/1475-6773.70171"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Opioid Use Disorder Treatment",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Impact of a National Stepped‐Care Model of Opioid Use Disorder Treatment on Access to Medication Therapies Among Homeless‐Experienced Veterans",
  "title_text": "Impact of a National Stepped‐Care Model of Opioid Use Disorder Treatment on Access to Medication Therapies Among Homeless‐Experienced Veterans",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:20:20Z",
  "url": "https://research.draconitic.com/paper/6bxh1z574qd6x",
  "venue": "Health services research",
  "versions": []
}