Skip to content
DraconiticResearch
Search Sources API
203,234 studies31 sourcesUpdated 55 min ago
Peer-reviewedCC BYHealth services research

Impact of a National Stepped‐Care Model of Opioid Use Disorder Treatment on Access to Medication Therapies Among Homeless‐Experienced Veterans

  • Haojia Li1,2,3
  • Jacob D. Baylis2,3,4
  • Sophia Huebler2,3,4
  • Adam J. Gordon1,3,4
  • Eric Hawkins5,6,7
  • Hildi J. Hagedorn6,7,8
  • Stefan G. Kertesz9,10,11
  • Ying Suo1,3
  • Yue Zhang1,2,3
  • Audrey L. Jones1,3,4
11 affiliations
  1. 1Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA
  2. 2Department of Population Health Sciences University of Utah School of Medicine Salt Lake City Utah USA
  3. 3Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System Salt Lake City Utah USA
  4. 4Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine University of Utah Salt Lake City Utah USA
  5. 5Health 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
  6. 6Center of Excellence in Substance Addiction Treatment and Education VA Puget Sound Health Care System Seattle Washington USA
  7. 7Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA
  8. 8Center for Care Delivery & Outcomes Research Minneapolis VA Health Care System Minneapolis Minnesota USA
  9. 9Birmingham VA Health Care System Birmingham Alabama USA
  10. 10Department of Medicine University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA
  11. 11Department of Health Behavior University of Alabama at Birmingham School of Public Health Birmingham Alabama USA
Read full textPDFDOICite

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).

Study 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.

Data 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.

Principal 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.

Conclusions: 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.

Related

  1. Impact of opioid agonist therapies on non-fatal and fatal overdose: treatment patterns among individuals with opioid use disorder in Ontario, Canada
    Kenneth Lee, Vincent Lam, Jennifer Nicolle +4
    Frontiers in public healthPeer-reviewedCC BYFull textEpidemiology & public healthEurope PMC
  2. Attention-Deficit/Hyperactivity Disorder (ADHD) Temperament Profiles Predict Treatment Response to Combined Medication and Behavioral Intervention
    Candence Choi, Katherine Schmarder, Cameron Riopelle +1
    PsyArXivPreprintCC BY 4.0Full textPsychiatry & mental healthOSF
  3. Past-year violence experienced by transgender women living with HIV with or without recent involvement in transactional sex: the French national cross-sectional ANRS-Trans&HIV study
    Marion Fiorentino, Margot Annequin, Aissatou Faye +15
    BMJ OpenPeer-reviewedCC BY-NC 4.0Full textInfectious diseaseCrossref
  4. Patient preferences for antihypertensive medication dispensing trade-offs in cardiovascular disease prevention: national survey in Australia
    Carissa Bonner, Michael Anthony Fajardo, Rachael Keast +6
    BMJ OpenPeer-reviewedCC BY 4.0Full textCardiovascular medicineCrossref
  5. Medication for Alcohol Use Disorder Awareness and Attitudes Among US Adults
    Lori Uscher-Pines, Alisa B. Busch, Jessica Sousa +4
    JAMA Internal MedicinePeer-reviewedLicence not statedFull textEpidemiology & public healthPMC

Cite

BibTeXRIS
BibTeX
@article{li2026impact,
  title = {{Impact of a National Stepped‐Care Model of Opioid Use Disorder Treatment on Access to Medication Therapies Among Homeless‐Experienced Veterans}},
  author = {Haojia Li and Jacob D. Baylis and Sophia Huebler and Adam J. Gordon and Eric Hawkins and Hildi J. Hagedorn and Stefan G. Kertesz and Ying Suo and Yue Zhang and Audrey L. Jones},
  journal = {Health services research},
  year = {2026},
  month = oct,
  doi = {10.1111/1475-6773.70171},
  url = {https://europepmc.org/article/PMC/PMC13661296},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Impact of a National Stepped‐Care Model of Opioid Use Disorder Treatment on Access to Medication Therapies Among Homeless‐Experienced Veterans
AU  - Haojia Li
AU  - Jacob D. Baylis
AU  - Sophia Huebler
AU  - Adam J. Gordon
AU  - Eric Hawkins
AU  - Hildi J. Hagedorn
AU  - Stefan G. Kertesz
AU  - Ying Suo
AU  - Yue Zhang
AU  - Audrey L. Jones
PY  - 2026
DA  - 2026/10/01
JO  - Health services research
DO  - 10.1111/1475-6773.70171
UR  - https://europepmc.org/article/PMC/PMC13661296
AB  - 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).  Study 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.  Data 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.  Principal 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.  Conclusions: 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.
SN  - 0017-9124
SN  - 1475-6773
ER  -