title: Using a Learning Collaborative Strategy With Office-based Practices to Increase Access and Improve Quality of Care for Patients With Opioid Use Disorders.
abstract: OBJECTIVE
  Rapidly escalating rates of heroin and prescription opioid use have been widely observed in rural areas across the United States. Although US Food and Drug Administration-approved medications for opioid use disorders exist, they are not routinely accessible to patients. One medication, buprenorphine, can be prescribed by waivered physicians in office-based practice settings, but practice patterns vary widely. This study explored the use of a learning collaborative method to improve the provision of buprenorphine in the state of Vermont.
  
  
  METHODS
  We initiated a learning collaborative with 4 cohorts of physician practices (28 total practices). The learning collaborative consisted of a series of 4 face-to-face and 5 teleconference sessions over 9 months. Practices collected and reported on 8 quality-improvement data measures, which included the number of patients prescribed buprenorphine, and the percent of unstable patients seen weekly. Changes from baseline to 8 months were examined using a p-chart and logistic regression methodology.
  
  
  RESULTS
  Physician engagement in the learning collaborative was favorable across all 4 cohorts (85.7%). On 6 of the 7 quality-improvement measures, there were improvements from baseline to 8 months. On 4 measures, these improvements were statistically significant (P < 0.001). Importantly, practice variation decreased over time on all measures. The number of patients receiving medication increased only slightly (3.4%).
  
  
  CONCLUSIONS
  Results support the effectiveness of a learning collaborative approach to engage physicians, modestly improve patient access, and significantly reduce practice variation. The strategy is potentially generalizable to other systems and regions struggling with this important public health problem.
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (BRN); Dartmouth Psychiatric Research Center, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (ECS, BM); Department of Psychiatry, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (AM, CL-H); Department of Biomedical Data Science, and Department of Community and Family Medicine, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (HX); Department of Vermont Health Access, Williston, Vermont (BT); Departments of Psychiatry and Family Medicine, University of Vermont College of Medicine, Burlington, Vermont (JB); Primary Care Health Partners, Bennington, Vermont (GK); Hawthorn Recovery Center, Bennington, Vermont (NK); Connecticut Valley Recovery Services, Windsor, Vermont (CFL); Northwestern Medical Center Comprehensive Pain Management, St. Albans, Vermont (WR); Department of Psychiatry and of Community and Family Medicine, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (MPM).
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Nordstrom
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Saunders
authors.forename: Bethany
authors.initials: B
authors.lastname: McLeman
authors.forename: Andrea
authors.initials: A
authors.lastname: Meier
authors.forename: Haiyi
authors.initials: H
authors.lastname: Xie
authors.forename: Chantal
authors.initials: C
authors.lastname: Lambert-Harris
authors.forename: Beth
authors.initials: B
authors.lastname: Tanzman
authors.forename: John
authors.initials: J
authors.lastname: Brooklyn
authors.forename: Gregory
authors.initials: G
authors.lastname: King
authors.forename: Nels
authors.initials: N
authors.lastname: Kloster
authors.forename: Clifton Frederick
authors.initials: CF
authors.lastname: Lord
authors.forename: William
authors.initials: W
authors.lastname: Roberts
authors.forename: Mark P
authors.initials: MP
authors.lastname: McGovern
mesh_terms: D002047:Buprenorphine / Q000627:therapeutic use; D002983:Clinical Competence; D003299:Cooperative Behavior; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007858:Learning; D009292:Narcotic Antagonists / Q000627:therapeutic use; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D014707:Vermont
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine