Table 3 Primary outcome definitions

Aim 1 primary outcomes

Reach

The proportion of program patients with OUD and receiving MOUD (buprenorphine, naltrexone) within the index quarter

Adoption

The number of onsite integrated DEA x-waivered prescribers of buprenorphine or prescribers of naltrexone, who are prescribing MOUD

Effectiveness

Access: The proportion of patients prescribed MOUD who start the medication within 72 h of OUD diagnosis. For patients requiring detoxification for naltrexone, Access will be operationalized as the proportion of patients who start the medication within 72 h of when it is safe

Retention: The proportion of patients who are retained in continuous care for at least 6 months from the start of medication, or if in time-limited care situations (e.g., residential detoxification) for the entire treatment episode

Implementation

Changes in the IMAT Index at the assessment points are indicated in Fig. 3

Maintenance

To assess sustainment, the primary outcomes detailed above will be monitored quarterly, even as an organization moves into the sustainment phase. IMAT data collection for the organizations in the sustainment phase will follow the same timeline as that of organizations still engaged in the active implementation (post each strategy, and at 1-year follow-up)

Together, these four outcomes (RE-AI) will reflect the sustainment of gains made during the active implementation phase as a function of (a) implementation strategies, (b) contextual determinants, and (c) participation in and fidelity to the implementation strategies