To improve the use of medication for opioid use disorder (MOUD), authors conducted a pilot study of a “hub and spoke” model in which patients were shifted from the “hub” to appropriate “spokes.” The authors conclude, “This program led to rapid improvement in MOUD uptake across the facility. Future efforts should focus on improving program maintenance, including supporting the exchange of patients from the hub to appropriate spokes.”
In New York, researchers used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to conduct a secondary data analysis of clinical and administrative data to characterize program outcomes. Based on provider progress notes and key informant interviews with program staff, the investigators looked at the success of the model in a novel approach to MOUD: “Nearly half of patients with opioid use disorder (45.48%, n = 156) were reached by the program over 2 years. Of those, 91.67% had 1 or more program visits after an initial intake appointment, and 78.85% had a buprenorphine prescription. Patients in the program were 2.44 times more likely to have a buprenorphine prescription than those in comparator site that did not have a Hub and Spoke program (95% CI: 1.77–3.37; P <0.001). There was significantly greater program reach in year 1 than year 2, suggesting rapid initial uptake followed by modest program growth. Key informant interviews illustrated several themes regrading program implementation, including the importance of process champions, the beneficial impact of MOUD for patients, and addressing facility performance metrics. A supportive organizational culture and a receptive climate were also key factors for implementation.”