Post on 03-Feb-2021
VIRTUAL KICK-OFF MEETING
June 2020
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PART 1 of 3: CHAMP Overview
DIVISION OF POPULATION HEALTH IN COLLABORATION WITH
THE AIMS CENTER
Welcome!
John Fortney, PHD
Collaborating to Heal Addiction and Mental Health in Primary Care
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Anna Ratzliff, MD, PHDAndy Saxon, MD
Agenda
• Why are We Here – Andy Saxon
• NIMH and HEAL Introduction – Michael Schoenbaum
• CHAMP Team Introduction – Lori Ferro
• Health System Introductions – Lori Ferro
• CHAMP Objectives, Study Phases, and Trials – John Fortney and Anna Ratzliff
• Questions
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“Our disease jeopardizes our jobs and
our relationships with the people we love. It's a terrible disease…
It's kind of counterintuitive that people who need the help the most are the ones that
people least want to help…”- Patrick J. Kennedy
Founder The Kennedy Forum and Former Congressman
Why CHAMP? To Save Lives!
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58,220
48,344 48,000
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Vietnam War1955-1975
Suicide in US2018
Opioid Overdoses in US2019
Tota
l Dea
ths
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55,347 persons with OUD in British
Columbia, 1996-2018
7030 (12.7%) died
Pearce et al., 2020
Maintenance vs. Detoxification:Retention
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Treatment duration (days)
Rem
ain
ing in tre
atm
ent (
nr)
0
5
10
15
20
0 50 100 150 200 250 300 350
Detox/placebo
Buprenorphine
Maintenance vs. Detoxification:Mortality
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c2=5.9; p=0.0150/20 (0%)4/20 (20%)Dead
Cox regressionBuprenorphineDetox/Placebo
Kakko J et al. 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in
Sweden: a randomized, placebo-controlled trial. Lancet 361(9358):662-8, 2003.
Gap in OUD Treatment
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Williams, Nunes, and Olfson, Health Affairs Blog, 2017
Past Year Substance Use Disorder (SUD) and Mental Illness among Adults Aged 18 or Older
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SAMSHA, 2018 National Survey on Drug Use and Health
Other Benefits of Medication for OUD
• Reduced infectious disease transmission
• Reduced health care utilization
• Reduced illegal activity
• Improved employment
• Improved mental health
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Helping to End Addiction Long-Term (HEAL)
12
NIH’s HEAL
Initiative is an
aggressive, trans-
agency effort to
speed scientific
solutions to stem the
national opioid
public health crisis.
The initiative is funding hundreds of projects nationwide.
Researchers are taking a variety of approaches to tackle the
opioid epidemic through:
• Understanding, managing, and treating pain
• Improving treatment for opioid misuse and addiction
https://heal.nih.gov/
https://heal.nih.gov/
NIMH’s Collaborative Care HEAL Initiative
13
• Collaborating to Heal Addiction and Mental Health in Primary Care (CHAMP)■ Led by University of Washington■ Clinics & patients in states across the US
• Improving Access and Treatment for Co-occurring Opioid Use Disorders and Mental Illness■ Led by RAND■ Clinics & patients in NM
• Patient-Centered Team-Based Primary Care to Treat Opioid Use Disorder, Depression, and Other Conditions■ Led by Kaiser Foundation Research Institute ■ Clinics & patients in WA & IN
• The Whole Health Study: Collaborative Care for OUD and Mental Health Conditions■ Led by University of Pennsylvania■ Clinics & patients in PA (& possibly NJ)
For more info: search title in https://projectreporter.nih.gov/
https://projectreporter.nih.gov/
Get to Know the CHAMP Team
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Steering Committee NIMH: Michael Schoenbaum, PhD
Project Scientist
Executive CouncilJohn Fortney, Anna Ratzliff, Andrew Saxon
PM: Lori Ferro, MHA, PMP RC: Danielle Bohonos, MPH
NIMH: Michael Freed, PhD, Chief, Services Research and Clinical Epidemiology Branch
Data and Safety Monitoring Board
NIMH: Galia Siegel, PhD Clinical Trials Program
Coordinator Single IRB: Advarra (Pro00037200)
Evaluation Team
John Fortney, PhDDeb Bowen, PhD
Geoff Curran, PhD, MACara Lewis, PhD, HSPPKaren Drummond, PhD
Intervention Team
Andrew Saxon, MDAnna Ratzliff, MD, PhD
Mark Duncan, MDJoseph Merrill, MDTracy Simpson, PhD
Anna Hink, MSW, LICSWTyler Stewart, MA, LMFT, LMHC
Patrick Raue, PhDJohn Kern, MD
Implementation Team
Anna Ratzliff, MD, PhDPaul Barry, MSW, LICSWAshley Heald, MA, CPHQ
Emily Williams, PhD, MPHElizabeth Austin, MPH
Health Systems
CHAS, WAKootenai Health, IDMorris Hospital, ILOneWorld CHC, NEPrisma Health, SCProject Vida, TX
U.Wisc. Health, WIUnity Health Care, WDC
Introduction to Health Systems
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• Jennifer Timoney & Joy Powell
• Cheney Health Center
• Lewiston Clinic
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CHAS HEALTH
• Chrystal Anardi & Jill Weeks
• Family Medicine Residency
• 6454 Patients
• Internal Medicine Post Falls
• 5376 Patients
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KOOTENAI HEALTH
PROJECT VIDA
• Luis Garza & Rachel Quintanilla
• Naftzger Clinic
• 3,500 Patients
• NE Family Practice
• 3,200 Patients
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ONEWORLD CHC
• Kelly Dorfmeyer
• Livestock Exchange Clinic
• 25,017 Patients
• OneWorld Northwest
• 7,830 Patients
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MORRIS HOSPITAL
• Jen Thomas & Pam Butler
• Gardner Healthcare Center
• 5133 Patients
• Morris – Dresden
• 7391 Patients
• Minooka – Mondamin &
Ottawa Campus
• 7941 & 9209 Patients
• Minooka – Ridge Road
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UW HEALTH
• Beth Lonergan & Brad Price
• Deforest-Windsor
• 11,000 Patients
• Yahara
• 11,000 Patients
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PRISMA HEALTH
• Jessica Anderson
• Family Medicine Travelers Rest
• 7,085 Patients
• Internal Medicine Simpsonville
• 5,676 Patients
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UNITY HEALTH CARE
• Jenny Pauk & Mary Wozniak
• Anacostia Health Center
• 12,305 Patients
• Minnesota Avenue Health
Center
• 12,963 Patients
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What We Want to Learn
1. Does systematic screening for OUD help us identify more people with OUD?
2. Is Collaborative Care (CoCM) for OUD and MHD more effective for patients with co-occurring disorders than CoCM for MHD only?
3. What kind of sustainment support helps maintain high quality CoCM for co-occurring disorders?
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CHAMP is based on a series of 3 questions
Fidelity Assessment and Randomization
• Clinics complete the CHAMP Fidelity Assessment to determine their adherence to the Collaborative Care Model.
• Please return by Friday, June 19th
• Scores are used to separate clinics into Cohort 1 or 2
• Clinics are randomized to Intervention or Control Groups
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Clinics take CHAMP Fidelity
Assessment
Cohort 1: High Fidelity
Cohort 2: Low Fidelity
Intervention Group
Control Group
Intervention Group
Control Group
Overview of the CHAMP Study
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Co
CM
Fid
elit
y Sc
ree
n
ImplementationPhase
SustainmentPhase
KickOff
COHORT 1 High Fidelity
Clinics
COHORT 2 Low Fidelity
Clinics
3 Months
9 Months
18 Months 12 Months
12 Months18 Months
PreparationPhase
Oct. 1, 2020
Screening & CoCMImplementation
Launch Date
Apr. 1, 2021
Screening & CoCMImplementation
Launch Date
R R
R = Randomization
Does OUD screening help identify more patients with OUD?
• No consent; No PHI collected
• Health Systems perform EHR data queries
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OUD Screening InitiatedCohort 1 – Oct. 2020Cohort 2 – Apr. 2021
End of Post-Screen PeriodCohort 1 – Mar. 2021Cohort 2 – Sept. 2021
Start of Pre-Screen PeriodCohort 1 – Apr. 2020Cohort 2 – Oct. 2020
Pre-Screen Data Pull
Post-Screen Data Pull
Does CoCM for OUD and MHD work better than CoCM for MHD only?
• Clinics screen, consent, and enroll patients in CHAMP to receive treatment
• Evaluation data comes from two primary sources
• REDCap Patient Surveys
• Care Management Tracking System (CMTS) encounter records
• Formative Evaluation of Intervention Clinics to evaluate the implementation
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TreatmentConsentScreen
Baseline Patient Survey
3-Month Patient Survey
6-Month Patient Survey
CHAMP
Based on key principles:
• Team-based
• Patient-centered
• Population-based
• Measurement-based
• Evidence-based
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CHAMP CMTS
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CHAMP Quality AIMS
MHD Quality Aims
• CoCM Early Engagement
• CoCM Continuous Engagement
• Psychiatric Case Review
• Depression Symptom Response
• Anxiety Symptom Response
• PTSD Symptom Response
• BA Engagement
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OUD Quality Aims
• MOUD Dosing
• OUD Symptom Response
• MOUD 3-Month Retention
What kind of sustainment support helps maintain high quality CoCM for co-occurring disorders?
Implementation StrategyBarrier
TargetedMechanism(s) of Action
Proximal Outcome Measure
Distal Outcome Measure
Produce a report documenting current financing and billing practices
Lack of revenue
Creating revenue streams for CHAMP encounters
Proportion of CHAMP encounters billed, denied, and paid
Adoption Reach
Develop a formal training plan to manage staff turnover
Staff turnover
Cover CHAMP roles with existing staff transferring knowledge to new staff
All CHAMP roles adequately staffed and trained
AdoptionReachEffectiveness
Develop a systematic audit and feedback system and quality improvement skills
Fidelity drift
Monitoring drift and correcting course over time
Drift detect and corrected FidelityEffectiveness
• Stratified by cohort, CHAMP clinics randomized to
• Low-intensity strategy: internal facilitation
• High-intensity strategy: internal facilitation AND external facilitation
Kick-Off Meeting Series
Next Steps
• Complete Fidelity Assessments for each clinic participating in CHAMP by Friday, June 19th
• June 23rd Kick-Off Meeting – Preparation Phase: Part 1 – Clinic Level Prep
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Kick-Off Meeting 1June 16th
CHAMP Overview
Kick-Off Meeting 2June 23rd
Preparation Phase Part 1: Clinic Level Prep
Kick-Off Meeting 3June 30th
Preparation Phase Part 2: Clinician Training &
Implementation Phase
QUESTIONS?
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