NCT07214389

Brief Summary

This study tests ways to help opioid treatment programs (OTPs) keep patients in care. Staying on methadone or buprenorphine is linked to better outcomes, yet many people leave treatment early. The project will compare two approaches that provide clinics with retention/outcome quality measures and a quality-improvement (QI) toolkit-either alone or with added facilitation-against usual care. Forty-five BayMark OTPs in multiple states will be randomly assigned to one of three groups: (1) quality measures + QI toolkit; (2) quality measures + QI toolkit + external QI facilitation; or (3) usual care. The primary outcome is 90-day retention in treatment, measured from OTP electronic health records and Medicaid claims. Secondary outcomes include emergency department visits, hospitalizations, overdoses, and mortality. Findings will identify practical, scalable strategies to improve patient retention in OTPs.

Trial Health

77
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
4,500

participants targeted

Target at P75+ for not_applicable

Timeline
19mo left

Started Oct 2025

Typical duration for not_applicable

Geographic Reach
1 country

1 active site

Status
recruiting

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

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Study Timeline

Key milestones and dates

Study Progress28%
Oct 2025Dec 2027

Study Start

First participant enrolled

October 3, 2025

Completed
4 days until next milestone

First Submitted

Initial submission to the registry

October 7, 2025

Completed
2 days until next milestone

First Posted

Study publicly available on registry

October 9, 2025

Completed
1.8 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

August 1, 2027

Expected
4 months until next milestone

Study Completion

Last participant's last visit for all outcomes

December 1, 2027

Last Updated

April 21, 2026

Status Verified

April 1, 2026

Enrollment Period

1.8 years

First QC Date

October 7, 2025

Last Update Submit

April 16, 2026

Conditions

Keywords

Opioid Treatment Programs (OTPs)MethadoneBuprenorphineQuality Improvement (QI)Treatment RetentionAddiction ServicesImplementation Science

Outcome Measures

Primary Outcomes (1)

  • OTP's 90-day treatment retention rate

    The primary endpoint in the quantitative analyses will be the OTP's 90-day treatment retention rate.

    90 days after treatment initiation (episodes initiating within the 12 months after intervention launch)

Secondary Outcomes (3)

  • OTP's 90-day retention rate of medications to treat OUD

    90 days after treatment initiation

  • ED visit or hospitalization for a substance use disorder (SUD)

    Within 12 months after treatment initiation (claims-based outcome window)

  • ED visit or hospitalization for any cause

    Within 12 months after treatment initiation (claims-based outcome window)

Study Arms (3)

Arm 1 - Title: Quality Measures + QI Toolkit

EXPERIMENTAL

OTPs in this arm receive clinic-level quality measures (claims-based, case-mix-adjusted retention/outcome measures with benchmarks and peer comparisons) plus a self-guided QI toolkit (evidence summaries, change packages, templates, and examples) to support retention-focused practice changes. No external facilitation is provided

Behavioral: Quality Measures (Audit and Feedback)Behavioral: Quality Improvement (QI) Toolkit

Arm 2 - Title: Quality Measures + QI Toolkit + External QI Facilitation

EXPERIMENTAL

OTPs receive the quality measures and QI toolkit as in Arm 1 plus structured external QI facilitation based on the NIATx model. Facilitators coach an OTP change team, review data, and guide PDSA cycles to implement retention-focused improvements

Behavioral: Quality Measures (Audit and Feedback)Behavioral: Quality Improvement (QI) ToolkitBehavioral: External QI Facilitation

Arm 3 - Title: No Intervention: Usual Care

NO INTERVENTION

OTPs continue usual practice without access to the quality measures or QI toolkit and with no external facilitation during the study. Outcomes are assessed from EHR and Medicaid claims.

Interventions

Clinic-level reports/dashboards providing case-mix-adjusted retention and outcome measures with benchmarks and peer comparisons, derived from EHR and Medicaid claims; delivered periodically to guide quality improvement.

Arm 1 - Title: Quality Measures + QI ToolkitArm 2 - Title: Quality Measures + QI Toolkit + External QI Facilitation

A self-guided QI toolkit for OTPs with step-by-step change packages, PDSA templates, training materials, and case examples to improve retention. Provided together with the quality measures in Arms 1-2; designed for use without external facilitation.

Arm 1 - Title: Quality Measures + QI ToolkitArm 2 - Title: Quality Measures + QI Toolkit + External QI Facilitation

Structured facilitation based on the NIATx model. Facilitators provide training, coaching, and feedback to an OTP change team, using the measures and toolkit to guide retention-focused QI.

Arm 2 - Title: Quality Measures + QI Toolkit + External QI Facilitation

Eligibility Criteria

Age18 Years+
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)
Only BayMark OTPs are eligible for participation.

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

Study Sites (1)

RTI International

Research Triangle Park, North Carolina, 27709, United States

RECRUITING

MeSH Terms

Conditions

Opioid-Related Disorders

Interventions

Quality Improvement

Condition Hierarchy (Ancestors)

Narcotic-Related DisordersSubstance-Related DisordersChemically-Induced DisordersMental Disorders

Intervention Hierarchy (Ancestors)

EngineeringTechnology, Industry, and AgricultureQuality of Health CareHealth Services Administration

Study Officials

  • Tami L Mark, PhD

    RTI International

    PRINCIPAL INVESTIGATOR

Central Study Contacts

Tami L Mark, PhD

CONTACT

Emily C Costilow, MA, PMP

CONTACT

Study Design

Study Type
interventional
Phase
not applicable
Allocation
RANDOMIZED
Masking
NONE
Masking Details
This is an open-label, cluster-randomized implementation trial. OTPs, care providers, and investigators will be aware of arm assignment. Masking is not feasible because the interventions-provision of clinic-level quality measures and a QI toolkit, with or without external QI facilitation-are organizational changes visible to staff. Patient outcomes are obtained from EHR and Medicaid claims; the central analytic team may be masked to arm labels when feasible.
Purpose
HEALTH SERVICES RESEARCH
Intervention Model
PARALLEL
Model Details: Parallel-group, cluster-randomized trial at the opioid treatment program (OTP) level. Forty-five BayMark OTPs (\~15 per arm) are randomized 1:1:1 to: (1) quality measures + QI toolkit; (2) quality measures + QI toolkit + external QI facilitation (NIATx); or (3) usual care. Patients are not individually assigned; outcomes are derived from routinely collected EHR and Medicaid claims. Enrollment reflects the expected number of adult MOUD initiations during the 12-month post-implementation window across participating sites (\~100 per site; total ≈ 4,500). Open-label; analyses account for clustering at the OTP level.
Sponsor Type
OTHER
Responsible Party
PRINCIPAL INVESTIGATOR
PI Title
Distinguished Fellow, Health Policy

Study Record Dates

First Submitted

October 7, 2025

First Posted

October 9, 2025

Study Start

October 3, 2025

Primary Completion (Estimated)

August 1, 2027

Study Completion (Estimated)

December 1, 2027

Last Updated

April 21, 2026

Record last verified: 2026-04

Data Sharing

IPD Sharing
Will not share

Individual participant data (IPD) will not be shared because the study relies on de-identified Medicaid claims and electronic health records obtained through data use agreements, as well as site-level information from opioid treatment programs (OTPs). These data are protected by federal and state privacy regulations and cannot be shared at the participant level. Only aggregated results will be disseminated.

Locations