VIRTUAL KICK-OFF MEETING · 2020. 10. 27. · Kick-Off Meeting Series Next Steps •Complete Fidelity Assessments for each clinic participating in CHAMP by Friday, June 19th •June

VIRTUAL KICK-OFF MEETING

June 2020

CONFIDENTIAL – DO NOT DISTRIBUTE

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


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



“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!


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


55,347 persons with OUD in British

Columbia, 1996-2018

7030 (12.7%) died

Pearce et al., 2020

Maintenance vs. Detoxification:Retention


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


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


Williams, Nunes, and Olfson, Health Affairs Blog, 2017

Past Year Substance Use Disorder (SUD) and Mental Illness among Adults Aged 18 or Older


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


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


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


• Jennifer Timoney & Joy Powell

• Cheney Health Center

• Lewiston Clinic


CHAS HEALTH

• Chrystal Anardi & Jill Weeks

• Family Medicine Residency

• 6454 Patients

• Internal Medicine Post Falls

• 5376 Patients


KOOTENAI HEALTH

PROJECT VIDA

• Luis Garza & Rachel Quintanilla

• Naftzger Clinic

• 3,500 Patients

• NE Family Practice

• 3,200 Patients


ONEWORLD CHC

• Kelly Dorfmeyer

• Livestock Exchange Clinic

• 25,017 Patients

• OneWorld Northwest

• 7,830 Patients


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


UW HEALTH

• Beth Lonergan & Brad Price

• Deforest-Windsor

• 11,000 Patients

• Yahara

• 11,000 Patients


PRISMA HEALTH

• Jessica Anderson

• Family Medicine Travelers Rest

• 7,085 Patients

• Internal Medicine Simpsonville

• 5,676 Patients


UNITY HEALTH CARE

• Jenny Pauk & Mary Wozniak

• Anacostia Health Center

• 12,305 Patients

• Minnesota Avenue Health

Center

• 12,963 Patients


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?


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


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


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


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


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


CHAMP CMTS


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


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


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?


Documents

VIRTUAL KICK-OFF MEETING · 2020. 10. 27. · Kick-Off Meeting Series Next Steps •Complete Fidelity Assessments for each clinic participating in CHAMP by Friday, June 19th •June