Framework to Action: Developing and Implementing a Statewide Network to Expand Opioid Treatment Access Using SHIFT-Evidence in Texas.

Abstract

Background: In Texas, the expansion of access to effective treatments for opioid use disorder remains a significant public health challenge. This study aimed to demonstrate the application of the Successful Healthcare Improvement from Translating Evidence in Complex Systems (SHIFT-Evidence) framework in developing and implementing a statewide network for office-based opioid treatment (OBOT) to underserved populations.

Methods: We identified systemic gaps in access to medications for opioid use disorder (MOUD) across Texas, using a targeted needs assessment of barriers and facilitators to buprenorphine prescribing. Findings were integrated into a planning template based on SHIFT-Evidence, which guided the identification of additional barriers across the health care system and iterative selection of strategies to address implementation barriers at multiple health care system levels, drawing on the Expert Recommendations for Implementing Change taxonomy. Strategies were prioritized based on feasibility and impact. To evaluate the program's effectiveness in expanding access to MOUD, we conducted a descriptive analysis of data from the Texas Department of State Health Services' Clinical Management for Behavioral Health Services data system to assess geographic reach and clients served within the program.

Results: Applying SHIFT-Evidence provided a structured process for identifying key barriers occurring at multiple levels (patient, prescriber, and prescriber organization) and selecting tailored strategies to address each. This approach supported the successful development and expansion of an OBOT provider network, increasing access to treatment services from 6 provider organizations (10 locations) serving 52 clients in fiscal year 2019 to 23 provider organizations (48 locations) serving 1311 clients in fiscal year 2023.

Conclusions: The comprehensive, multilevel approach supported by the application of SHIFT-Evidence effectively facilitated prioritization and planning to address systemic gaps across multiple health care system levels. The successful enhancement of treatment access highlights the framework's utility in supporting improvements within complex health care systems.