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Implementation Strategies to Enhance Safety-Net Hospitals' Adoption of Screening, Brief Intervention, and Referral to
Zoe Lindenfeld1, Berkeley Franz2, Cheyenne Fenstemaker2
1Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA. Zoe.Lindenfeld@Rutgers.edu.
Background:
To support adoption of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for opioid use disorder (OUD), hospitals are likely to benefit from implementation strategies that are responsive to their unique environments. Yet there remains a gap in knowledge regarding which implementation strategies are needed to support SBIRT implementation and sustainment for OUD within safety-net hospitals.
Objectives:
To obtain expert consensus on the most effective implementation strategies to enhance the adoption of SBIRT for OUD in safety-net hospitals.
Design And Setting:
A modified Delphi study, with two rounds of online surveys.
Participants:
Eighteen US-based experts from within the fields of OUD-focused health services research, addiction medicine, and emergency medicine.
Main Measures:
The primary outcome was consensus on 35 potential SBIRT implementation strategies, ranked on a 5-point Likert scale across three domains: Effectiveness, Feasibility, Impact on Equity. Consensus across respondents within both rounds was evaluated using the interquartile range. If the IQR was 1 or below on the 0 to 5 Likert scale, consensus was considered obtained. Items with a median value of 4 or higher were considered high priority.
Results:
Following two rounds of ranking, consensus was achieved for all survey items. In total, 62.85% strategies (n = 22) were rated as High in Effectiveness, 20.0% (n = 7) were rated as High in Feasibility, and 11.42% (n = 4) were rated High in Impact on Equity. Seven strategies ranked high in two areas, with three-Identify and Prepare Champions, Identify Early Adopters, and Conduct Educational Meetings-ranked as highly effective and feasible.
Conclusions:
This consensus process provides strong support for implementation strategies that can be used to guide future practice and study. This work can encourage implementation of SBIRT for OUD within safety-net hospitals, and set the stage for future studies to evaluate the impact of different implementation strategies on patient outcomes following SBIRT.
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