Healthcare
Rural Opioid Use Disorder Treatment and Recovery Network logic model
A four-county rural service area has one buprenorphine prescriber per 11,000 residents, no peer recovery services after 5 p.m., and an overdose death rate roughly twice the state average. Residents with opioid use disorder often drive more than 60 miles to start treatment.
Inputs
- Consortium of a critical access hospital, an FQHC, a county health department and a peer-run recovery community organization
- 2.0 FTE certified peer recovery specialists and 0.4 FTE addiction medicine physician
- Naloxone supply and a telehealth MOUD platform
- Signed MOU defining referral, data-sharing and governance roles
Activities
- Start buprenorphine in the hospital ED with a guaranteed next-day bridge appointment at the FQHC
- Train and mentor 12 primary care clinicians to prescribe MOUD
- Deploy peer recovery specialists to the ED, the county jail and two pharmacies
- Distribute naloxone kits through pharmacies, first responders and the recovery center
- Hold monthly consortium meetings that review referral and retention data
Outputs
- 12 primary care clinicians actively prescribing buprenorphine by month 12
- 240 individuals start MOUD through the ED bridge pathway over 3 years
- 3,600 naloxone kits distributed
- 1,900 peer recovery contacts logged each year
Short-term outcomes
- 70% of ED-initiated patients attend a bridge appointment within 72 hours
- Clinician confidence in managing OUD rises on pre and post training surveys
Intermediate outcomes
- 55% of MOUD patients retained in treatment at 180 days
- Repeat ED visits for nonfatal overdose among enrolled patients fall by 25%
Long-term impact
- Overdose death rate in the four counties moves toward the state average
- MOUD and peer services are sustained through Medicaid billing and county opioid settlement funds
Indicators and data sources
| Indicator | Source | Frequency |
|---|---|---|
| Number of active buprenorphine prescribers in the service area | State prescription drug monitoring program (PDMP) | Quarterly |
| MOUD retention at 90 and 180 days | FQHC EHR and consortium referral tracker | Quarterly |
| Nonfatal overdose ED visits | State syndromic surveillance (ESSENCE) county data | Quarterly |
| Overdose deaths by county of residence | State vital statistics and CDC WONDER | Annual |
| Naloxone kits distributed and reported reversals | Consortium naloxone distribution log | Monthly |
Assumptions
- The hospital keeps ED leadership support for buprenorphine induction
- Telehealth reimbursement for MOUD continues under state Medicaid rules
Programs this model suits
- HRSA Rural Communities Opioid Response Program (RCORP) implementation grants
- State opioid response funds administered by the single state agency
- County and state opioid settlement abatement grants
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