Background: Approximately 12% of hospitalizations are related to substance use disorder (SUD), an estimated 20% of hospitalized patients may have SUD, and patients with SUDs are nearly twice as likely to be readmitted. Pharmacotherapies for SUD are underutilized in hospitals, especially in Texas, due to lack of training, structures, and organizational cultures to support evidence-based care.In 2017, we launched the “B-Team” (buprenorphine team), the first hospital-based opioid use disorder (OUD) treatment program in Texas.(1,2) Based on initial success, we obtained funding from Texas Health & Human Services to spread the model to other hospitals in Texas through the Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program. Our implementation approach combined training, tailoring, and technical assistance following the Replicating Effective Programs (REP) strategy(3) with statewide Telementoring delivered via Project ECHO(4) (Figure 1).

Purpose: To evaluate the spread and adoption of the SHOUT Texas model to four diverse sites using an integrated REP-ECHO implementation approach.

Description: We conducted a multi-site mixed-method pilot study using REP (training, tailoring, and technical assistance) and project ECHO (Telementoring) strategies to support the spread of the SHOUT Texas model(3,4) Formative evaluation included quantitative assessment of engagement (number providers trained) and reach (number of patients initiating treatment for OUD). Semi-structured interviews with local clinical champions and key stakeholders at each implementation site were performed by trained qualitative experts to assess implementation progress, barriers, and facilitators. Rapid qualitative analysis was completed by a team of two analysts who transcribed and summarized interviews to identify key domains of interest (e.g., barriers and facilitators) and emergent themes (e.g., resources needed for sustainability).Between 2020 and 2023 the SHOUT Texas program was spread to and adopted in four diverse Texas hospital sites, resulting in more than 3,000 hospitalized adult patients starting treatment for OUD (Figure 2). More than 2,000 interprofessional clinicians received training regarding inpatient initiation of OUD treatment by the SHOUT Texas team, with more than 200 attending at least one hour-long Project ECHO session. Eight key stakeholders at expansion sites were interviewed. Participants identified prepared training resources, in-person launches, relative ease of roll-out, and collaboration with other Addiction Medicine physicians as supportive of SHOUT program implementation. Barriers included challenges in identifying outpatient follow-up for patients, aligning with local pharmacy and medication policies, and nursing education. Stakeholders also identified early resources needed for expansion, educational opportunities, and resources needed for sustainability and ongoing growth. Interviews identified lessons learned, advice to other hospitals, and next steps to build capacity.

Conclusions: Implementation of the SHOUT Texas model across diverse hospital settings using REP and Project ECHO resulted in significant provider engagement and rapid increase in the number of patients initiating OUD treatment during hospitalization. Insights from data analyses and stakeholder interviews inform future adjustments for sustainability and further growth.

IMAGE 1: Figure 1: SHOUT Texas Strategy using REP Framework

IMAGE 2: Figure 2: Patients Served by SHOUT Texas Expansion