# The Cascade of Care for Patients with Opioid Use Disorder Identified Through a Large Public Health System

> **NIH NIH R21** · RAND CORPORATION · 2024 · $459,045

## Abstract

SUMMARY/ABSTRACT
Arguably the most important question within the field of addiction treatment today is how to close the
implementation gap between evidence-based treatment and the fraction of people who receive care; medication
for opioid use disorder (MOUD) is a case in point. Efforts to close this gap require accurate data to monitor
performance and direct quality improvement efforts across the different systems in which patients receive care,
and for different subpopulations. The cascade of care framework, originally developed for HIV, is a conceptual
model that has been applied to OUD to assess and improve system performance; to date it has only been applied
to single systems of care for OUD. However, OUD care is fundamentally different from HIV care and MOUD
delivery has evolved since the cascade framework was proposed. Policy changes, such as the ability to provide
MOUD through telehealth and the removal of the X-waiver, have changed how patients receive care. Thus, the
current OUD cascade of care model may be inaccurate and insufficient for quality improvement efforts. Rather,
a cross-system approach is needed that specifically accounts for different care trajectories utilized by patients
with OUD. For example, MOUD can be initiated prior to linkage, (e.g., through emergency department or inpatient
settings) and patients may move between primary and specialty care, necessitating the ability to link data from
different systems. This project proposes modifying the OUD cascade of care model to reflect the changing
landscape of real-world OUD treatment, enabling us to answer critical research questions about treatment gaps
for patients identified with OUD who receive care across different public-sector systems. In doing so, we advance
the science of performance measurement for OUD and identify opportunities for cross-system quality
improvement efforts. We also examine differences in care by population and facility characteristics—essential
information for organizing and prioritizing intervention efforts to have the biggest impact on limiting the opioid
crisis. Although we use OUD as an exemplar condition, our long-term goal is to describe the care cascade for
patients with other substance use disorders (SUD) beyond OUD. We conduct our study in Los Angeles County
(LAC), which had a nearly 50% increase in overdose deaths from 2019-2020; these deaths predominantly
involved fentanyl and disproportionately were from poorer areas and the safety net population, who have limited
access to care. Our proposal builds upon an existing partnership between RAND, the Department of Health
Services (the second largest county health system in the US by patient volume; includes primary care,
emergency department and inpatient care) and the Department of Public Health Substance Abuse Prevention
and Control Program (oversees and funds all specialty public SUD treatment in LAC, including methadone). This
will be the first study to link data from both the healthcare...

## Key facts

- **NIH application ID:** 11048398
- **Project number:** 1R21DA062182-01
- **Recipient organization:** RAND CORPORATION
- **Principal Investigator:** Mariah M Kalmin
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $459,045
- **Award type:** 1
- **Project period:** 2024-09-30 → 2026-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11048398

## Citation

> US National Institutes of Health, RePORTER application 11048398, The Cascade of Care for Patients with Opioid Use Disorder Identified Through a Large Public Health System (1R21DA062182-01). Retrieved via MORVS 2026-10-27 from https://api.morvs.ai/grant/nih/11048398. Licensed CC0.

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