Application of an opioid use disorder cascade of care in a large public health system

Emily Carter, Daniel Schatz, Noah Isaacs, Juan Garcia, Brandy Henry, Noa Krawczyk, Arthur Robin Williams

Research output: Contribution to journalArticlepeer-review


Background: Over the past decade, hospitals and health systems have increasingly adopted interventions to address the needs of patients with substance use disorders. The Opioid Use Disorder (OUD) Cascade of Care provides a framework for organizing and tracking patient health milestones over time and can assist health systems in identifying areas of intervention to maximize the impact of evidence-based services. However, detailed protocols are needed to guide health systems in how to operationalize the OUD Cascade and track outcomes using electronic health records. Objective: In this paper, we describe the process of operationalizing and applying the OUD Cascade in a large, urban, public hospital system. Methods: Through this case example, we describe the technical processes around data mining, as well as the decision-making processes, challenges encountered, lessons learned from compiling preliminary patient data and defining stages and outcome measures for the OUD Cascade of Care, and preliminary data Results: We identified 33,616 (26.17% female) individuals with an OUD diagnosis. Almost half (48%) engaged with addiction services, while only 10.7% initiated medication-based treatment in an outpatient setting, 6.7% had timely follow-up, and 3.5% were retained for a minimum of 6 months. Conclusion: The current paper serves as a primer for other health systems seeking to implement data-informed approaches to guide more efficient care and improved substance use-related outcomes. An OUD Cascade of Care must be tailored to local systems based on inherent data limitations and services design with an emphasis on early stages wherein drop-off is the greatest.

Original languageEnglish (US)
Pages (from-to)181-190
Number of pages10
JournalAmerican Journal of Drug and Alcohol Abuse
Issue number2
StatePublished - 2024

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health

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