Evidence map›Paper›PMID 39437904›Full record

Observational studyJournal of substance use and addiction treatment2025

Relationship of hub and treatment characteristics with client outcomes in the initial Washington State hub and spoke cohort.

Sharon Reif, Maureen T Stewart, Shay M Daily, Mary F Brolin, Margaret T Lee, Lee Panas, Grant Ritter, Morgan C Shields, Shayna B Mazel, Jennifer J Wicks

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of substance use and addiction treatment, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Sharon ReifInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 35, Waltham, MA 02453, USA. Electronic address: reif@brandeis.edu.
Maureen T StewartInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 35, Waltham, MA 02453, USA.
Shay M DailyInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 35, Waltham, MA 02453, USA.
Mary F BrolinInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 35, Waltham, MA 02453, USA.
Margaret T LeeInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 35, Waltham, MA 02453, USA.
Lee PanasInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 35, Waltham, MA 02453, USA.
Grant RitterInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 35, Waltham, MA 02453, USA.
Morgan C ShieldsInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 35, Waltham, MA 02453, USA; Brown School, Washington University, 1 Brookings Drive, St. Louis, MO 63130, USA.
Shayna B MazelInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 35, Waltham, MA 02453, USA; NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA.
Jennifer J WicksInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 35, Waltham, MA 02453, USA.

Funding

Research Support CoreP30DA035772 · NIDA · BRANDEIS UNIVERSITY · PI Haiden A Huskamp, SHARON REIF · 2015 to 2026
$11.3M
Washington University Career Development Program in Drug Abuse and AddictionK12DA041449 · NIDA · WASHINGTON UNIVERSITY · PI Laura J. Bierut, Patricia A Cavazos-Rehg · 2017 to 2026
$4.2M
Hub and Spoke Model to Improve Pharmacotherapy Use for Opioid Addiction and Promote RecoveryR33DA045851 · NIDA · BRANDEIS UNIVERSITY · PI REIF, SHARON · 2018 to 2020
$2.1M
NIDA NIH HHS K12 DA041449NIDA NIH HHS P30 DA035772NIDA NIH HHS R33 DA045851
6 · The paper itself

Abstract

introductionWashington State's Hub and Spoke (HS) approach aims to improve availability of opioid use disorder (OUD) treatment. Washington initially funded six hubs with expertise in medications for opioid use disorder (MOUD) that built care networks with referral and treatment partners (spokes). We assessed outcomes for the initial HS cohort, considering the role of HS and treatment characteristics.

methodsWe conducted a cohort-based observational study using 2017-2019 Medicaid claims data for 2841 HS participants aged 18-64, excluding those with past-month MOUD, in an intent-to-treat analysis. We describe treatment characteristics (MOUD type, treatment setting, and hub type at the initial HS visit, number of outpatient services in their first HS month), and six-month outcomes (MOUD continuity, emergency department (ED) utilization, hospitalization, and intensive SUD treatment). We used multivariable regressions to assess associations with six-month outcomes, adjusting for client characteristics.

resultsTwo-thirds (68 %) of participants received buprenorphine, 22 % methadone, 5 % naltrexone, and 5 % outpatient without MOUD for their initial visit. Within six months, 45 % had an ED visit, 14 % any hospitalization, and 18 % entered intensive SUD treatment. Only 24 % remained on MOUD for six months. Compared to buprenorphine, the methadone sample had higher odds of MOUD continuity (aOR = 2.81, 95%CI 2.21-3.55), and the naltrexone sample had lower odds (aOR = 0.36, 95%CI 0.19-0.66). FQHC/public health treatment settings had higher odds of MOUD continuity (aOR = 1.70, 95%CI 1.17-2.47) but hub type was not significant. MOUD continuity increased with 2+ outpatient services for the buprenorphine sample (aOR range 2.55-4.73). Odds of intensive SUD treatment were lower for the methadone sample, compared to buprenorphine (aOR = 0.16, 95%CI 0.11-0.23), all settings compared to SUD settings (aOR range 0.32-0.58), and SUD + MH and medical/hospital hubs compared to SUD only hubs (aOR range 0.28-0.41).

conclusionsMost participants did not attain six-month MOUD continuity, despite the HS approach, with variations by MOUD type and treatment setting. The number of outpatient services in the first month for buprenorphine clients was associated with greater odds of MOUD continuity and reduced odds of intensive SUD treatment. More work is needed to improve MOUD continuity for people with OUD within the HS model.

Indexed as

BuprenorphineMedicaidOpiate Substitution TreatmentOpioid-Related DisordersAdolescentAdultCohort StudiesEmergency Service, HospitalFemaleHospitalizationHumansMaleMethadoneMiddle AgedNaltrexoneUnited StatesBuprenorphineMethadoneNaltrexoneMedicationMOUDOpioid use disorderOutpatient treatmentTreatment setting

Identifiers

PMID39437904
PMCPMC11926888

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.