{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:42:48Z","timestamp":1792482168294,"version":"4.5.0"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007181","name":"Quality Enhancement Research Initiative","doi-asserted-by":"publisher","award":["EBP 22\u2010109"],"award-info":[{"award-number":["EBP 22\u2010109"]}],"id":[{"id":"10.13039\/100007181","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether the Veterans Health Administration's (VHA) Stepped Care for Opioid Use Disorder Train\u2010the\u2010Trainer (SCOUTT) initiative increased medication treatment for opioid use disorder (MOUD) among persons experiencing homelessness (PEH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>We conducted a national retrospective cohort study of MOUD, including buprenorphine, naltrexone, or methadone, in federal fiscal years (FY) 2016\u20132020. In late FY2018, VHA regional directors nominated facilities to receive SCOUTT implementation support to expand prescribing of MOUD (primarily buprenorphine) in select primary care, pain, and general mental health settings. We used mixed\u2010effects quasi\u2010Poisson regression models with entropy balancing to estimate the Average Treatment Effect on the Treated in the years after SCOUTT was implemented (FY2019\u20132020), controlling for pre\u2010implementation levels of MOUD. Secondary analyses applied synthetic difference\u2010in\u2010differences (DiD) to estimate changes associated with SCOUTT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>\n                      We used yearly pooled cross\u2010sectional data from VHA electronic health records, FY2016\u20132020. The sample included annual cohorts of PEH with an opioid use disorder diagnosis and \u2265\u20091 primary care visit in the pre\u2010implementation (FY2016\u20132018,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200931,354) or post\u2010implementation (FY2019\u20132020,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920,746) periods.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>\n                      From FY2016\u20132020, MOUD receipt increased more in SCOUTT facilities (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930, 45.0% to 61.1%) than in non\u2010SCOUTT facilities (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009811, 41.9% to 49.7%). In post\u2010implementation years, PEH in SCOUTT facilities, compared to non\u2010SCOUTT facilities, were more likely to receive any MOUD (risk difference [RD]\u2009=\u20096.16, 95% CI\u2009=\u20092.33\u20139.99), including buprenorphine (RD\u2009=\u20097.16, 95% CI\u2009=\u20094.35\u20139.97). There were no significant differences in methadone (RD\u2009=\u2009\u22120.19, 95% CI\u2009=\u2009\u22121.03\u20130.65) or naltrexone (RD\u2009=\u20090.10, 95% CI\u2009=\u2009\u22121.85\u20132.05). Synthetic DiD offered similar results: any MOUD DiD\u2009=\u20097.85, 95% CI\u2009=\u20092.15\u201313.55; buprenorphine DiD\u2009=\u20099.31, 95% CI\u2009=\u20093.56\u201315.06.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A national initiative to advance a stepped\u2010care model that encourages MOUD initiation outside specialty addiction settings improved access to buprenorphine among PEH. Similar initiatives could help to close treatment gaps in health care settings serving PEH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70171","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:59:08Z","timestamp":1791943148000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of a National Stepped\u2010Care Model of Opioid Use Disorder Treatment on Access to Medication Therapies Among Homeless\u2010Experienced Veterans"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1295-4341","authenticated-orcid":false,"given":"Haojia","family":"Li","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University of Utah School of Medicine  Salt Lake City Utah USA"},{"name":"Department of Population Health Sciences University of Utah School of Medicine  Salt Lake City Utah USA"},{"name":"Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8251-4704","authenticated-orcid":false,"given":"Jacob D.","family":"Baylis","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences University of Utah School of Medicine  Salt Lake City Utah USA"},{"name":"Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9940-9604","authenticated-orcid":false,"given":"Sophia","family":"Huebler","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences University of Utah School of Medicine  Salt Lake City Utah USA"},{"name":"Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2453-8871","authenticated-orcid":false,"given":"Adam J.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Utah School of Medicine  Salt Lake City Utah USA"},{"name":"Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5467-1553","authenticated-orcid":false,"given":"Eric","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Health Systems Research (HSR) Seattle Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care Veterans Affairs (VA) Puget Sound Health Care System  Seattle Washington USA"},{"name":"Center of Excellence in Substance Addiction Treatment and Education VA Puget Sound Health Care System  Seattle Washington USA"},{"name":"Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5118-7624","authenticated-orcid":false,"given":"Hildi J.","family":"Hagedorn","sequence":"additional","affiliation":[{"name":"Center of Excellence in Substance Addiction Treatment and Education VA Puget Sound Health Care System  Seattle Washington USA"},{"name":"Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine  Seattle Washington USA"},{"name":"Center for Care Delivery &amp; Outcomes Research Minneapolis VA Health Care System  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6101-8421","authenticated-orcid":false,"given":"Stefan G.","family":"Kertesz","sequence":"additional","affiliation":[{"name":"Birmingham VA Health Care System  Birmingham Alabama USA"},{"name":"Department of Medicine University of Alabama at Birmingham Heersink School of Medicine  Birmingham Alabama USA"},{"name":"Department of Health Behavior University of Alabama at Birmingham School of Public Health  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Suo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Utah School of Medicine  Salt Lake City Utah USA"},{"name":"Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Utah School of Medicine  Salt Lake City Utah USA"},{"name":"Department of Population Health Sciences University of Utah School of Medicine  Salt Lake City Utah USA"},{"name":"Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1533-7469","authenticated-orcid":false,"given":"Audrey L.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Utah School of Medicine  Salt Lake City Utah USA"},{"name":"Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(19)32229\u20109"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889\u2010024\u201019142\u20100"},{"key":"e_1_2_12_4_1","unstructured":"Substance Abuse and Mental Health Services Administration Key Substance Use and Mental Health Indicators in the United States: Results From the 2023 National Survey on Drug Use and Health. PEP24\u201007\u2010021 NSDUH Series H\u201059 2024 https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/reports\/rpt47095\/National%20Report\/National%20Report\/2023\u2010nsduh\u2010annual\u2010national.pdf."},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12954\u2010021\u201000539\u20108"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2019.112585"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108717"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.42676"},{"key":"e_1_2_12_9_1","first-page":"174","volume-title":"Medications for Opioid Use Disorder Save Lives","author":"National Academies of Sciences Engineering and Medicine","year":"2019"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0308791"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000719"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2018.04.012"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.josat.2023.209216"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2022.108752"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/29767342231218529"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.0477"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.13055"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0279973"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2018.1509251"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2020.1787299"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.37238"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.43543"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010006\u20100023\u20101"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2019.305525"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43058\u2010021\u201000119\u20108"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13722\u2010021\u201000263\u20105"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010025\u201006722\u20106"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2025.112995"},{"key":"e_1_2_12_29_1","volume-title":"Not the Final Answer: Medical Records and Natural Language Processing for Detecting Homelessness","author":"Kertesz S. G.","year":"2026"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.25919"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.3389\/frai.2023.1187501"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usac066"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13051"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/pan\/mpr025"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1257\/aer.20190159"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.12993"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000001252"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2018.1449166"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.12788\/fp.0186"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000860"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13212710"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010023\u201008027\u20104"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70171","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1475-6773.70171","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70171","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:32:24Z","timestamp":1792481544000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.70171"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":41,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/1475-6773.70171"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.70171","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-01-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70171"}}