Health Systems Research

AHRQ funds grants and contracts to study how the healthcare system can effectively solve the challenge of the substance use disorder epidemic, from improving management of prescription opioids in clinical care to screening and treatment for substance use disorder.

Increasing Access to MAT in Rural Primary Care Practices

AHRQ awarded funds to five Primary Care Medication-Assisted Treatment for Opioid Use Disorders Grantees through the initiative Increasing Access to MAT in Rural Primary Care Practices—a cooperative grant program that provides access to MAT to more than 20,000 individuals struggling with opioid addiction using innovative technology. Strategies include patient-controlled smart phone apps, remote training, and expert consultation using Project ECHO—a telehealth program started with AHRQ support that links specialists at an academic hub to primary care providers working on the frontlines in rural communities.

AHRQ's Opioids and Older Adults Initiative

Between 2010 and 2015, the rate of opioid-related inpatient stays and emergency department visits increased for people age 65 or older by 34% and 74%, respectively. This includes older adults who experienced common side effects from opioids (such as constipation, confusion, nausea, falls, etc.), as well as overdoses. Managing opioids in older adults is especially complex and challenging. Older adults have a high prevalence of chronic pain and are especially vulnerable to adverse events from opioids. Furthermore, substance use disorders may be overlooked or misdiagnosed in older adults.

AHRQ is funding multiple responses to this challenge:

• Prevention, Diagnosis, and Management of Opioids, Opioid Misuse, and Opioid Disorder in Older Adults

This Technical Brief includes a conceptual framework and a map of the current evidence base to describe issues that are driving the current rise in opioid-related morbidity and mortality in older adults, and what evidence is  needed to support effective interventions.

• Identifying and Testing Strategies for Management of Opioid Use and Misuse In Older Adults

In September 2019, AHRQ launched a 3-year pilot project to assess and describe current perceptions of the challenges associated with managing opioid use and misuse in older adults; to create a compendium of tools, strategies, and approaches for managing opioid use and misuse in older adults in primary care settings; to support primary care practices in developing and testing innovative strategies, approaches, or tools for opioid management within the context of a facilitated Learning Collaborative; and to identify remaining evidence gaps and areas of needed research. Products and results will be posted to this website as they become available.

• Improving Management of Opioids and Opioid Use Disorder (OUD) in Older Adults

AHRQ has awarded three grants to develop, implement, evaluate, and disseminate strategies to improve the management of opioid use, misuse, and opioid use disorder (OUD) in older adults in primary care settings. The grants will use practice facilitation, academic detailing, clinical decision support, and Project ECHO modalities to support primary care clinicians in managing opioids for older adult patients. The grantees are based at the University of Chicago, the University of Michigan Ann Arbor, and the University of Oklahoma. 

Interoperable electronic (eCare) plan to support pragmatic, patient centered outcomes research (PCOR) for patients who have multiple co-morbid conditions that include pain with opioid use disorder (OUD)

AHRQ is collaborating with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) build data capacity to conduct pragmatic PCOR by developing an interoperable eCare plan to facilitate aggregation and sharing of critical patient-centered data across home-, community-, clinic-, and research-based settings by extracting data from EHRs and exchanging that data across settings. The pilot eCare Plan tool developed for this project will be designed for use with patients who have chronic kidney disease and the following co-morbid health conditions: cardiovascular disease, OUD, and diabetes.

Unhealthy Alcohol Use Initiative

In October 2019, AHRQ launched the Unhealthy Alcohol Use Initiative. This 3-year grant program aims to disseminate and implement into primary care practices evidence-based approaches to improve the use of screening for unhealthy alcohol use, brief intervention for those at risk, and medication therapy for alcohol use disorder.

Other recent AHRQ-funded grants related to opioids and other substance use disorders

• Toward Safer Opioid Prescribing for Chronic Pain in High Risk Populations: implementing the Centers for Disease Control and Prevention (CDC) Guideline in the primary care HIV clinic.
• Advancing Patient Safety Implementation through Pharmacy-Based Naloxone Prescribing.
• Optimizing Acute Post-Operative Dental Pain Management Using New Health Information Technology.
• Assessing the Relationship Between Care Processes and Clinical Decision Support for Order Entry.
• Improving the Safety of Diagnosis and Therapy in the Inpatient Setting.
• The effects of State policies on opioid use disorders in pregnant women: prevalence, treatment, and outcomes.
• Risk of Acute Asthma Associated With the Pediatric Use of Opioids.
• Real-time Assessment of Dialogue in Motivational Interviewing training (ReadMI).
• Characterizing Opioid-Related Adverse Events in Older Adults After Hospital Discharge. 
• Preventing opioid overdose deaths by empowering pharmacists to dispense naloxone.
• Prescription Opioid Use Trajectories and Risk Factors Associated with Opioid-Related Hospitalizations in Older Adults.
• Patient-Reported Outcome Measures in Chronic Pain—Feasibility and Usability for Care Planning and Performance Measurement.
• PROMIS Learning Lab: Partnership in Resilience for Medication Safety.
• Improving quality of postoperative pain care through innovative use of electronic health records.
• Prescribing of opioids at hospital discharge and associated adverse patient outcomes.
• Dental prescribing of antibiotics and opioids: high use in the absence of evidence.
• The Michigan Sustained Patient-Centered Alcohol-Related Care (MI-SPARC) Trial.

Journal Publications

AHRQ-funded studies on opioids that appear in academic journals are summarized on the  AHRQ Research Studies page.