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Table 1 Framework for systems transformation and RAMP project activities undertaken by implementation team

From: Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers

Vision Leadership Performance measurement Internal learning External learning Organizational culture/behavior Organizational structure
Develop site-specific vision statement that interfaces with RAMP project implementation vision statement, e.g.: [Name of Primary Care Practice] will increase patient access to MAT and addiction specialty services in [the community] by providing the highest quality MAT services to our patients who suffer from opioid use disorder Identify system/site decision makers for collaboration and engagement
Identify champions to support implementation at each site
Provide ongoing support to site/system leaders throughout the implementation process
Develop core set of data components for primary care, care management, and others to collect in the course of delivering the project activities
Assist sites in collection of data components, tailoring methods to sites’ capabilities
Clean, verify, and report back aggregated data to sites for performance improvement planning
Employ Lean principles to support sites to improve implementation
Employ Lean Rules in Use to ensure implementation process/roles are accurately specified
Update/improve performance management reports continuously to ensure understanding and identification of needed changes
Assign/monitor performance benchmarks to metrics to provide sites and RAMP team targets for implementation efforts
Develop curriculum and training to provide skills/resources to physicians, advanced practice professionals, care management staff, and other involved staff that these professionals and the Implementation Team identify as important
Update/modify curriculum and training topics based on site requests/needs, including attainment buprenorphine prescribing waivers
Perform brief organizational health assessments of systems and sites to determine level of implementation difficulty in order to anticipate barriers and required resources to support implementation Facilitate primary care sites to participate in 1 of 4 MAT models to enhance site engagement/sustainability, which include
 (1) Site performs all aspects of MAT and patient monitoring
 (2) Site performs all aspects of MAT, and patient monitoring is referred to community partners
 (3) Site screens patients for potential MAT need and refer patients to “hubs” for induction and monitoring
 (4) Site screens patient for MAT need and refers to “hub” for induction, monitoring, and primary care services
Implementation model involves “concierge technical assistance,” i.e., ongoing quasi real-time individualized assistance aimed at providing sites what they need when they need it determined via regular communication
  1. RAMP rural access to MAT in Pennsylvania, MAT medication assisted treatment