Reif Sharon, Stewart Maureen T, Daily Shay M, Panas Lee, Ritter Grant A, Brolin Mary F, Lee Margaret T, Wicks Jennifer J
Institute for Behavioral Health, Schneider Institutes for Health Policy and Research, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States.
Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States.
Health Aff Sch. 2025 Aug 7;3(8):qxaf157. doi: 10.1093/haschl/qxaf157. eCollection 2025 Aug.
Innovative strategies remain necessary to increase utilization of medications for opioid use disorder (MOUD), an effective approach to reduce overdoses and deaths. The hub and spoke (HS) model is increasingly used to improve MOUD treatment, yet the impact is relatively unknown. We assessed the effectiveness of Washington State's hub and spoke (WA-HS) model on 6-month outcomes of MOUD continuity and health care utilization.
We analyzed 25 368 adult Medicaid beneficiaries with new MOUD episodes in 2016-2019, comparing HS and non-HS cohorts in the 6 months after starting MOUD.
Across both cohorts, 26% stayed on MOUD for 6 months, and within 6 months of MOUD initiation, 42% had an emergency department (ED) visit, 14% had any hospitalization, and 13% entered intensive substance use treatment. No significant differences were found between cohorts for all outcomes.
Our null findings likely reflect the complexity of the OUD crisis, the many needs of people with OUD that require flexible approaches at the individual and systems levels, and the WA-HS focus on MOUD initiation. Findings highlight the need to ensure HS models incorporate strategies to address MOUD continuity to drive long-term recovery for people with OUD.
创新策略对于提高阿片类物质使用障碍药物（MOUD）的利用率仍然至关重要，这是一种减少过量用药和死亡的有效方法。中心辐射（HS）模式越来越多地被用于改善MOUD治疗，但其影响相对未知。我们评估了华盛顿州中心辐射（WA-HS）模式对MOUD连续性和医疗保健利用率6个月结果的有效性。
我们分析了2016年至2019年25368名有新MOUD发作的成年医疗补助受益人的情况，比较了开始MOUD治疗后6个月内HS队列和非HS队列。
在两个队列中，26%的人持续使用MOUD达6个月，在开始使用MOUD的6个月内，42%的人去过急诊科，14%的人有过住院治疗，13%的人进入强化物质使用治疗。在所有结果方面，队列之间未发现显著差异。
我们的阴性结果可能反映了阿片类物质使用障碍危机的复杂性、阿片类物质使用障碍患者的多种需求，这些需求需要在个人和系统层面采取灵活的方法，以及WA-HS模式对MOUD启动的关注。研究结果强调需要确保HS模式纳入解决MOUD连续性的策略，以推动阿片类物质使用障碍患者的长期康复。
