Planning for implementation scale-up of a medication for opioid use disorder program across rural Colorado: Ensuring fit to context

Opioid use is a major public health crisis in the United States. Colorado’s Medication for Opioid Use Disorders (MOUD) program expansion was funded to address this problem in rural counties, which are disproportionately affected. Aligning with a Fit to Context Framework for Designing for Dissemination and Sustainability (F2C D4DS), we used customer discovery and value proposition methods to engage partners in an iterative process of conceptualization and design of a MOUD program to guide implementation scale-up and dissemination plans. Interviews (N = 26) with target adopters and influencers (e.g. pilot and prospective agencies, community partners) revealed expansion barriers of greatest priority to solve: 1) organizations’ capacity to provide MOUD; (2) access to treatment and patient-centered care; (3) service and system coordination; (4) stigma associated with OUD; (5) concerns about financial sustainability; and (6) mandated reporting systems. We used process mapping to analyze each organization’s context, structure, and workflows. This phase of conceptualization led to the design of new MOUD program elements to enhance its value: a clinical toolkit and guidelines, an enhanced data collection system for reporting, a process map, and implementation logic models for integrated patient-centered MOUD treatment and reporting. The F2C D4DS process allowed us to identify needs and benefits of greatest value for adopters, and informed MOUD expansion into areas with high OUD overdose risk across the state, to maximize patient outcomes. This study also contributes to evaluation literature by systematically integrating the pre-implementation phase to enhance contextual fit and sustainability for large-scale MOUD initiatives.