Table 3.
Secondary outcomes
| Outcome | Measure | Data source | Timepoint(s) |
|---|---|---|---|
| Secondary implementation outcomes | |||
| Adoption | Self-reported adoption of overdose prevention practices | Building self-assessment surveysa | Before first intervention wave, then as each of the 4 waves ends (5 timepoints) |
| Acceptability | Acceptability of intervention measure [49] | Staff surveys | 5 timepoints as above |
| Appropriateness | Intervention appropriateness measure [49] | Staff surveys | 5 timepoints as above |
| Feasibility | Feasibility of intervention measure [49] | Staff surveys | 5 timepoints as above |
| Organizational priority | Adapted from Klein, et al. [50] | Staff surveys | 5 timepoints as above |
| Sustainment | Fidelity checklist (see “Primary outcome” section) | Two blinded raters | 8th month after end of each intervention waveb |
| Secondary effectiveness outcomes | |||
| Staff knowledge about OD risk | Brief Opioid Overdose Knowledge (BOOK) Survey [51] | Staff surveys | 5 timepoints as above |
| Staff stigma | Perceived Stigma Toward Substance Users Scale [52] | Staff surveys | 5 timepoints as above |
| Tenant substance use emergency department (ED) visits | Visit diagnosis ICD-10 codes including poisoning, abuse, or dependence for alcohol or any drug (AHRQ HCUP classification list) [53]. Exploratory analyses will examine visits with specific diagnosis of poisoning (OD) | Medicaid data | 5 timepoints as above plus 6th timepoint 6 months later |
| Tenant medication for opioid use disorder (MOUD) receipt | Tenant receipt of MOUD, MOUD initiation (new pharmacy claims) and adherence [54, 55] | Medicaid data | 6 timepoints as above |
| Tenant specialty SUD treatment | Outpatient, inpatient, detoxification | Medicaid data | 6 timepoints as above |
Legend: Table shows secondary implementation and effectiveness outcomes for the stepped-wedge cluster RCT. Secondary implementation outcomes are measured via PSH staff surveys, except as otherwise noted. Secondary effectiveness outcomes are measured via PSH staff surveys and analysis of Medicaid claims data for PSH tenants
aSelected building leaders and key staff (e.g., staff champions) will complete self-assessment surveys as described in the “Primary outcome” section
bBuildings in the final intervention wave (wave 4) will complete self-assessment surveys at one additional timepoint, to allow completion of a final fidelity checklist to assess sustainment for this wave