A learning health system model for addressing substance use: Denver Health Center for Addiction Medicine

Abstract

Introduction

Substance use disorders (SUDs) continue to place heavy burdens on patients, health systems, and communities. Rapidly evolving treatment for SUDs requires health systems that can efficiently and effectively assess data and integrate evidence to practice. This paper describes the implementation of a learning health systems model of SUD care at an urban, safety‐net, integrated health system in Denver, Colorado.

Methods

The health system created the Center for Addiction Medicine (CAM) to coordinate comprehensive services for patients with SUD, including research, evaluation, and quality improvement efforts. CAM implemented a hub‐and‐spoke model of care and developed four strategic areas to identify, integrate, and grow SUD services. CAM also created a process for engaging community members with lived experience with SUDs and a CAM Academy to educate partners within the health system and across the region.

Results

CAM successfully implemented processes for gathering and assessing evidence, informing clinical practice, fostering community partnerships, and strategically expanding services and reach. Key factors driving success include strategic planning, leadership buy‐in, data infrastructure, and community partnerships.

Conclusions

Integrated SUD care at a safety‐net institution is a continued challenge. Persistent barriers include the SUD policy and regulatory landscape, addressing co‐occurring social and health circumstances when treating SUDs, and accurate clinical documentation of SUDs. Applying a learning health system model can help health systems adapt to these challenges.

1. BACKGROUND

In the United States, the opioid epidemic has continued to accelerate and evolve over the past two decades, responsible for over one million overdose deaths since 1999. ¹ The exponential increase in overdose deaths that began in the early 2000s has brought a sense of urgency for action, and resulted in legislative, policy, and regulatory changes. ² , ³ In 2017, the opioid epidemic was declared a public health emergency. ⁴ Correspondingly, the US government has substantially increased financial investment in opioid overdose prevention and treatment. ⁵ This investment has contributed to development of effective interventions to address opioid use disorder (OUD), including expanding the availability of medication for opioid use disorder (MOUD). ³ , ⁶ However, use disorders for more common substances such as alcohol and methamphetamines still lack evidence‐based solutions. ⁷ , ⁸

Despite the evidence base, guidelines, and availability of treatment for OUD, these approaches have shown only gradual progress in effectively mitigating the challenges posed by opioids and other substances. Policy, system, and clinician‐level barriers along with patient knowledge and stigma have led to underutilization of MOUD for patients in need. Existing studies estimate that less than 10% of patients who qualified for MOUD were receiving prescriptions for buprenorphine. ⁹ , ¹⁰ , ¹¹ , ¹² , ¹³ Further, rates of prescribing MOUD among patients who identify as Black or Hispanic are significantly less than those provided to patients who identify as White. ¹⁴

Drivers of substance use disorders (SUDs) are multifactorial and complex, ⁶ and effective treatment and recovery require extended treatment periods that rely on integration and coordination across healthcare and community systems. Even within single health systems, care for persons with SUDs is often fragmented due to tensions between care coordination and protecting SUD documentation. ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ For instance, 42 CFR Part II has historically made it difficult to share information, such as notifying an emergency department that a patient is already engaged in outpatient SUD care. Improving systems for substance use treatment and prevention is urgently needed. ¹⁹ An implementation and evaluation framework is also necessary to determine the utility of different approaches in diverse populations.

A learning health system (LHS) model of care can provide an effective approach to addressing the complexity and rapidly evolving landscape of SUD treatment. The LHS model fosters the generation, translation, and application of evidence into practice and programs to advance health. ²⁰ , ²¹ , ²² , ²³ , ²⁴ Applying LHS components to SUD identification and treatment—including establishing a strong data infrastructure, gathering and assessing evidence, and partnering with practitioners, staff, patients, and community—can greatly enhance care and outcomes for individuals with SUD. ²¹ , ²⁵ , ²⁶ Despite the widespread adoption of the LHS model by many programs and academic healthcare systems ²⁷ , ²⁸ there are still substantial gaps in understanding how to implement the framework effectively for SUDs. ²⁹ , ³⁰ , ³¹

This paper describes Denver Health's Center for Addiction Medicine (CAM), established in 2018 to streamline substance use identification and treatment throughout the health care system, with an initial focus on OUD. We describe how CAM applies a LHS model to coordinate and integrate addiction services across the health system and broader community.

2. METHODS

2.1. Setting

Denver Health and Hospital Authority (Denver Health; DH) is a public safety net health system that has served residents in Denver, CO, USA for over 160 years. DH includes a 525‐bed hospital; an Adult Level One Trauma Center; primary care, school health and urgent care centers; paramedic and public health divisions; and correctional care health services. DH also includes Outpatient Behavioral Health Services (OBHS) with an Opioid Treatment Program (OTP) and intensive outpatient care for adolescents and adults. It also offers withdrawal management and transitional residential treatment [Denver Community Addiction Rehabilitation and Evaluation Services (CARES)]. In 2022, DH cared for nearly 270 000 of Denver's most vulnerable residents ³² : more than 60% of DH patients identify as members of racial and ethnic minoritized groups, and 70% live below the 200% federal poverty level.

In addition to being a nationally recognized safety‐net learning health system, DH boasts a strong academic mission. Many MDs and PhDs at DH hold academic appointments at the University of Colorado Anschutz Medical campus. CAM collaborates with academic partners within and outside of DH to advance research and support addiction medicine training. CAM integrates DH's addiction programs and medical resources into a single treatment model, ensuring a full continuum of care for SUDs. CAM is not a physical site but a network of services, including prevention and education, harm reduction, treatment, and recovery support. Annually, CAM serves more than 23 000 patients with SUD. ³³

CAM partners with external healthcare systems and community organizations to streamline referrals, track linkages, and monitor treatment outcomes. It also expanded a Substance Treatment Line to connect patients, providers, and families to SUD resources within and outside DH.

2.2. The CAM approach

2.2.1. Hub and spoke model

CAM integrated SUD treatment at DH using a hub‐and‐spoke model (Figure 1). The model, which has been implemented in county and state contexts but rarely within individual organizations, ³⁴ , ³⁵ , ³⁶ supports the multiple entry points for patients seeking SUD treatment. DH OBHS clinics serve as the central “hub” for specialized SUD services, while the “spokes” provide multiple entry points for identifying SUD, initiating treatment, and linking patients to different levels of care. DH's spokes include the primary care clinics [i.e., federally qualified health centers (FQHCs)], pediatric and adult emergency departments, psychiatric emergency services, hospital medicine, correctional care, school‐based health centers, Denver CARES withdrawal management and transitional residential treatment programs, and multiple community partners including Denver Recovery Group, Behavioral Health Group, and Sobriety House residential treatment. Patients with SUD can enter the system directly through the hub or through any spoke and move between the hub and spokes, or between multiple spokes, with integrated care.

FIGURE 1.

Center for Addiction Medicine hub and spoke model of care.

2.2.2. Identifying strategic areas

CAM embodies the LHS model by supporting activities across the LHS cycle. To achieve this breadth of services, CAM has a strategic process for selecting and scaling activities, foci, and programs, prioritizing relevance and feasibility. CAM's initial focus on OUD addressed the urgent opioid epidemic and availability of effective treatment. For new efforts, CAM prioritizes specific use cases (e.g., substances, departments, patient populations) that are both relevant and feasible to develop programs and standards before broader expansion.

Relevance and feasibility are determined through collaborative, iterative engagement with partners. The LHS model integrates data, evidence, and expertise—from clinical, administrative, and lived‐experiences—while considering organizational capacity and securing buy‐in from staff and leadership. In 2019, CAM used Lean mapping techniques ³⁷ to create a formal structure to organize partners into four strategic areas (Figure 2).

FIGURE 2.

Center for Addiction Medicine strategic areas.

Each strategic area has a workgroup that meets regularly (e.g., monthly or quarterly) and is comprised of members from different clinical services and data teams. Leaders from all strategic areas meet at least quarterly to provide updates and discuss alignment or pressing issues. Leaders also attend a day‐long retreat each fall to revisit strategic goals and priorities.

The strategic areas play different roles in achieving CAM's overall goals. The Full Continuum of Care Workgroup focuses on identifying areas across the system and in the community that could be better integrated or streamlined. The group facilitates development of clinical workflows and procedures so that patients can move as easily as possible between the hub and spokes.

The Knowledge Management Workgroup is the data hub of CAM. Analysts extract and synthesize data from the electronic health record (EHR) and other sources to support CAM efforts, including development of patient tracking tools for providers, program evaluation, research and dissemination, and fulfilling data requests for projects related to substance use.

The Fiscal Growth and Financial Partnerships Workgroup develops and enhances revenue streams within the organization and from external funders. The Workgroup develops strategic goals to ensure financial sustainability for CAM staff and initiatives.

The Inclusive and Compassionate Care Workgroup elevates CAM's health equity goals by identifying areas of improvement in caring for patients with SUDs and enacting campaigns or programs to achieve these improvements.

All of CAM's strategic areas are informed by and, in turn, support two broad CAM groups: Community Voice and CAM Academy. Community Voice is an advisory group of community members with lived experience with SUD. Many participants are recruited from OBHS through passive advertising and providers who alert their clients to the opportunity to participate. There has also been “snowball” recruiting, as participants have shared the opportunity with others in their networks. Community Voice meets monthly to advise on new or ongoing projects and provide feedback on CAM's processes or previous project results. Meetings are led by a dedicated facilitator who works across the organization to identify initiatives that would benefit from community voice within the formative stages. The facilitator crafts discussion questions, facilitates the discussion, and relays key themes back to partners. Participants are compensated $60 for every 90‐minute meeting, bus tickets if needed, and a meal is provided. All CAM's work is grounded in Community Voice to ensure efforts are relevant, socially and culturally appropriate, and sensitive to community needs and perspectives.

CAM Academy, the educational arm of CAM, provides trauma‐responsive addiction medicine training and consultation within DH and to the Western US. It disseminates knowledge from CAM's LHS model at DH, offering standardized curriculum, professional development, resources, tools, collaborative partnerships, and technical assistance. Trainings are available both internally and externally to DH. Internal advertising is coordinated by the DH Marketing department, reaching over 10 000 employees through monthly communications and training calendars. External advertising occurs via conferences, newsletters, email lists, and partnerships. Courses offer continuing education credits (e.g., CME/CNE) and are free for DH employees, with a $150 fee/workshop for external participants (discounts are available for bulk registration and non‐profits).

CAM's strategic areas, along with Community Voice and CAM Academy, enable CAM to function as a LHS. CAM regularly assesses its work to guide future projects and uses rigorous evaluation, quality improvement, and research activities to shape best practices and growth.

3. RESULTS

3.1. Gathering and assessing evidence

CAM has developed robust processes for gathering and assessing evidence to develop and improve efforts (Table 1).

TABLE 1.

Summary of learning health system process for each strategic area of the Center for Addiction Medicine (CAM) at Denver Health.

Strategic area	Project highlight	Gathering/assessing evidence	Informing clinical practice	Partner/community engagement	Expansion process
Inclusive and Compassionate Care	Words matter campaign: reducing stigmatizing language related to substance use	Track stigmatizing terms related to substance use in clinical notes; identify departments for improvement.	Provide anti‐stigma education to identified departments; launched words matter campaign across health system through presentations and employee pledge.	Community Voice feedback on impact of stigmatizing terms on care‐seeking behavior its impact on relationships with providers.	Provide training to other healthcare organizations and media outlets.
Full Continuum of Care Workgroup	Introduction of Buprenorphine inductions in the ED a and connection to services for patients with OUD. b	Track buprenorphine inductions in ED through real‐time dashboard; track linkage to care from ED.	Develop workflow to integrate intake data between departments; develop referral pathway from ED to outpatient	Community Voice reflections on patient experiences seeking substance use treatment services at Denver Health; establish long‐term partnership with City of Denver.	Add methadone option for ED inductions.
Knowledge Management Workgroup	Opioid Use Disorder Continuum of Care Model with enhanced definitions of OUD to capture burden of disease.	Develop a computable phenotype for opioid misuse; track patients with OUD through treatment and recovery; identify patients falling out of care	Develop opioid registry; create opioid dashboard visualizing treatment trajectories for patients with OUD	Community Voice insights into how they defined a use disorder, treatment, retention in care, and recovery.	Develop continuum of care models for other substances; develop streamlined infrastructure for SUD c data.
Fiscal Growth and Financial Partnership Workgroup	Establish a diverse funding model	Identify key internal/external leaders; evaluate funding streams from clinical practice	Secure operational funding; develop strong external funding partnerships	Community Voice input on spending funds and funding priorities.	Financial growth through grants; strong internal, and external partnerships

^a Emergency department.

^b Opioid use disorder.

^c Substance use disorder.

The Knowledge Management Workgroup is central to data collection and assessment through collaboration with other strategic area workgroups and CAM leadership. The Knowledge Management Workgroup employs a multi‐method approach, with subgroups that focus on evaluation and data integration. Evidence is gathered through data extraction from the EHR and other connected data systems and through structured and informal interviews with providers, and collaboration with Community Voice and other DH departments, including the Public Health Institute, Behavioral Health Services, the Office of Health Equity, and the Center for Health Systems Research.

The Knowledge Management Workgroup developed a request portal that allows clinicians, administrators, or researchers to request SUD data in multiple formats ranging from raw datasets to completed reports or presentations. The Workgroup creates products such as dashboards in Tableau or within the EHR to track patients and processes over time and streamlines data integration by developing standard criteria, code, and processes to extract substance‐related data. For example, the Knowledge Management Workgroup developed SUD treatment and referral tools to better track patient treatment episodes and movement across the system. ¹⁸ The Workgroup also developed an enhanced definition of OUD that captures metrics beyond diagnosis codes, and built out a comprehensive OUD continuum of care model to assess how patients with OUD access treatment and are retained in care. ³⁸ , ³⁹

The Inclusive and Compassionate Care Workgroup used data to shape its approach to the Words Matter Campaign to reduce the use of stigmatizing language related to SUDs (Table 1). The Workgroup identified service areas where providers were more likely to use stigmatizing language in clinical notes and directed education to those areas. ⁴⁰

Additionally, CAM Academy has conducted needs assessments and environmental scans, including surveys, focus groups, and interviews, to identify training gaps in addiction medicine and inform future curriculum development.

3.2. Informing clinical practice

It is essential for the data and evidence CAM gathers to inform clinical practice. CAM uses education, dissemination, and collaboration to share data and evidence internally to clinicians and externally to other health systems. The CAM Continuum of Care Workgroup facilitates quarterly meetings with internal programs (hub and spokes) to review clinical workflows (e.g., how patients with SUD move from one department to another) and implement modifications to improve patient transitions for care linkage and retention. CAM also works with external programs to create standardized referral pathways. For example, CAM identified a low post‐release linkage rate (around 6%) to OBHS for justice‐involved patients, and hypothesized that patients might better connect with SUD services in primary care. CAM helped develop a registry of patients who were engaged in SUD care in the Denver correctional setting. CAM facilitated a new pathway, including development of a clinical workflow, for patients to receive SUD treatment in primary care post‐release.

CAM Academy has developed formal curricula and educational events through partnership with the Denver Prevention Training Center. The Knowledge Management Workgroup has created data registries and dashboards to inform clinicians about patient processes in real time (e.g., buprenorphine and methadone inductions in the ED). CAM partners with the Center for Health Systems Research to support staff in writing implementation grants to transition evidence‐based results into projects and increased clinical support (e.g., a project that funded SUD peer navigators). CAM hosts a quarterly data and research meeting to inform partners in addiction research about data tools and current projects. In addition, CAM facilitates mentorship of early career research staff to develop addiction‐related projects.

3.3. Partner and community engagement

Community Voice has been leveraged to inform projects across CAM's strategic areas (Table 1). Persons with lived experience with substance use provide invaluable insight into feasibility of projects, strategic implementation, and interpretation of results. Community Voice has also facilitated partnerships with other community organizations by bridging gaps between clinical guidelines and real‐world applications. CAM continues to regularly partner with the City and County of Denver and its public health department, the justice system, residential treatment programs, and other core social and mental health support services across the region. These partnerships have expanded the hub‐and‐spoke model, creating more care pathways for patients have establishing diverse financial relationships to sustain program funding.

3.4. Expansion process

CAM took a systematic approach to expanding programs across the health system. After implementing initial programs and processes based on relevance and feasibility, CAM has broadened its focus to include new substances, departments, and populations. While it began with opioid‐related projects, its goal is to be SUD‐agnostic.

Since initial operational and philanthropic investments, CAM has expanded and diversified its funding structure, generating over $10 million in grants since 2019, $2 million in philanthropy gifts since 2021, and approximately $400 000 annually in operational funding. A continued partnership with the City and County of Denver has resulted in funding through the Denver Opioid Abatement Council to expand the Substance Treatment Line.

CAM has also expanded its ability to provide a higher level of care for adolescents with SUDs. DH has provided specialty outpatient addiction services to youth for years, including medication assisted treatment and linkage to outpatient care from the pediatric emergency department to school‐based and specialty adolescent addiction treatment on the main campus. In 2023, DH implemented Colorado's first inpatient adolescent withdrawal management program, providing a safe and supportive inpatient environment for youth to withdraw from substances and begin treatment before transitioning to outpatient care. DH is implementing a grant‐funded animal assisted therapy program, with CAM Academy supporting the initiative by creating an implementation toolkit for others interested in adopting a similar program. Additionally, we have a coalition of youth in Denver with lived experience who serve as advisors for CAM Community Voice and run community‐programming to create awareness and prevent overdose.

3.5. Key lessons learned through adoption of the LHS model for SUDs

The success of CAM stems from a 5‐year strategic plan (2019) and ongoing assessment using the LHS model. Key factors that also apply to other health systems include adapting to shifts in substance use patterns and using data‐driven evidence to maintain organizational support (Table 2). Partnerships with leadership and external organizations have been crucial, especially amid healthcare staff turnover.

TABLE 2.

Critical success factors and key considerations for establishing the Center for Addiction Medicine (CAM) using a LHS framework.

Topic area	Critical success factors	Key considerations
Strategy	Strategic plan to establish a roadmap and serve as a basis for assessment, re‐assessment	Recognize the dynamic nature of SUD a care and be adaptable to changes
	Establish success metrics	Distinguish between metrics that are tracked but not directly controllable (e.g., overdose deaths) versus success metrics that are directly controllable (e.g., establishing new SUD treatment pathways).
Leadership	SUD care as an organizational priority	Continuous competing priorities of the organization require continuous advocacy
	Leadership reengagement	High rates of staff turnover in healthcare: need to re‐establish relationships with new leaders
	Clinical champions across all service lines and clinics	Operational managers, staff at all levels need to be involved to make effective changes to clinical workflows
Infrastructure	Dedicated administrative core (program coordinator) to establish and foster relationships, monitor implementation, coordinate	Multiple dedicated staff members relying on other clinical and support staff to contribute to the work as volunteers
Policies and regulations	Develop and streamline internal policies on SUD care and treatment	State regulations for licensed clinical programs continuously change
Data	Data sharing and outcome visibility across partners	42 CFR Part 2 has led to disparate data systems for SUD care and treatment
	Establish a robust data infrastructure as the foundational building block to support all other strategic areas	SUD information within a single EHR is likely to be inconsistent, requiring assessment of workflows, documentation, and establishing standard definitions
Scope	Initial narrow focus (OUD b ) to establish and refine approaches and processes	Evolving SUD landscape—shift in opioid use (e.g., from prescriptions to fentanyl)
Partnerships	Partnerships—internal and external—to establish care pathways within and between systems (other organizations); essential to all aspects	Consider the size and breadth of services: important to collaborate across all services and organizations
Communications	Communications that are clear, transparent, and accessible, including resources for providers and the public	Ongoing need to update and maintain an inventory of CAM c ‐related data tools and services
Funding	Large investments in SUDs from national, state, and private funding sources	Shifting funding landscape: need to be able to adapt to funding opportunities, and ensure alignment with strategy and what is best for system and patients
		Funding for the LHS d component is not directly reimbursable

^a Substance use disorder.

^b Opioid use disorder.

^c Center for Addiction Medicine.

^d Learning health system.

SUDs are continually evolving and impacted by structural, health system, and patient‐level factors. A key CAM strategy has been to develop metrics of success that are directly actionable. CAM shifted from broad metrics, like overdose rates and treatment percentages, to actionable goals using a Lean approach and SMART (specific, measurable, achievable, relevant, time‐bound) criteria. Aligned with the LHS model, CAM now tracks improvements in treatment programs, workflows, training, and data systems, reporting progress quarterly and annually. Additionally, unanticipated events like the COVID‐19 pandemic also impact care delivery. Adaptability is key, as seen when CAM quickly adjusted protocols during the pandemic, allowing tracking and reporting on increased take‐home methadone doses and switching to telehealth to minimize treatment disruptions. ⁴¹

CAM relies on a small core team and volunteer staff, which can be difficult to sustain. Funding remains a priority but must align with system and patient needs. CAM has maintained transparency, issuing annual reports, hosting resources online, and building partnerships. Despite progress in patient outcomes and operational efficiency, core administrative CAM activities are not reimbursable, making a data‐driven business case essential for its growth.

4. DISCUSSION

The Denver Health CAM illustrates the application of the LHS model to address SUD across a large, safety‐net healthcare institution. The initial investment of funding and focus on OUD was strategically utilized to establish a foundational data and governance infrastructure. This infrastructure was leveraged to transition to supporting substance‐agnostic care, programs, and research, expanding services and improving outcomes. Broad adoption of the LHS model—through strategic and incremental expansion of capability and capacity—has uniquely positioned DH to implement new, evidence‐based and data‐driven initiatives to advance the health of its patients and community.

The LHS model is increasingly adopted by health systems and utilized for addressing specific health issues or programs. ⁴² Implementation of LHS models have consistently demonstrated value in fostering a culture of continuous improvement, providing the data infrastructure to inform clinical decision‐making, and improving patient care and outcomes. ⁴³ To our knowledge, this is the first description of implementation and application of the LHS model for SUD care across an entire health system. ²⁸ The CAM hub‐and‐spoke model and LHS model align closely with other prominent national addiction medicine programs, including the Grayken Center for Addiction at Boston Medical Center and the University of Vermont Medical Center Addiction Treatment Center. In addition to the illustrative examples across each CAM area, the CAM LHS model has also been applied to demonstrate the effectiveness of school‐based SUD programs on expanding access, decreasing disparities in retention, ⁴⁴ and improving behavioral and academic outcomes. ⁴⁵ Robust implementation science applied within the diverse DH population at an integrated safety‐net institution has resulted in a compilation of best practices, tools, and resources to expand to other applications and with other healthcare systems.

This paper describes critical components of implementing the LHS model focused on SUDs across an entire healthcare system, but there are limitations worth noting. DH includes emergency, inpatient, outpatient, and withdrawal management services, allowing for integrated care delivery within a single healthcare system. Because DH's LHS is uniquely within a healthcare delivery system rather than an academic institution that partners with healthcare clinics and systems, we were able to immediately implement incremental changes within the delivery system. Other, academically‐based LHS models will need to establish partnerships to achieve similar growth. However, we believe that the foundational elements described here provide guidance to adoption of the LHS model in different settings. The height of the opioid epidemic in the mid‐2010s was met with substantial funding through both extramural and philanthropic donations, which has allowed CAM to establish and maintain core staff with expertise in administrative and operational management, data management and analytics, and research. Since then, funding opportunities have expanded to address the broader spectrum of the SUD crisis, including various substances and integrated care approaches. Building and maintaining infrastructure to effectively identify opportunities, apply for grants, and secure donations is crucial for the sustainability of CAM. However, not all programs or healthcare systems may possess the same capability or capacity to leverage these funding opportunities. Differing funding sources, 42 CFR Part II, and reporting requirements have led to siloed systems for SUD treatment, including EHRs for patient care, data systems tracking admissions to SUD treatment facilities, and those used for monitoring prescription drugs. Although having these varying systems adds complexity in the ability to monitor programs and patient outcomes, DH had the advantage of having these databases within the same healthcare system for the same patient population. Other organizations that rely on data from disparate systems may face additional challenges in having comprehensive data to inform knowledge and ultimately change care practices.

Strategic focus, leadership and investment across all services, community partnerships, and establishing and maintaining core administrative leadership, support, and technical data expertise have all been critical to the success of the CAM LHS model. Data infrastructure and workflows have allowed for integrated, patient‐centered care across all touchpoints in the system. CAM leaders across multiple strategic areas act as a resource for supporting individuals across the organization to carry out quality improvement projects and research aiming to improve healthcare practices and programs specific to SUD. A consistent line of sight on sustainability and financial stability has allowed CAM to adapt to and harness opportunities associated with the evolving landscape of SUDs and funding opportunities.

CAMs' successes so far have created the foundation for future strategic direction. CAM is expanding the hub‐and‐spoke model to include clinical workflows to link patients into and out of adolescent withdrawal management and to specialty obstetrics support for persons who have SUD during the prenatal and postpartum period. Future plans also include expansion of tools used for OUD to identify other SUDs and polysubstance use and testing workflows to optimize patient‐centered care and operational efficiency.

Ongoing challenges include issues around the increasing mental health, medical, and social needs of patients with SUD; data integration and sharing; recruiting and retaining staff; policy changes; continued engagement at all levels across the system; maintaining financial stability to support current and expanding demands; and optimizing dissemination and communication. In addition, changes to 42 CFR Part II effective January 1, 2025 ⁴⁶ will relax rules to align more closely with the Health Insurance Portability and Accountability Act (HIPAA) for the use, disclosure, and redisclosure of SUD treatment records. This will greatly expand the ability to share records for the purposes of treatment, payment, or healthcare operations. While this change is welcomed, it continues to demonstrate the need for adaptability in sharing data across disparate systems with community and referral partners.

Despite these challenges, CAM has been able to establish a process to continuously assess and refine opportunities for improvement and incorporate external and internal evidence to ensure equitable, patient‐centered, high‐quality care for persons with SUD. Mapping the system components of CAM to the LHS cycle can serve as a roadmap for other programs and healthcare systems in their LHS journey.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Bacon E, Podewils LJ, Bender B, et al. A learning health system model for addressing substance use: Denver Health Center for Addiction Medicine. Learn Health Sys. 2025;9(3):e70003. doi: 10.1002/lrh2.70003