. 2019 Aug 1;14:25. doi: 10.1186/s13722-019-0154-4

Table 1.

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

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

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

RAMP rural access to MAT in Pennsylvania, MAT medication assisted treatment