Hannah Cheng

All Publications

• Implementation Outcomes of Low Threshold Care for Persons with Opioid Use Disorders. Journal of general internal medicine Kepner, W., Cheng, H., Franz, B., Jakubowski, A., Lowenstein, M., Rosenberg-Carlson, E., McGovern, M. 2026

  Abstract

  Low-threshold care (LTC) practices for prescribing medication for opioid use disorder (MOUD) systematically remove treatment barriers, increasing access to lifesaving MOUD. Despite its promise, LTC operationalization is unclear and heterogeneous, and lacks standardized measures.To develop and test LTC composite measures as useful predictors of implementation outcomes.This prospective cohort study was embedded within a California state MOUD practice change collaborative involving safety-net primary care clinics.Data were collected at baseline, midpoint, and endpoint from 20 clinics.Clinics received a multifaceted implementation-support package designed to improve MOUD delivery.Four LTC scales (LTC12, LTC5, LTC3, LTC2) were developed and tested using team-reported one to five Likert items. Implementation outcomes included Reach (monthly new MOUD patients), Retention (monthly new MOUD patients engaged in treatment after initial diagnosis), and Adoption (active MOUD prescribers). Analyses included repeated-measures ANOVA for LTC change and Poisson GEE for incidence rate ratios, adjusting for panel size, medically underserved area designation, and time.Clinics showed significant improvements in LTC scores over time. The LTC12 scale demonstrated the largest effect size (d = 1.18, p = .003). A 1-point increase on the LTC3 index was associated with a 37% increase in new patients receiving MOUD (IRR = 1.37, 95% CI [1.01,1.86], p = .047). A 1-point increase on LTC2 was associated with a 24% increase (IRR = 1.24, 95% CI [1.01,1.53], p = 0.049).Our findings provide preliminary empirical support for a replicable measure of LTC in primary care settings. Longer scales showed greater internal consistency and sensitivity to change, while brief scales predicted patient reach outcomes. These measures may be useful for clinical programs to gauge the extent to which their MOUD services align with low threshold care principles and to guide quality improvement efforts. Future research should validate these scales in larger, diverse cohorts and test causal impact.

  View details for DOI 10.1007/s11606-025-10112-9

  View details for PubMedID 41535639

  View details for PubMedCentralID 7075734

• A mixed methods analysis of clinics' perspectives on community factors influencing access to medications for opioid use disorder. Addiction science & clinical practice Jaros, S., Magid, M. A., Cheng, H., Gassman, M., Garneau, H. C., Ford Ii, J. H., McGovern, M. 2026

  Abstract

  How communities impact patients taking medication for opioid use disorder (MOUD) has not been well-studied. Understanding the experience of MOUD providers allows us to better understand and measure community attitudes toward MOUD and identify strategies to increase support.We deployed an explanatory sequential mixed methods design to analyze baseline data from the SITT-MAT clinical trial. Our quantitative instrument was seven Likert-scale questions asking about community attitudes toward MOUD analyzed through means, standard deviations, and principal components. The qualitative data were semi-structured interviews coded inductively using a thematic analysis. The quantitative and qualitative results were integrated to produce the findings.We surveyed staff from 20 specialty care addiction and primary care clinics in Washington state as part of a larger clinical trial. Eleven sites were also selected to complete an interview. Participating clinics were primarily specialty addiction treatment programs (N = 14, 70%), outpatient (N = 17, 85%), and/or located in urban areas (N = 12, 81%). In the survey, participants most agreed that relationships with other clinics help provide better care and least agreed that system-level policies mandate MOUD. In interviews, some staff described how reliable relationships with other clinics improved employee morale and patient care while others added that loose collaborations had fallen apart, leaving patients without the care they need. Interviewees described how insurer and government policies have made it difficult to expand their MOUD offerings. The interview data also indicated community attitudes on MOUD have improved over time with some clinics using direct outreach to garner support for MOUD.Our results suggest that building local peer networks of clinics can improve staff morale and patient care in areas where community support for MOUD is low. Though system-level barriers to MOUD have been reduced, there is still room for improvement in simplifying reimbursements and funding for clinics looking to improve care. Our findings encourage further measurement of community attitudes toward MOUD and development of implementation strategies to build networks that support patients and clinics alike.The data for this study is from the Stagewise Implementation-to-Target - Medications for Addiction Treatment clinical trial registered as NCT05343793 on April 25, 2022.

  View details for DOI 10.1186/s13722-025-00643-1

  View details for PubMedID 41508111

• Implementation outcomes included in NIDA clinical trials network (CTN) studies: A systematic review of studies conducted over 20 years. Journal of substance use and addiction treatment Gonzalez, S. T., Horigian, V. E., Cheng, H., Hagedorn, H. J., Shmueli-Blumberg, D., Campbell, C. I., Lin, C., Rogers, E., Baloh, J., Hilton, R., Vena, A., McNeely, J., Glass, J. E. 2025: 209811

  Abstract

  The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) has supported clinical trials of substance use disorder (SUD) interventions for 25 years. This review describes the use of implementation outcomes across CTN trials, characterizes outcomes included, and identifies gaps and potential opportunities to strengthen implementation research within the CTN and the field of SUD treatment.This systematic review included active or completed studies listed on the CTN Dissemination Library webpage as of August 18, 2021, and approved by the CTN for development by January 1, 2022. Study summaries and protocols were reviewed if they: 1) measured at least one implementation outcome and 2) examined a practice change, intervention, or process. Extracted data elements included trial design characteristics, implementation frameworks, and outcome assessment domains informed by the RE-AIM and Proctor Implementation Outcomes Frameworks.114 protocols were considered, 42 full-text protocols were screened, and 25 were included for data extraction. Start dates of trials spanned a 20-year period (2004-2024) with latter studies including more implementation outcomes. Fidelity (n = 29) and reach/penetration (n = 26) were the most included implementation outcomes. Equity was not identified in any protocols. Methods of defining, capturing, and evaluating outcomes data varied across trials and outcomes.The inclusion of implementation outcomes increased over time, perhaps reflecting a growing emphasis on implementation research. Incorporating measures of equity could advance knowledge about differential receipt or effectiveness of SUD interventions. Future research should seek to improve the consistency and comprehensiveness in descriptions of implementation science elements.

  View details for DOI 10.1016/j.josat.2025.209811

  View details for PubMedID 41135832

• A pragmatic approach to estimating the cost to deliver and participate in implementation strategies. Implementation science : IS Cheng, H., Abdel Magid, M., McGovern, M. P., Ford, J. H., Manja, V., Chokron Garneau, H., Wagner, T. H. 2025; 20 (1): 44

  Abstract

  Implementation costs-the combined costs of delivering expert support and participating in an implementation endeavor-are often omitted from economic evaluations. When included, delivery and participation costs are usually combined, even though these may be covered by different funders. We propose a pragmatic micro-costing approach that separates the delivery and participation costs as well as outlines practical considerations for measuring implementation costs.Sixty-four specialty addiction treatment programs and primary care clinics participated in a stepped sequence of implementation strategies focused on improving access to buprenorphine and naltrexone for persons with opioid use disorder. The implementation strategies deployed were: audit and feedback (A&F), a two-day workshop, internal facilitation, and external facilitation. Our micro-costing approach separately measured the cost to deliver and participate in implementation strategies, as demonstrated through the A&F case example, which was the first of four implementation strategies deployed. We applied the following practical considerations to maximize the precision and accuracy of cost data: 1) Balance the frequency and length of cost survey, 2) Cost tracking training, 3) Regular survey reminders, 4) Tailor cost surveys, 5) Perform frequent cost data validation, 6) Iterative evaluation and refinement.In A&F, the implementation setup cost was $32,266, and the annual recurring costs were $4,231 per clinic. While the majority of the setup cost (99%) can be attributed to A&F delivery, over half of the annual recurring costs (63%) were attributed to clinic participation in A&F.This micro-costing approach appears both pragmatic and meaningful. By understanding the total cost implications of implementation, decision-makers can better select the most suitable strategy based on the context, goals, and budget constraints to efficiently optimize the pace and desired outcome of an implementation endeavor.The trial protocol is registered with ClinicalTrials.gov (NCT05343793).

  View details for DOI 10.1186/s13012-025-01459-y

  View details for PubMedID 41107954

  View details for PubMedCentralID 8796347

• Three trajectories of implementation of medications for opioid use disorder in primary care. Addiction science & clinical practice Kepner, W., Vest, N., Risner, E., Cheng, H., Hurley, B., Snyder, H., McGovern, M. 2025; 20 (1): 69

  View details for DOI 10.1186/s13722-025-00600-y

  View details for PubMedID 40887602

  View details for PubMedCentralID 11060908

• Longitudinal evaluation examining implementation and sustainment of an opioid overdose education and naloxone distribution among veterans who are unstably housed. Implementation science communications Javier, S. J., Midboe, A. M., Perez, T., Kyrish, A. M., Golding, M., Cheng, H., Bruemmer, K., Bogicevic, D. 2025; 6 (1): 83

  Abstract

  Rigorous implementation evaluations are needed to understand factors that influence implementation and sustainability of evidence-based interventions across contexts. In this study, we conducted a longitudinal, multi-methods, multi-site evaluation guided by the Dynamic Sustainability Framework (DSF). This evaluation focused on implementation of the Homeless Overdose Prevention-Expansion (HOPE), an opioid overdose education and naloxone distribution (OEND) trial in a permanent supportive housing program in the Veterans Health Administration (VA).We used a multi-methods study design comprised of qualitative interviews and completion of a three-item survey. Semi-structured interviews were completed with Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) staff, site leaders, and site prescribers at four VA healthcare systems in the Western United States. Interviews were conducted at three timepoints: pre-implementation, implementation, and sustainment. Site staff also completed the Provider REport of Sustainment Scale (PRESS) during sustainment to provide more context for our interpretation of results. We analyzed interview data using rapid directed content analysis guided by DSF constructs and analyzed PRESS using descriptive statistics.We conducted 96 interviews with 67 unique individuals. Six determinants influenced the reciprocal fit of the intervention, practice setting, and ecological system across our study: (1) OEND for unstably housed veterans; (2) Staffing shortages and competing demands; (3) Training-related concerns; (4) Supervisor and leadership buy-in at site; (5) Social workers' scope of practice; and (6) Cultural climate and saliency of OEND initiatives. Both planned and unplanned implementation strategies were optimized by different actors (i.e., the implementation team, target practitioners) in response to evolving determinants at all three DSF levels to maintain overall fit. Approaches taken to optimize fit depended on longitudinal data collection and evaluation of determinants at each phase.Our approach is a theoretically driven example of capturing important determinants of implementation and sustainment of OEND in a high-risk setting. Despite the uniqueness of our study setting, our approach is generalizable and has the potential to promote sustainability of other public health interventions.

  View details for DOI 10.1186/s43058-025-00764-3

  View details for PubMedID 40770670

  View details for PubMedCentralID PMC12330058

• Correction to: Development and validation of a pragmatic measure of context at the organizational level: the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS). Implementation science communications Garneau, H. C., Cheng, H., Kim, J., Abdel Magid, M., Chin-Purcell, L., McGovern, M. 2025; 6 (1): 81

  View details for DOI 10.1186/s43058-025-00773-2

  View details for PubMedID 40760676

• Medication Approaches for Patients With Opioid Use Disorders: Differences Between Primary Care Clinics and Specialty Addiction Treatment Programs. Journal of addiction medicine Franz, B., Ford, J. H., Cheng, H., Garneau, H. C., Mount, K., McGovern, M. P. 2025

  Abstract

  Efforts to increase access to highly effective medications for opioid use disorder (MOUD) have largely focused on primary care. Ironically, many specialty addiction treatment programs have yet to adopt MOUD. To bring MOUD access to scale, researchers need to better understand medication practices across these 2 major portals of care for patients with opioid use disorder (OUD). In this study, our team examined baseline prescribing data from 62 primary care clinics and specialty addiction treatment programs (SATPs) participating in MOUD implementation endeavors across 2 states.Our primary outcomes included MOUD prescribing practices, measured by the integrating medications for addiction treatment (IMAT), which includes 7 dimensions of guideline-adherent delivery of MOUD, and an additional subscale on low threshold care. We also measured reach of MOUD to patients and adoption as the number of current MOUD prescribers. Secondary outcomes included community characteristics surrounding each type of organization. Descriptive statistics and bivariate tests explored differences between primary and specialty care settings.SATPs had lower MOUD capacity and implementation as compared with primary care clinics. Specialty settings also had lower organizational support for low threshold prescribing. SATPs were located in counties with higher overdose rates, higher unemployment, fewer MOUD prescribers, and with more opioid prescriptions per capita.SATPs have lower MOUD implementation capacity than their primary care counterparts and are more likely to be in counties with greater OUD-related needs, economic distress, and fewer treatment resources. Selecting more precise implementation support strategies for SATPs that are late adopters of MOUD is a major need.

  View details for DOI 10.1097/ADM.0000000000001556

  View details for PubMedID 40747925

• A phase II pilot randomized controlled trial of an integrated stepped collaborative care intervention for patients awaiting kidney transplantation (CARES-transplant). Journal of behavioral medicine Kallem, C. J., Tevar, A. A., Bradley, T., Jackson, H., Haggerty, D., Cheng, H., Pathak, R., Wang, Y., Carney, M., Gardner, S., Deshpande, A., Jhamb, M., Steel, J. L. 2025

  Abstract

  Patients awaiting kidney transplant carry a high symptom burden which has been associated with waitlist inactivation, mortality, and poorer post-transplant outcomes. However, few studies have tested the effects of symptom management interventions in this population. This Phase II study aimed to (1) test the feasibility and preliminary efficacy of an integrated stepped collaborative care intervention (CARES-Transplant) on patient-reported outcomes and unplanned healthcare utilization, and (2) explore treatment effects on family caregiver outcomes. The study was a randomized controlled trial designed to test the efficacy of CARES-Transplant versus standard of care (SC). Patients completed a battery of questionnaires at baseline and 3-months including the Center for Epidemiological Studies-Depression (CES-D) scale, Brief Pain Inventory, and Functional Assessment of Chronic Illness Therapy-Fatigue, and Rand Short Form-36. Caregivers were administered the CES-D, Perceived Stress Scale, and Pittsburgh Sleep Quality Index at baseline and 3-months. Patient unplanned health care utilization was assessed over the course of one-year post-randomization. Nineteen patients (mean age = 65 ± 6 years, 74% male, 90% White) and 8 caregivers (mean age = 61.3 ± 8.1 years, 100% female and white) were randomized. Reductions in pain intensity and interference were observed for CARES (- 0.2) while patients in the SC arm had increases in pain intensity and interference (+ 1.3, ES = 0.30). Similar trends were observed for fatigue (CARES = - 0.4 versus SC = - 7.7, ES = 0.41) and depressive symptoms (CARES = - 2.0 versus SC =  + 2.33, ES = 0.56). Lower rates of transplant-related complications (CARES mean = 1 versus SC = 3), fewer emergency room visits (CARES = 1.0 versus SC = 2.67) and 90-day readmissions (CARES = 0% versus SC = 28.6%) were also observed. A moderate to large effect size was observed for changes on caregiver reported depressive symptoms (CARES =  + 0.5 versus SC =  + 3.3, ES = 0.55) and sleep quality (CARES = - 1.5 versus SC =  + 0.07, ES = 0.34). The findings of this pilot study warrant a Phase III trial to test the efficacy of CARES-Transplant.Clinical trials registration number ClinicalTrials.gov NCT02938351.

  View details for DOI 10.1007/s10865-025-00574-x

  View details for PubMedID 40643797

• Development and validation of a pragmatic measure of context at the organizational level: The Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS). Implementation science communications Chokron Garneau, H., Cheng, H., Kim, J., Abdel Magid, M., Chin-Purcell, L., McGovern, M. 2025; 6 (1): 50

  Abstract

  Successful implementation and sustainment of interventions is heavily influenced by context. Yet the complexity and dynamic nature of context make it challenging to connect and translate findings across implementation efforts. Existing methods to assess context are typically qualitative, limiting potential replicability and utility. Existing quantitative measures and the siloed nature of implementation efforts limit possibilities for data poolinXg and harmonization. The Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS) was developed to be a pragmatic, quantitative, organizational-level assessment of contextual factors. The intention is to characterize context with a measure that may enhance replication and reproducibility of findings beyond single implementation case studies. Here, we present the development and validation of the IFASIS.A literature review was conducted to identify major concepts of established theories and frameworks to be retained. IFASIS data were examined in relation to implementation outcomes gathered from two studies. Psychometric validation efforts included content and face validity, reliability, internal consistency, and predictive and concurrent validity. Predictive validity was evaluated using generalized estimating equations (GEE) for longitudinal data on three implementation outcomes: reach, effectiveness, and implementation quality. Pragmatic properties were also evaluated.The IFASIS is a 27-item, team-based, instrument that quantitatively operationalizes context. Two rating scales capture current state and importance of each item to an organization. It demonstrated strong reliability, internal consistency, and predictive and concurrent validity. There were significant associations between higher IFASIS scores and improved implementation outcomes. A one-unit increase in total IFASIS score corresponded to a 160% increase in the number of patients receiving a medication (reach). IFASIS domains of factors outside the organization, factors within the organization, and factors about the intervention, and subscales of organizational readiness, community support, and recipient needs and values, were predictive of successful implementation outcomes. IFASIS scores were also significantly associated with measures of implementation quality.The IFASIS is a psychometrically and pragmatically valid instrument to assess contextual factors in implementation endeavors. Its ability to predict key implementation outcomes and facilitate data pooling across projects suggests it can play an important role in advancing the field.

  View details for DOI 10.1186/s43058-025-00726-9

  View details for PubMedID 40281591

  View details for PubMedCentralID PMC12032751

• Patient and provider perspectives of personal health record use: a multisite qualitative study in HIV care settings. Translational behavioral medicine Conti, J., Fix, G. M., Javier, S. J., Cheng, H., Perez, T., Dunlap, S., McInnes, D. K., Midboe, A. M. 2023

  Abstract

  Use of tethered personal health records (PHRs) can streamline care, reduce unnecessary care utilization, and improve health outcomes for people living with human immunodeficiency virus (HIV). Providers play a role in influencing patients' decision to adopt and use PHRs. To explore patient and provider acceptance and use of PHRs in an HIV care setting. We used a qualitative study design guided by the Unified Theory of Acceptance and Use of Technology. Participants included providers of HIV care, patients living with HIV, and PHR coordinating and support staff in the Veterans Health Administration (VA). Interviews were analyzed using directed content analysis. We interviewed providers (n = 41), patients living with HIV (n = 60), and PHR coordinating and support staff (n = 16) at six VA Medical Centers between June and December 2019. Providers perceived PHR use could enhance care continuity, appointment efficiency, and patient engagement. Yet, some expressed concerns that patient PHR use would increase provider workload and detract from clinical care. Concerns about poor PHR interoperability with existing clinical tools further eroded acceptance and use of PHRs. PHR use can enhance care for patients with HIV and other complex, chronic conditions. Negative provider attitudes toward PHRs may impact providers' encouragement of use among patients, consequently limiting patient uptake. Multipronged interventions at the individual, institutional, and system level are needed to enhance PHR engagement among both providers and patients.

  View details for DOI 10.1093/tbm/ibac118

  View details for PubMedID 37084300

• A scoping review of implementation of health-focused interventions in vulnerable populations. Translational behavioral medicine Daniels, S. I., Cheng, H., Gray, C., Kim, B., Stave, C. D., Midboe, A. M. 2022; 12 (9): 935-944

  Abstract

  Vulnerable populations face significant challenges in getting the healthcare they need. A growing body of implementation science literature has examined factors, including facilitators and barriers, relevant to accessing healthcare in these populations. The purpose of this scoping review was to identify themes relevant for improving implementation of healthcare practices and programs for vulnerable populations. This scoping review relied on the methodological framework set forth by Arksey and O'Malley, and the Consolidated Framework for Implementation Research (CFIR) to evaluate and structure our findings. A framework analytic approach was used to code studies. Of the five CFIR Domains, the Inner Setting and Outer Setting were the most frequently examined in the 81 studies included. Themes that were pertinent to each domain are as follows-Inner Setting: organizational culture, leadership engagement, and integration of the intervention; Outer Setting: networks, external policies, and patients' needs and resources; Characteristics of the Individual: knowledge and beliefs about the intervention, self-efficacy, as well as stigma (i.e., other attributes); Intervention Characteristics: complexities with staffing, cost, and adaptations; and Process: staff and patient engagement, planning, and ongoing reflection and evaluation. Key themes, including barriers and facilitators, are highlighted here as relevant to implementation of practices for vulnerable populations. These findings can inform tailoring of implementation strategies and health policies for vulnerable populations, thereby supporting more equitable healthcare.

  View details for DOI 10.1093/tbm/ibac025

  View details for PubMedID 36205470

• Stepped implementation-to-target: a study protocol of an adaptive trial to expand access to addiction medications. Implementation science : IS Ford, J. H., Cheng, H., Gassman, M., Fontaine, H., Garneau, H. C., Keith, R., Michael, E., McGovern, M. P. 2022; 17 (1): 64

  Abstract

  In response to the US opioid epidemic, significant national campaigns have been launched to expand access to `opioid use disorder (MOUD). While adoption has increased in general medical care settings, specialty addiction programs have lagged in both reach and adoption. Elevating the quality of implementation strategy, research requires more precise methods in tailoring strategies rather than a one-size-fits-all-approach, documenting participant engagement and fidelity to the delivery of the strategy, and conducting an economic analysis to inform decision making and policy. Research has yet to incorporate all three of these recommendations to address the challenges of implementing and sustaining MOUD in specialty addiction programs.This project seeks to recruit 72 specialty addiction programs in partnership with the Washington State Health Care Authority and employs a measurement-based stepped implementation-to-target approach within an adaptive trial design. Programs will be exposed to a sequence of implementation strategies of increasing intensity and cost: (1) enhanced monitoring and feedback (EMF), (2) 2-day workshop, and then, if outcome targets are not achieved, randomization to either internal facilitation or external facilitation. The study has three aims: (1) evaluate the sequential impact of implementation strategies on target outcomes, (2) examine contextual moderators and mediators of outcomes in response to the strategies, and (3) document and model costs per implementation strategy. Target outcomes are organized by the RE-AIM framework and the Addiction Care Cascade.This implementation project includes elements of a sequential multiple assignment randomized trial (SMART) design and a criterion-based design. An innovative and efficient approach, participating programs only receive the implementation strategies they need to achieve target outcomes. Findings have the potential to inform implementation research and provide key decision-makers with evidence on how to address the opioid epidemic at a systems level.This trial was registered at ClinicalTrials.gov (NCT05343793) on April 25, 2022.

  View details for DOI 10.1186/s13012-022-01239-y

  View details for PubMedID 36175963

• Expanding access to medications for opioid use disorder in primary care clinics: an evaluation of common implementation strategies and outcomes. Implementation science communications Cheng, H., McGovern, M. P., Garneau, H. C., Hurley, B., Fisher, T., Copeland, M., Almirall, D. 2022; 3 (1): 72

  Abstract

  BACKGROUND: To combat the opioid epidemic in the USA, unprecedented federal funding has been directed to states and territories to expand access to prevention, overdose rescue, and medications for opioid use disorder (MOUD). Similar to other states, California rapidly allocated these funds to increase reach and adoption of MOUD in safety-net, primary care settings such as Federally Qualified Health Centers. Typical of current real-world implementation endeavors, a package of four implementation strategies was offered to all clinics. The present study examines (i) the pre-post effect of the package of strategies, (ii) whether/how this effect differed between new (start-up) versus more established (scale-up) MOUD practices, and (iii) the effect of clinic engagement with each of the four implementation strategies.METHODS: Forty-one primary care clinics were offered access to four implementation strategies: (1) Enhanced Monitoring and Feedback, (2) Learning Collaboratives, (3) External Facilitation, and (4) Didactic Webinars. Using linear mixed effects models, RE-AIM guided outcomes of reach, adoption, and implementation quality were assessed at baseline and at 9 months follow-up.RESULTS: Of the 41 clinics, 25 (61%) were at MOUD start-up and 16 (39%) were at scale-up phases. Pre-post difference was observed for the primary outcome of percent of patient prescribed MOUD (reach) (betatime = 3.99; 0.73 to 7.26; p = 0.02). The largest magnitude of change occurred in implementation quality (ES = 0.68; 95% CI = 0.66 to 0.70). Baseline MOUD capability moderated the change in reach (start-ups 22.60%, 95% CI = 16.05 to 29.15; scale-ups -4.63%, 95% CI = -7.87 to -1.38). Improvement in adoption and implementation quality were moderately associated with early prescriber engagement in Learning Collaboratives (adoption: ES = 0.61; 95% CI = 0.25 to 0.96; implementation quality: ES = 0.55; 95% CI = 0.41 to 0.69). Improvement in adoption was also associated with early prescriber engagement in Didactic Webinars (adoption: ES = 0.61; 95% CI = 0.20 to 1.05).CONCLUSIONS: Rather than providing an all-clinics-get-all-components package of implementation strategies, these data suggest that it may be more efficient and effective to tailor the provision of implementation strategies based on the needs of clinic. Future implementation endeavors could benefit from (i) greater precision in the provision of implementation strategies based on contextual determinants, and (ii) the inclusion of strategies targeting engagement.

  View details for DOI 10.1186/s43058-022-00306-1

  View details for PubMedID 35794653

• Social Support is Associated with Survival in Patients Diagnosed with Gastrointestinal Cancer JOURNAL OF GASTROINTESTINAL CANCER Bou-Samra, P., Scott, P., Cheng, H., Kallem, C., Pathak, R., Geller, D. A., Marsh, W., Wang, Y., Antoni, M., Penedo, F., Tsung, A., Steel, J. L. 2021

  Abstract

  The aim of this study was to examine the link between psychological, behavioral, and social factors and survival in patients diagnosed with gastrointestinal cancer.A cohort of gastrointestinal cancer patients were administered a battery of questionnaires that assessed trauma, depression, social support, sleep, diet, exercise, quality of life, tobacco and alcohol use, pain, and fatigue. Analyses included Pearson's correlations, analyses of variance, Kaplan Meier survival, and Cox regression analyses.Of the 568 patients, the majority were male (57.9%) and Caucasian (91.9%), with a mean age of 61 (S.D. = 10.7). The level of perceived social support was comparable to patients with other medical conditions. Sociodemographic predictors of social support included the number of years of education (r = 0.109, p = 0.05), marital status (F(6,387) = 5.465, p ≤ 0.001), and whether the patients' income met the family's basic needs (F(1,377) = 25.531, p < 0.001). Univariate analyses revealed that older age (p < 0.001), male gender (p = 0.007), being black (p = 0.005), diagnosis of hepatocellular carcinoma (p = 0.046), higher body mass index (p = 0.022), larger tumor size (p = 0.032), initial treatment including chemotherapy rather than surgery (p < 0.001), and lower level of perceived social support (p = 0.037) were associated with poorer survival. Using multivariate Cox regression and adjusting for all factors found to be significant in univariate survival analyses, older age (p = 0.024) and lower perceived social support (HR = 0.441, 95% CI = 0.233, 0.833; p = 0.012) were the factors that remained significantly associated with poorer survival.There are several biological and psychosocial factors that predict cancer mortality. Social support appears to be a robust factor affecting mortality in gastrointestinal cancer patients.

  View details for DOI 10.1007/s12029-021-00741-8

  View details for Web of Science ID 000720805000001

  View details for PubMedID 34806126

• A COST-EFFECTIVENESS ANALYSIS OF GESTATIONAL CARRIERS FOR INFERTILE WOMEN OF VERY ADVANCED MATERNAL AGE Bavan, B., Cheng, H., Phibbs, C., Leonard, S., Lyell, D., Murugappan, G. ELSEVIER SCIENCE INC. 2021: E43-E44

  View details for Web of Science ID 000680508800064

• The Integrating Medications for Addiction Treatment (IMAT) Index: A measure of capability at the organizational level. Journal of substance abuse treatment Chokron Garneau, H., Hurley, B., Fisher, T., Newman, S., Copeland, M., Caton, L., Cheng, H., McGovern, M. P. 2021; 126: 108395

  Abstract

  Primary care provides a treatment opportunity for many persons with opioid use disorder (OUD). The push to integrate and expand reach and adoption of medications for opioid use disorder (MOUD) within primary care has been a major focus of national, state and health systems endeavors. To guide high capability MOUD practice, we introduce the Integrating Medications for Addiction Treatment (IMAT) Index. The research team has developed IMAT along similar lines to other organizational measures of integrated services capability. We present the development and validation of the measure, and suggest its applicability for systems and organizations, as well as for process improvement and implementation research. Forty-one primary care clinics completed the IMAT at two time points: baseline and 9-month follow-up. Findings support the IMAT Index as psychometrically acceptable and pragmatically useful. It has good internal consistency, as well as concurrent and predictive validity. Changes in IMAT scores between baseline and follow-up significantly predicted increases in proportion of patients on MOUD. The IMAT has the potential to support both scientific and public health care activities.

  View details for DOI 10.1016/j.jsat.2021.108395

  View details for PubMedID 34116810

• A mapping review of NIDA-funded implementation research studies on treatments for opioid and/or stimulant use disorders. Drug and alcohol dependence Cheng, H., Chokron Garneau, H., Yuan, M., McGovern, M. P. 2021; 225: 108767

  Abstract

  BACKGROUND: The biomedical research enterprise invests greatly in discovery-oriented science, but significantly less in how to implement the most effective of these innovations. The return on investment in public health benefit is therefore low. In the context of substance-related overdose epidemics, presently with opioids and/or stimulants, the gap in proven treatments and routine access is amplified. Implementation research is designed to deepen understanding of how best to scale-up proven treatments. This study assessed how implementation research has been deployed in the National Institute on Drug Abuse (NIDA) efforts to address the opioid and stimulant epidemics.METHODS: Adapting a procedure developed to categorize HIV-focused research, a four-stage systematic mapping review of NIDA-funded R01, R34, R61, and U studies pertaining to opioids and/or stimulants funded between 2015 and 2019 was performed. Abstracts were retrieved using NIH Research Portfolio Online Reporting Tools. Key study characteristics were abstracted and coded by two independent reviewers.RESULTS: An initial search across NIH institutes yielded 5963 relevant records. Of these, 666 (11.2 %) were NIDA funded. One-hundred-and-thirty-four (20.1 %) of the 666 studies were opioid and/or stimulant treatment related. Of these, 28 (4.2 %) were categorized as Implementation Preparation (IP), and 16 (2.4 %) were categorized as Implementation Research (IR). Over the five-year period, there was a gradual increase in both IP and IR studies.CONCLUSIONS: Implementation research is a small but slowly growing component of the federal portfolio to address substance-related public health issues. To more effectively respond to contemporary overdose epidemics, implementation research must take on an even more significant role.

  View details for DOI 10.1016/j.drugalcdep.2021.108767

  View details for PubMedID 34052689

• COVID-19 Adaptations in the Care of Patients with Opioid Use Disorder: a Survey of California Primary Care Clinics. Journal of general internal medicine Caton, L. n., Cheng, H. n., Garneau, H. C., Fisher, T. n., Harris-Mills, B. n., Hurley, B. n., Newman, S. n., McGovern, M. P. 2021

  Abstract

  With the onset of the COVID-19 crisis, many federal agencies relaxed policies regulating opioid use disorder treatment. The impact of these changes has been minimally documented. The abrupt nature of these shifts provides a naturalistic opportunity to examine adaptations for opioid use disorder treatment in primary care.To examine change in medical and behavioral health appointment frequency, visit type, and management of patients with opioid use disorder in response to COVID-19.A 14-item survey queried primary care practices that were enrolled in a medications for opioid use disorder statewide expansion project. Survey content focused on changes in service delivery because of COVID-19. The survey was open for 18 days.We surveyed 338 clinicians from 57 primary care clinics located in California, including federally qualified health centers and look-alikes. A representative from all 57 clinics (100%) and 118 staff (34.8% of all staff clinicians) participated in the survey.The survey consisted of seven dimensions of practice: medical visits, behavioral health visits, medication management, urine drug screenings, workflow, perceived patient demand, and staff experience.A total of 52 of 57 (91.2%) primary care clinics reported practice adaptations in response to COVID-19 regulatory changes. Many clinics indicated that both medical (40.4%) and behavioral health visits (53.8%) were now exclusively virtual. Two-thirds (65.4%) of clinics reported increased duration of buprenorphine prescriptions and reduced urine drug screenings (67.3%). The majority (56.1%) of clinics experienced an increase in patient demand for behavioral health services. Over half (56.2%) of clinics described having an easier or unchanged experience retaining patients in care.Many adaptations in the primary care approach to patients with opioid use disorder may be temporary reactions to COVID-19. Further evaluation of the impact of these adaptations on patient outcomes is needed to determine whether changes should be maintained post-COVID-19.

  View details for DOI 10.1007/s11606-020-06436-3

  View details for PubMedID 33511572

• Sleep problems in advanced cancer patients and their caregivers: Who is disturbing whom? JOURNAL OF BEHAVIORAL MEDICINE Chen, Q., Terhorst, L., Lowery-Allison, A., Cheng, H., Tsung, A., Layshock, M., Buysse, D. J., Geller, D. A., Marsh, J. W., Wang, Y., Steel, J. L. 2020; 43 (4): 614-622

  Abstract

  Background The aims of the study were to understand sleep problems and their effects in advanced cancer patients and spousal and intimate partner caregivers and to examine the directionality of the link between patients' and caregivers' sleep problems. Methods Fifty-four advanced cancer patients and their spousal and intimate partners were administered a battery of questionnaires that included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Studies at the patients' cancer diagnosis and at 2, 4, and 6 months after diagnosis. Results Patients' and caregivers' sleep duration was significantly related. Using cross-lagged panel analyses, caregivers' sleep quality significantly predicted patients' sleep quality and patients' sleep quality subsequently predicted caregivers' sleep quality. Patients' sleep latency significantly was found to significantly predict caregivers' sleep latency. Conclusion Patients diagnosed with cancer and their intimate partners have poor sleep quality and sleep patterns are related.

  View details for DOI 10.1007/s10865-019-00088-3

  View details for Web of Science ID 000549600000010

  View details for PubMedID 31435891

  View details for PubMedCentralID PMC7035154

• Implementation of health-focused interventions in vulnerable populations: protocol for a scoping review. BMJ open Midboe, A. M., Gray, C., Cheng, H., Okwara, L., Gale, R. C. 2020; 10 (7): e036937

  Abstract

  INTRODUCTION: Vulnerable populations face significant challenges in navigating the care continuum, ranging from diagnosis of illness to linkage and retention in healthcare. Understanding how best to move individuals within these vulnerable populations across the care continuum is critical to improving their health. A large body of literature has focused on evaluation of implementation of various health-focused interventions in this population. However, we do not fully understand the unique challenges to implementing healthcare interventions for vulnerable populations. This study aims to examine the literature describing implementation of health service interventions among vulnerable populations to identify how implementations using the Consolidated Framework for Implementation Research are adapted. Findings from this review will be useful to implementation scientists to identify gaps in evidence and for adapting similar interventions in unique settings.METHODS AND ANALYSIS: This study protocol outlines a scoping review of the peer-reviewed and grey literature, using established approaches delineated in Arksey and O'Malley's scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist. Search strategies will be developed and refined by a medical librarian in collaboration with the research team. Searches will be conducted in electronic databases (CINAHL, Cochrane, PsychINFO, PubMed, Social Services Abstracts, Web of Science, Google and Google Scholar) and limited to studies published between 1 August 2009 and 1 June 2020. Additionally, hand searches will be conducted in three relevant journals-Implementation Science, Systematic Reviews and BMJ Open. English-language studies and reports meeting inclusion criteria will be screened independently by two reviewers and the final list will be abstracted and charted in duplicate.ETHICS AND DISSEMINATION: This is a review of the literature; ethics approval is not indicated. We will disseminate findings from this study in peer-reviewed journals as well as presentations to relevant stakeholders and conferences.

  View details for DOI 10.1136/bmjopen-2020-036937

  View details for PubMedID 32690530

• Socioeconomic disparities of depressive symptoms and cytokines in hepatocellular carcinoma PSYCHO-ONCOLOGY Cheng, H. H., Kamarck, T. W., Gianaros, P. J., Roecklein, K. A., Vanegas, Y., Tsung, A., Geller, D. A., Marsh, J. W., Ahmed, N. S., Steel, J. L. 2019; 28 (8): 1624-1632

  Abstract

  To examine the associations among socioeconomic factors, depressive symptoms, and cytokines in patients diagnosed with hepatocellular carcinoma (HCC).A total of 266 patients diagnosed with HCC were administered a battery of questionnaires including a sociodemographic questionnaire and the Center for Epidemiologic StudiesDepression (CES-D) scale. Blood samples were collected to assess serum levels of cytokines using Luminex. Descriptive statistics, Mann-Whitney U, Kruskal-Wallis, linear regression, and Bonferroni corrections were performed to test the hypotheses.Of the 266 patients, 24% reported depressive symptoms in the clinical range (CES-D ≥ 22). Females had higher CES-D score than males (Mann-Whitney U = 7135, P = .014, Padj  = .028). Being unemployed/disabled (Kruskal-Wallis = 14.732, P = .001, Padj  = .005) was found to be associated with higher depressive symptoms in males but not in females. Serum level of IL-2 (Kruskal-Wallis = 17.261, P = .001, Padj  = .005) were found to be negatively associated with education level. Gender (β = .177, P = .035), income (β = -.252, P = .004), whether the patient's income met their basic needs (β = .180, P = .035), and IL-1β (β = -.165, P = .045) independently predicted depressive symptoms and together explained 19.4% of variance associated with depressive symptoms.Sociodemographic and socioeconomic factors were predictive of inflammation and depressive symptoms. Recommendations include the development of gender-targeted interventions for patients diagnosed with HCC who have low socioeconomic status (SES) and may suffer from depressive symptoms.

  View details for DOI 10.1002/pon.5127

  View details for Web of Science ID 000478101300004

  View details for PubMedID 31119824

  View details for PubMedCentralID PMC7241307

• Psychosocial and behavioral pathways of metabolic syndrome in cancer caregivers PSYCHO-ONCOLOGY Steel, J. L., Cheng, H., Pathak, R., Wang, Y., Miceli, J., Hecht, C., Haggerty, D., Peddada, S., Geller, D. A., Marsh, W., Antoni, M., Jones, R., Kamarck, T., Tsung, A. 2019; 28 (8): 1735-1742

  Abstract

  Cancer caregivers are at increased risk for cardiovascular disease (CVD) and mortality. The aims of this study were to examine psychosocial and behavioral predictors of metabolic syndrome, an intermediate endpoint of CVD.Cancer caregivers were administered a battery of questionnaires assessing sociodemographic characteristics, depressive symptoms, perceived stress, caregiver quality of life, sleep, physical activity, alcohol and tobacco use, social support, relationship quality, and loneliness. Metabolic syndrome was defined using the American Heart Association guidelines and the National Cholesterol Education Program's Adult Treatment Panel (ATP) III, which includes the presence of at least three of the following abnormalities: blood pressure, glucose, abdominal girth, high-density lipoprotein (HDL), and triglycerides.Of the 104 caregivers, 77% were female, 94% were Caucasian, and the mean age was 59.5 (SD = 12.8). Of the 104 caregivers, 35.6% reported depressive symptoms in the clinical range of the Center for Epidemiologic Studies-Depression (CES-D) and 69.2% reported Perceived Stress Scale scores at least one standard deviation above the general population norms. A total of 16.3% of caregivers currently used tobacco, 28.8% consumed alcohol, and 26.7% were overweight (BMI = 25-29.9) and 48.5% were obese (BMI ≥ 30). Forty-nine percent of the caregivers met the criteria for metabolic syndrome. After age, gender, and race were adjusted, the following remained as significant predictors of metabolic syndrome: low levels of caregiver quality of life (Odds Ratio (OR) = 1.067; 95% CI, 1.019-1.117; P = .006), high levels of hostility (OR = 1.142; 95% CI, 1.030-1.267; P = .012), and current alcohol use (OR = 4.193; 95% CI, 1.174-14.978; P = .027).Development of interventions to reduce the risk of metabolic syndrome in cancer caregivers is recommended.

  View details for DOI 10.1002/pon.5147

  View details for Web of Science ID 000478101300018

  View details for PubMedID 31206896

  View details for PubMedCentralID PMC6768062

• Illness perceptions and perceived stress in patients with advanced gastrointestinal cancer PSYCHO-ONCOLOGY Miceli, J., Geller, D., Tsung, A., Hecht, C., Wang, Y., Pathak, R., Cheng, H., Marsh, W., Antoni, M., Penedo, F., Burke, L., Ell, K., Shen, S., Steel, J. 2019; 28 (7): 1513-1519

  Abstract

  According to the Common-Sense Model of Self-Regulation, when faced with a health threat, we make cognitive and emotional assumptions about the illness. The aims of this study were to (a) examine the role of sociodemographic and disease-specific factors on illness perception and perceived stress and (b) test the association between perceived stress and illness perception in participants diagnosed with gastrointestinal cancer.Participants completed a battery of questionnaires including a Sociodemographic and Disease-Specific Questionnaire, the Illness Perception Questionnaire, Brief Version (Brief-IPQ), and the Perceived Stress Scale (PSS-14). Descriptive statistics, Pearson correlations, analysis of variance (ANOVA), and linear regression were performed to test the hypotheses.Of the 627 participants, the mean age was 62 years (SD = 11); the majority were male (63.3%) and Caucasian (90.9%). Younger (F3,625 = 5.80, P < .01) and divorced or never married participants reported higher levels of perceived stress when compared with older and married participants (F4,618 = 3.52, P < .01). Younger participants (18-74 years old) reported more negative illness perceptions than older participants (75 years and older) (F3,511 = 4.08, P < .01). A weak, positive relationship between perceived stress and illness perceptions was observed (r = 0.22, P < .01), and illness perceptions predicted 36.1% of the variance of perceived stress.Our findings suggest that participants who negatively perceived their illness experienced greater levels of perceived stress. Interventions that aim to adjust patients' illness perceptions in order to facilitate a reduction of stress and improvement in quality of life are needed.

  View details for DOI 10.1002/pon.5108

  View details for Web of Science ID 000474293000019

  View details for PubMedID 31090125

  View details for PubMedCentralID PMC6610754

• Broad-spectrum non-nucleoside inhibitors of human herpesviruses ANTIVIRAL RESEARCH McClain, L., Zhi, Y., Cheng, H., Ghosh, A., Piazza, P., Yee, M. B., Kumar, S., Milosevic, J., Bloom, D. C., Arav-Boger, R., Kinchington, P. R., Yolken, R., Nimgaonkar, V., D'Aiuto, L. 2015; 121: 16-23

  Abstract

  Herpesvirus infections cause considerable morbidity and mortality through lifelong recurrent cycles of lytic and latent infection in several tissues, including the human nervous system. Acyclovir (ACV) and its prodrug, the current antivirals of choice for herpes simplex virus (HSV) and, to some extent, varicella zoster virus (VZV) infections are nucleoside analogues that inhibit viral DNA replication. Rising viral resistance and the need for more effective second-line drugs have motivated searches for additional antiviral agents, particularly non-nucleoside based agents. We evaluated the antiviral activity of five compounds with predicted lysosomotropic activity using conventional and human induced pluripotent stem cell-derived neuronal (iPSC-neurons) cultures. Their potency and toxicity were compared with ACV and the lysosomotropic agents chloroquine and bafilomycin A1. Out of five compounds tested, micromolar concentrations of 30N12, 16F19, and 4F17 showed antiviral activity comparable to ACV (50μM) during lytic herpes simplex virus type 1 (HSV-1) infections, reduced viral DNA copy number, and reduced selected HSV-1 protein levels. These compounds also inhibited the reactivation of 'quiescent' HSV-1 infection established in iPSC-neurons, but did not inhibit viral entry into host cells. The same compounds had greater potency than ACV against lytic VZV infection; they also inhibited replication of human cytomegalovirus. The anti-herpetic effects of these non-nucleoside agents merit further evaluation in vivo.

  View details for DOI 10.1016/j.antiviral.2015.06.005

  View details for Web of Science ID 000360511500003

  View details for PubMedID 26079681

  View details for PubMedCentralID PMC4536133