Improving existing treatment by understanding brain processes underlying behaviour

Jodie Trafton conducts research, program evaluation, and policy implementation, and develops decision support tools to support clinical operations at the U.S. Veterans Health Administration (VHA) and Stanford Medical School. Jodie’s research focuses on understanding and improving behavior around opioid drugs, from prevention and treatment of opioid use disorders to safe and effective patient use and provider prescribing of prescription opioid medications. Her research has spanned basic neuroscience on the mechanisms of action of opioids to implementation interventions to improve use of risk mitigation strategies for opioid prescribing and improve access to substance use disorder treatment. As examples, Jodie led development of a point-of-care computerized decision support system that mines information from a patient’s electronic medical record to provide personalized recommendations to improve use of guideline recommended clinical practices around opioid prescribing. Her studies of use of this tool in clinical practice found that even this highly tailored and automated information and reminder system alone was not sufficient to motivate primary care clinicians to engage in recommended but potentially uncomfortable and time-consuming interactions with patients regarding pain and opioid use behaviors. Jodie subsequently undertook research and clinical initiatives to make clinicians and health care systems more prepared and motivated to address pain and opioid use disorders. She developed performance measures to assess health care system level implementation of opioid guideline recommendations and effective mental health and substance use disorder treatments, which have been used nationally within the Veterans Health Administration to prioritize and evaluate quality improvement efforts to reduce opioid-related risk. Based on 2010 models where Dr. Trafton examined relationships between suicide attempt and overdose events and use of guideline recommended practices for opioid prescribing, VHA prioritized quality improvement efforts around use of urine drug screening for reducing risk of serious adverse events when patients are prescribed opioid medications. Recent evaluation has shown that this use of urine drug screening in VHA’s 141 health care systems has increased over the last 4 years and higher facility rates are associated with lower suicide attempt and overdose risk at the patient level. Likewise, she has worked collaboratively with mental health and pharmacy leadership to develop technical assistance programs to implement key practices, including national mentoring and targeted funding for effective opioid agonist treatment, a site visit and quality improvement action planning program for mental health treatment implementation, academic detailing and high-risk case review programs for opioid safety, standardized kits, case-finding tools, and education to encourage opioid education and naloxone distribution for patients at risk of opioid overdose, and staffing models to ensure adequate access to mental health and substance use disorder treatment within VHA health care systems. Subsequent to these programs, VHA’s 141 health care systems out-paced non-VHA health care in increasing availability and use of buprenorphine-based opioid agonist treatment, expanding availability of intensive outpatient substance use disorder treatment, and making naloxone rescue kits available to at-risk patients nationally. Support for these efforts from SSA has facilitated Dr. Trafton’s work and connected her with research and policy makers internationally to expand use of these tools, measures, and implementation strategies to other populations.