# C-DIAS RP3: Scaling-out app-based treatments: a multi-level strategy to promote equity across primary care patients with substance use

> **NIH NIH P50** · STANFORD UNIVERSITY · 2022 · $570,499

## Abstract

C-DIAS RESEARCH PROJECT 3: PROJECT SUMMARY/ABSTRACT
At the SUSTAIN phase, C-DIAS Research Project 3 addresses a critical scientific and public health gap: How
can we improve equity when offering digital treatments to patients with substance use disorders (SUDs) in
primary care? A wide range of effective digital treatments —app or web-based interventions—for SUDs and
comorbid conditions are available for use in primary care, and many have been evaluated in diverse
populations. Digital treatments for SUDs could potentially reduce inequities, as they: 1) have the potential to
reach more people by reducing access barriers; 2) can circumvent SUD stigma; and 3) allow patients to initiate
interventions from the comfort and privacy of home. At the same time, digital treatments may also magnify
inequities due to factors stemming from the “digital divide.” We will rigorously evaluate an implementation
strategy to “scale-out” digital treatments to disadvantaged populations as an approach to potentially improve
equity in digital care for people with SUDs, and as a model for how to ethically sustain digital treatments in
real-world healthcare. Prior pragmatic trials found that evidence-based practices and other initiatives are hard
to sustain without leadership and clinic buy-in, so our multi-level study design and analytic plan focuses on
these issues. Our delivery system partners in Kaiser Permanente Washington are committed to collaborating
with us to study multi-level strategies for scaling-out existing digital treatments in 32 primary care clinics in
Washington State to address expected equity challenges. All clinics will receive a 3-part system-level set of
implementation strategies that are suitable for primary care: 1) system-wide audit and feedback; 2) patient
stories from members of disadvantaged populations; and, 3) engaging key stakeholders in problem solving to
reduce barriers to the use of digital treatments among disadvantaged populations. To test a clinic-level
implementation strategy, a subset of 12 clinics will be randomized to receive external facilitation or to a control
condition (no facilitation) in a 1:1 parallel-groups design. Equity outcomes will be assessed by comparing reach
across subgroups of patients defined by key social determinants (e.g., race/ethnicity). Specific Aims are to: 1)
estimate the impact of a multi-level implementation strategy (system- and clinic-level) in increasing equity in
the reach of digital treatments among patients with SUD in primary care clinics; and 2) describe the costs of
and adherence to the implementation strategies, and examine how contextual determinants can impact equity
in implementation and patient outcomes. Research Project 3 leverages a bi-directional relationship with C-
DIAS, demonstrated in part by: 1) standardized measures of implementation context, outcomes and procedural
details of strategies; 2) PI (Glass)’s role on the C-DIAS Research Core; 3) a close network of collaboration and
ment...

## Key facts

- **NIH application ID:** 10493961
- **Project number:** 1P50DA054072-01A1
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** Joseph Edwin Glass
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $570,499
- **Award type:** 1
- **Project period:** 2022-08-01 → 2027-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10493961

## Citation

> US National Institutes of Health, RePORTER application 10493961, C-DIAS RP3: Scaling-out app-based treatments: a multi-level strategy to promote equity across primary care patients with substance use (1P50DA054072-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10493961. Licensed CC0.

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