PROJECT SUMMARY The opioid overdose crisis necessitates adapting and implementing evidence-based interventions for opioid use disorder (OUD) in primary care settings to increase access to evidence-based treatment. Buprenorphine treatment for OUD in primary care is highly effective, patient-centered, and recent changes have removed bar- riers to prescribing, yet retention in these settings remains low. Measurement-based OUD treatment, a guide- line-recommended best practice, involves collecting patient outcome data to monitor treatment response and guide changes, thereby improving patient outcomes and retention. Patient-reported outcome measures (PROMs) are validated instruments that assess patients' response to treatment and focus on their experience, making them suitable for measurement-based OUD treatment. Despite the potential benefits, implementing and maintaining measurement-based OUD treatment using PROMs in primary care settings is lacking. This proposal aims to develop and pilot test the “Patient Reported Outcome Measures to Individualize Treat- ment And Improve ReteNtion” (ReTAIN) program intervention package to capture PROMs in Federally-Quali- fied Health Center (FQHC)-based OUD treatment. FQHCs are increasingly caring for patients with OUD who come from underserved communities that are disproportionality impacted by the overdose crisis. Utilizing the Pragmatic, Robust Implementation and Sustainability Model (PRISM) and user-centered design strategies, we will accomplish the following Aims: Aim 1) describe contextual factors and identify intervention package adap- tations and ideal PROM characteristics; Aim 2) Apply user-centered design strategies to refine the ReTAIN program intervention package adaptations; and Aim 3) Conduct a pilot randomized control trial to assess the ReTAIN program's initial effectiveness over 6-months, feasibility, and acceptability. Dr. Jarratt Pytell's research and training plan aligns with the national Overdose Prevention Strategy and NIDA's strategic plan to study the implementation of evidence-based treatments in real-world settings and bridge the evidence-to-practice gap. Dr. Pytell's long-term career goal is to become an independent clinician- investigator leading addiction medicine implementation research in primary care. As a fellowship-trained addic- tion medicine specialist providing primary care-based addiction treatment in an FQHC, Dr. Pytell seeks to lev- erage the HEAL Initiative K23 award to build on his experience and receive training in implementation science, user-centered design, and pragmatic trials. Dr. Pytell will receive guidance from an internationally recognized team of mentors and advisors with expertise in implementation science, pragmatic trials, user-centered design, and patient-centered decision-making who have a proven track record of independent funding and mentoring. Completion of the research and training aims will result in a definitive trial evaluating the effectiveness of m...