0BPROJECT SUMMARY/ABSTRACT Opioid overdose deaths reached the highest level ever in 2021. Medications to treat opioid use disorder (MOUD) can markedly reduce overdose risks when taken for long enough. More than 650,000 people receive MOUD in Opioid Treatment Programs (OTPs) annually. Unfortunately, on average, less than half of patients stay in opioid use disorder (OUD) treatment for the recommended minimum 1 year of time. OTP retention and outcome quality measures (i.e., “audit and feedback”) may improve treatment retention rates and outcomes. Quality measures can also help monitor the effect of new OTP reimbursement and regulatory policies. Eventually, OTP quality measures could be incorporated into the Federal government’s public facing healthcare provider Compare website. However, research is needed to determine how to most effectively create and disseminate OTP quality measures. The literature on audit and feedback points to three features that influence the probability that measures will result in improved quality: (1) the characteristics of the measures and benchmarks, (2) the knowledge that providers have about how to improve the measures, and (3) the control that providers have over the factors that matter to improve the measure. This study will test approaches for optimizing each of these factors. NIDA RFA-DA-23-046 is supporting multi-project OUD Quality Measurement and Management Research Centers that pair researchers with partner organizations that have an OUD quality measurement and management strategy that research could advance. RTI International, University of California Los Angeles, and Beacon Health Connecticut are the research organizations leading this study. They are partnering with two organizations that need to develop an effective OTP quality measurement and management system: BayMark Health Services and the Los Angeles County Division of Substance Abuse Prevention and Control. The team is implementing three inter-related research projects with the following overall aims: Overall Aim 1. Create and psychometrically test OTP measures of retention, overdose emergency department visits, overdose hospitalizations, and mortality with benchmarks and toolkits describing how OTPs can improve retention. Overall Aim 2. Test the effect of the giving OTPs quality measures and information on how to improve retention (a retention toolkit), with and without quality improvement training, by conducting a clustered randomized trial that assigns OTPs to receive either: (1) retention and outcome measures with the toolkit; or (2) retention and outcome meaures with the toolkit as well as quality improvement (QI) training (i.e., NIATx) (Arm 2), or (3) treatment as usual (Control Arm). Overall Aim 3. Test the effect of aligning OTP-level and LA county population-level OUD measures on retention and outcomes in LA county relative to other counties in California.