Evaluating Improvement Strategies in Addiction Treatment
Condition: Addiction
MeSH terms: Behavior, Addictive
Intervention: Learning Session; Interest Circle Calls; Coaching; Website
Intervention description: Learning Sessions occur bi-annually as change teams convene to learn and gather support from each other and outside experts who offer advice on how best to adopt the innovations and learn about new directions for the collaborative (e.g., the need to create business cases for improvements). Learning Sessions and Interest Circles (see below) have similar objectives-to help agencies learn and gather support from each other and from outside experts.; Interest Circles are monthly teleconferences where agency change leaders discuss change-related issues and progress. Circles address how to improve timeliness, continuation, admissions, dropouts and transitions. They also address specialty topics (e.g., programs for women, adolescents). Participants discuss successes, failures, and challenges, and get advice and assignments for their improvement plans. Meeting summaries appear on the Web site. Interest Circles are inexpensive, but are they are sufficient? Should Interest Circles prove effective, they would provide a low-cost, convenient diffusion approach; Coaching assigns an expert in process improvement to work with an agency to make, sustain, and spread process improvement efforts. Consultations focus on executive directors, change leaders and improvement teams. Coaches help agencies address key issues, but also broker relationships with other agencies, offer process improvement training, and promote the innovations to make and how to make them. Coaching takes place during site visits, monthly phone conferences, and via email.; The NIATx Web site features resources central to improvement. The site includes: 1) a catalog of change ideas and case studies; 2) a toolbox providing just-in-time training on topics such as conducting a walk-through and key innovations; 3) on-line tools to assess organizational (or project) readiness for and ability to sustain change; 4) electronic communication services to ask questions of experts, and participate in peer discussion groups; 5) links to relevant process improvement Web sites; and 6) a secure portion for treatment agencies to report and track progress. Hence, our control group will have access to the entire website.
Phase: Phase 3
Study type: Interventional
Primary purpose: Health Services Research
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 201.0
Sex: All
Healthy volunteers: Accepts Healthy Volunteers
Keywords: Organizational change; process improvement; addiction treatment; cost effectiveness study

Summary:

      Addiction treatment is often characterized by long delays between first contact and treatment
      as well as high no-show and drop out rates leading to unused capacity in apparently full
      agencies. Patients do not get needed care and agency financial stability is threatened. The
      Network for Improvement of Addiction Treatment (NIATx) began as a high-intensity improvement
      collaborative of 39 addiction treatment agencies distributed across 25 states. NIATx
      substantially improved time to treatment and continuation in treatment by making improvements
      to organizational processes (such as first contact, intake and assessment, engagement, level
      of care transitions, paperwork, social support, outreach, and scheduling) in preliminary
      studies. While the results are very encouraging, they have, by intent, been obtained from a
      select group of agencies using a high-cost combination of services. A more practical
      diffusion model is needed to spread process improvements across the spectrum of treatment
      agencies. This study is a cluster-randomized trial to test the effectiveness and cost of less
      expensive combinations of the services that make up the NIATx collaborative (interest
      circles, coach calls, coach visits and learning sessions).
    

Eligibility criteria:

        Inclusion Criteria:

          -  at least 60 admissions/year

          -  provide outpatient and intensive outpatient levels of care (as defined by ASAM)

          -  provide or use detox services provided by others

          -  have tax-exempt or government status or rely on public funding (e.g., block grants,
             Medicare, Medicaid, local government, private philanthropy) for at least 50% of their
             budget

          -  have adopted no more than two of the planned interventions

        Exclusion Criteria:

          -  are current NIATx members