Abstract What is NIATx? What is NIATx 200? Intervention Timeline

#154 Translating Ideas into Practice: Implementation of a Process Improvement
Randomized Control Trial for 200 Drug Treatment Agencies
200
The Network for the
Improvement of Addiction Treatment
J. H. Ford, A. Quanbeck, A. Pulvermacher, D.H. Gustafson, D. McCarty, K. Hoffman, J. McConnell
Abstract
Authors
J. H. Ford , A. Quanbeck , A. Pulvermacher , D.H. Gustafson , D. McCarty ,
K. Hoffman2, J. McConnell2
1
What is NIATx 200?
What is NIATx?
1
1
1
2
Institutions
1. University of Wisconsin – Madison, WI, USA.
2. Oregon Health & Science University, Portland, OR, USA.
Aims
This study presents the protocol for a five-year randomized control trial designed
to evaluate the cost-effectiveness of combinations of four process improvement
(PI) interventions designed to improve client access to and retention in treatment
across 200 agencies in five U.S. states. Research questions were:
(1) What challenges arose when transforming research into practice
for each intervention?
NIATx is a pioneering improvement collaborative that works with
substance abuse and behavioral health organizations across the
country. We teach organizations to use a simple process improvement model
developed by industrial engineers at the University of Wisconsin – Madison.
NIATx helps behavioral health providers improve access to and retention in
treatment for all of their clients. We do this primarily by helping treatment
providers use process improvement methods to achieve the four NIATx aims:
s
2EDUCEWAITINGTIMES
s
2EDUCENOSHOWS
s
)NCREASEADMISSIONS
s
NIATx 200 is a five-year, randomized trial designed to evaluate the
cost-effectiveness of field-tested process improvement strategies for
addiction treatment providers. The study aims to help determine which
combinations of collaborative services produce the greatest improvement for the
economic investment.
Providers in the NIATx 200 study commit to an 18-month engagement in which they
participate in the services provided to their randomly assigned study group. At the
same time, they test promising practices, collect and report their data, and provide
staff responses to questionnaires and surveys.
The participating treatment providers, with support from their single state agency
(SSA), focus their efforts in three areas—providing same day therapeutic services,
increasing client participation, and increasing admissions.
)NCREASECONTINUATION
Over the last four years, agencies working with NIATx have realized significant
improvements in the reduction of waiting times and no-shows and in the increase
of admissions and treatment continuation. Since its inception, NIATx has worked
with over 400 treatment agencies to help them improve access to and retention
in treatment.
NIATx 200 is a partnership between NIATx, the National Institute on Drug Abuse,
and more than 200 treatment providers and state agencies in Massachusetts,
Michigan, New York, Oregon, and Washington.
The initial protocol outlined four process improvement interventions – learning
sessions, interest circle calls, coaching, and a web site. Using an anthropological
framework for action research, the evolution of each intervention was tracked to
examine key changes over time.
Study Interventions
1. Low-level coaching (one site visit + monthly one-hour calls)
2. High-level coaching (three site visits + monthly one-hour calls)
3. Learning sessions
4. Interest circle calls
5. Web site
Available Study Conditions
Grant Application
Before Recruitment
During Recruitment
Six Study Arms
Five Study Arms
Four Study Arms
1) Learning Sessions +
Interest Circle Calls +
High-level Coaching + Web site
1) Interest Circle Calls + Web site
1) Interest Circle Calls
2) Learning Sessions + Web site
2) Learning Sessions
2) Learning Sessions +
Interest Circle Calls +
Web site
3) Interest Circle Calls +
Web site
3) Coaching + Web site
4) Interest Circle Calls +
Learning Sessions +
Coaching + Web site
5) Web only (Control Group)
4) High-level Coaching +
Interest Circle Calls +
Web site
(2) How were intervention arms modified to ensure study integrity?
Methods
Evolution of the Treatment Arms
3) Coaching
4) Interest Circle Calls +
Learning Sessions +
Coaching
All study arms have access
to the NIATx 200 web site.
5) Low-level Coaching +
Interest Circle Calls + Web site
Intervention Timeline
Results
Learning sessions and interest circle calls employ process improvement coaches
to teach participating agencies to use customer experiences to identify key intake
issues, to select an area for change, and to pick a promising practice for
implementation. Coaches use a one-day site visit and bimonthly calls to teach
process improvement tools and change ideas for improving client access to and
retention in treatment. The web site provides step-by-step instructions for
implementing key promising practices designed to improve client access to and
retention in treatment. Preliminary learning session results show an average
attendance of 41 persons. Learning session evaluations support the hypothesis
(=0.05) that no differences exist across the evaluation scores for 56 out of 63
possible comparisons.
Conclusions
This study provides a snapshot of the randomized control trial designed to test the
cost-effectiveness of process improvement techniques in 200 drug treatment
agencies. It highlights the importance of listening and reviewing the study design
while developing study interventions for clinical trials involving real-world
organizations.
Support
This project is funded by the National Institute on Drug Abuse (5 R01 DA020832-02).
Learning Objective Road Map Framework
Activities
Objectives
Competencies
Beginning and Learning
First Six Months
NIATx fundamentals
Learn the NIATx way
Learn the basics of PDSA cycles and the NIATx way
Review the walk-through baseline data
Share findings and compare to the baseline data
Learn how to conduct the walk-through and recognize the emotional and leadership
aspects of the walk-through
Using and Mastering
Second Six Months
Review and deepen understanding of NIATx fundamentals
Move toward NIATx as a way of doing business
Demonstrate understanding of and an ability to produce the business case
Present Change Projects and what has worked, barriers,
and successes
Master rapid-cycle change projects (PDSAs)
Produce two strong examples of PDSAs conducted in the organization and display
examples in storyboards
Build the NIATx fundamentals into the fabric of
the organization
Make the business case part of the strategic and
leadership culture of the organization
Identify and effectively use strategies for building NIATx in organizational
infrastructure and culture
Spreading excitement about process improvement
and NIATx
Understand the need for refreshment and excitement
in process improvement
Demonstrate continuous use of refreshment and excitement strategies
Strengthening and Sustaining
Third Six Months
CPDD Transl Ideas Poster.indd 1
Acknowledgments
NIATx 200 is funded by the National Institute on Drug Abuse (5 R01
DA020832-02).
We’d like to thank the five single state agencies and more than 200 addiction
treatment providers in the states of Michigan, Massachusetts, New York, Oregon
and Washington, as well as the NIATx 200 team and consultants.
5/22/08 8:45:40 AM