Clinical Trial: Evaluating Improvement Strategies in Addiction Treatment

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title: Randomized Control Trial (RCT) Evaluating Improvement Strategies in Addiction Treatment

Brief 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).

Detailed Summary: This cluster-RCT randomly assign 201 treatment agencies in 5 states to four experimental arms. The agencies were randomized to an intervention for 18 months with a 9 month sustainability period. The study aimed to: 1) Determine whether a state-based strategy can (with NIATx support) can lead mainstream treatment agencies to implement and sustain process changes that improve the study's primary outcomes: time to treatment, annual clinic admissions, and continuation in treatment; and 2) Evaluate the effectiveness and cost of the services making up NIATx. This study aims to create a practical model for improving efficiency and effectiveness of addiction treatment.
Sponsor: University of Wisconsin, Madison

Current Primary Outcome:

  • Change in Average Waiting Time From First Contact to Treatment [ Time Frame: Baseline and 15 months ]

    The average length of time in days it takes from when a patient first calls for help to the time a patient was able to meet a clinician. In this quality improvement study, changes in this measure over time are reported. Estimates of improvement show the average days of improvement per month based on a best linear unbiased predictor estimate for each site.

    Note: this study has three primary outcomes. The number of participants analyzed varies for each outcome. The (higher) number of clinics shown in the flow diagram results because clinics may have been analyzed on a subset of the three primary outcomes (e.g., analyzed for waiting time and continuation, but not for annual number of new patients). To be considered "analyzed" in the flow diagram, a clinic must have been included in at least one primary outcomes analysis.

  • Change in Annual Number of Patient Admissions [ Time Frame: 48 months (2 year baseline period and 2 year post-intervention period) ]

    We aimed to increase clinics' treatment capacity in this quality improvement study. Capacity was measured by counting clinics' annual number of patient admissions. We monitored changes in admission counts, per clinic, in a pre-post analysis. Changes in the natural logarithm of annual admissions are presented, which approximates the average percentage change (year-to-year) in the number of new patient admissions per clinic.

    Note: this study has three primary outcomes. The n

    Original Primary Outcome:

    • Time to treatment from first contact, rates of assessment no-shows, admissions to treatment, and continuation in treatment. [ Time Frame: monthly ]
    • no-show rates to assessment [ Time Frame: monthly ]
    • rates of admissions to treatment [ Time Frame: monthly ]
    • continuation in treatment [ Time Frame: monthly ]


    Current Secondary Outcome: Cost of Group [ Time Frame: Baseline and 18 months ]

    The goal of the economic analysis was to estimate costs of each group for governmental authorities who might organize improvement collaboratives. We collected the cost of personnel (state employees, NIATx employees, coaches and consultants), data management, buildings and facilities, lodging, travel, telephone calls and miscellaneous costs. Costs were categorized as group specific (such as hotel costs for the learning sessions group) or non-group-specific, which included state-incurred costs for outreach, data management and infrastructure, encouraging participation and administration. Cost data were collected three times during the study period and aggregated to create a total cost estimate. Figures reported below represent costs at the arm/group level (costs were not assessed at the organizational level). Measure type is "Number."


    Original Secondary Outcome:

    • Collaborative cost: cost-effective combinations of services to disseminate key access and retention improvements [ Time Frame: annually ]
    • Contribution to margin [Gross Revenues-Variable Cost adjusted for changes in reimbursement and salary]: process improvement may enhance an organization's financial condition. [ Time Frame: annually ]
    • Voluntary employee turnover: high turnover rates increase training costs, create dangerous discontinuities in care, impair organizational memory about improvement processes and thus, the capacity to make more improvements. [ Time Frame: annually ]
    • Readiness for change and sustainability: process improvement may improve an organization's environment for making and sustaining change. [ Time Frame: every 9 months ]
    • Treatment completion rate: clients getting into treatment quicker stay longer and have better treatment completion rates, especially when outcomes are defined as reducing the number of exacerbations. [ Time Frame: monthly ]
    • Arms vs. Innovations: some collaborative services may be more effective in promoting some kinds of innovations (e.g., Coaching may be needed to adopt open access, but Interest Circle Calls may be sufficient support for reminder calls). [ Time Frame: every 9 months ]


    Information By: University of Wisconsin, Madison

    Dates:
    Date Received: July 6, 2009
    Date Started: October 2006
    Date Completion:
    Last Updated: July 29, 2013
    Last Verified: July 2013