Evaluating Improvement Strategies in Addiction Treatment (NIATx 200)

University of Wisconsin (UW)

Status and phase: Completed; Phase 3

Conditions: Addiction

Treatments: Other: Coaching; Other: Learning Session; Other: Website; Other: Interest Circle Calls

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT00934141

5R01DA020832-05 (U.S. NIH Grant/Contract)

DA020832

Details and patient eligibility

About

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).

Full description

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.

Enrollment: 201 patients

Sex: All

Volunteers: Accepts Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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201 participants in 4 patient groups

Interest Circle Call + Website

Experimental group

Description:

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.

Treatment:

Other: Website

Other: Interest Circle Calls

Coaching + Website

Experimental group

Description:

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.

Treatment:

Other: Website

Other: Coaching

Full: LS, Coaching, ICC, Website

Experimental group

Description:

Learning Session, Coaching, Interest Circle Calls, Website, see descriptions above

Treatment:

Other: Website

Other: Interest Circle Calls

Other: Coaching

Other: Learning Session

Learning Session + Website

Experimental group

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.

Treatment:

Other: Website

Other: Learning Session