Abstract

Isolated efforts, small sample sizes and interventions with limited duration hamper research on quality improvement for drug abuse treatment. An initiative that includes nearly 50 drug abuse treatment programs provides an opportunity to examine the longitudinal application of process improvement and to assess organizational ability to sustain process improvements. The Robert Wood Johnson Foundation's Paths to Recovery (Paths) and the Center for Substance Abuse Treatment's Strengthening Treatment Access and Retention (STAR) are coordinated initiatives using process improvement strategies to enhance access to care and improve retention in care. This proposal addresses a major issue-sustainability and generalization of process improvement after program participation is finished. Participating sites will continue to report access and retention data for 18 months and continue to participate in quarterly interviews and site visits. A validated model of organizational change (the Organizational Change Manager) guides the analysis.
The specific aim (i.e., Assess stability of change, record generalization beyond the initial focus on access and retention, and identify organizational factors that contribute to sutainability and generalization during an 18 month period following termination of program support) tests 3 hypotheses: H1: Gains achieved during the project (reduced days to admission, increased admissions, improved continuation, and reduced no-shows) will be maintained at a stable plateau during 18 months of follow-up. H2: The use of process improvement will continue and generalize to other treatment units within the organization and to other treatment processes within the participating center. H3: Six OCM dimensions (change leader is strong, executive leadership is involved, staff support change, external ideas, environment is supportive, and tension for change) will be associated with a greater likelihood of sustained use of process improvement and sustained gains in access and retention.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA018282-05
Application #
7631235
Study Section
Special Emphasis Panel (ZDA1-TXL-Q (04))
Program Officer
Hilton, Thomas
Project Start
2005-06-01
Project End
2011-05-31
Budget Start
2009-06-01
Budget End
2011-05-31
Support Year
5
Fiscal Year
2009
Total Cost
$541,254
Indirect Cost

  Institution

Name
Oregon Health and Science University
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
096997515
City
Portland
State
OR
Country
United States
Zip Code
97239

  Publications

Choi, Dongseok; Hoffman, Kim A; Kim, Mi-Ok et al. (2013) A high-resolution analysis of process improvement: use of quantile regression for wait time. Health Serv Res 48:333-47
Quanbeck, Andrew R; Madden, Lynn; Edmundson, Eldon et al. (2012) A business case for quality improvement in addiction treatment: evidence from the NIATx collaborative. J Behav Health Serv Res 39:91-100
Hoffman, Kim A; Green, Carla A; Ford 2nd, James H et al. (2012) Improving quality of care in substance abuse treatment using five key process improvement principles. J Behav Health Serv Res 39:234-44
Hoffman, Kim A; Ford, James H; Tillotson, Carrie J et al. (2011) Days to treatment and early retention among patients in treatment for alcohol and drug disorders. Addict Behav 36:643-7
McCarty, Dennis; Chandler, Redonna K (2009) Understanding the importance of organizational and system variables on addiction treatment services within criminal justice settings. Drug Alcohol Depend 103 Suppl 1:S91-3
McCarty, Dennis; Gustafson, David; Capoccia, Victor A et al. (2009) Improving care for the treatment of alcohol and drug disorders. J Behav Health Serv Res 36:52-60
McCarty, Dennis; Roman, Paul M; Sorensen, James et al. (2009) Health Services Research for Drug and Alcohol Treatment and Prevention. J Drug Issues 39:197-208
Wisdom, Jennifer P; Hoffman, Kim; Rechberger, Elke et al. (2009) Women-focused treatment agencies and process improvement: Strategies to increase client engagement. Women Ther 32:69-87
Fussell, Holly E; Kunkel, Lynn E; Lewy, Colleen S et al. (2008) Using a standardized patient walk-through to improve implementation of clinical trials. J Subst Abuse Treat 35:470-5
Hoffman, Kim A; Ford 2nd, James H; Choi, Dongseok et al. (2008) Replication and sustainability of improved access and retention within the Network for the Improvement of Addiction Treatment. Drug Alcohol Depend 98:63-9

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