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) is a high-intensity improvement collaborative of 39 addiction treatment agencies distributed across 25 states. Over the past three years, NIATx has substantially improved time to treatment, no-show rates, admission to, 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). 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 is a resubmission of an application to conduct a randomized trial to test the effectiveness and cost of less expensive combinations of the services that make up the NIATx collaborative (Web site, interest circles, coach calls, coach visits and learning sessions). This RCT will randomly assign 240 treatment agencies in 5 states to six experimental arms, including a control group. It will have two primary aims: 1) Determine whether a state-based strategy can (with NIATx support) lead mainstream treatment agencies to implement and sustain process changes that improve the study's Primary Outcomes: time to treatment, no-show rates, admissions to, and continuation in treatment;and 2) Evaluate the effectiveness and cost of five combinations of the services making up NIATx. Secondary outcomes include impact of the study arms on treatment completion, status of innovations attempted, impact of study arms on particular innovations, employee turnover, contribution to margin, organization-wide readiness to implement and sustain process innovations. This study should create a practical model for improving efficiency and effectiveness of addiction treatment.
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