Performance Measurement Within NIATX Dennis McCarty Oregon Health & Science University Using Performance and Outcome Measures to Improve Treatment Los Angeles, CAMarch 21, 2008

March 21, 2008NIATx Measures2 Paths to Recovery STAR State Pilot Project Self-Initiated Members NIATx Participants STAR – State Initiative Advancing Recovery NIATx 200

March 21, 2008NIATx Measures3 Reduce Wait Times (days to trt) Reduce No-Shows (% kept appts) Increase Admissions (# admits) Increase Continuation Rates (% returning for next visit) NIATx Aims (and Measures)

March 21, 2008NIATx Measures4 Acadia: Admissions and Revenues Increased

March 21, 2008NIATx Measures5 NIATX National Results: Days to Treatment Declined 39% (McCarty et al, 2007)

March 21, 2008NIATx Measures6 Access Improvements Sustained

March 21, 2008NIATx Measures7 Retention in Care Increased (Session 1 to 2 = 18%; Session 1 to 3 = 17%; 1 to 4 = 11% ns) (McCarty, et al, 2007)

March 21, 2008NIATx Measures8 Retention Improvements Sustained

March 21, 2008NIATx Measures9 Second Cohort Reduced Days to Treatment 38% (30.7 to 19.4 days)

March 21, 2008NIATx Measures10 Second Cohort Increased Retention 13% session 1 to 2; 12% session 1 to 3; 18% session 1 to 4

March 21, 2008NIATx Measures11 IOM Reports on Crossing the Quality Chasm

March 21, 2008NIATx Measures12 IOM Six Dimensions of Quality  Safe  Effectively  Patient-Centered  Timely  Efficient  Equitable

March 21, 2008NIATx Measures13 Safe Care Measures & Examples  Care improves patient safety Reduced HIV and HCV risks Reduced criminal involvement Reduced risk of suicide  Acadia Hospital use of restraint: # of incidents and patients restrained mechanical restraint: -36% physical restraint: -44%  Prairie Ridge enhanced building security Staff perceptions of security

March 21, 2008NIATx Measures14 Effective Care & Measures of the use of Evidence-Based Practices  System changes to promote the adoption of evidence-based practices Pharmacotherapy: FL, ME, MO  # screened; prescribed; still using  Reductions in days of use Behavioral therapies: DE  # treated; retention; fidelity Case mgmnt & continuing care: KY, RI  # treated; units of care, weeks of care  Transitions between levels of care

Florida: Months of Vivitrol and days of heaving drinking  59 with 1+ injections  22 with 3+ injections March 21, 2008NIATx Measures15

March 21, 2008NIATx Measures16 Patient-Centered Care and Measures  Walkthroughs provide insight into patient barriers Treatment processes often inhibit effective care  Understand and know your customers Customer satisfaction surveys Focus groups Suggestion boxes

March 21, 2008NIATx Measures17 Efficient Care and Measures  Enhanced retention reduces repeat admissions  Reduced no-show rates improve counselor productivity Productivity and efficiency measures  Timely admissions increase reimbursable units of care Billable units and total reimbursements

March 21, 2008NIATx Measures18 Prairie Ridge increased 3 rd party and client revenues

March 21, 2008NIATx Measures19 Connecticut Renaissance Reduced No Shows  Appt reminders and follow ups  Letter of expectations  17% increase in revenues  Improved client and referral satisfaction

March 21, 2008NIATx Measures20 Timely Care and Measures  Delayed care is less effective Retention rates are higher among patients admitted more quickly Delays reduce rather than improve motivation for treatment  Record date of first contact Monitor days to admission and first treatment

March 21, 2008NIATx Measures21 Terros: % completing 4 sessions of care – faster admits = longer stays

March 21, 2008NIATx Measures22 Equitable Care and Measures  Identify and address disparities in access and retention  Improve access to care for under-served groups  Analyze measures for disparities Terros: Younger clients less likely to complete 4 sessions

March 21, 2008NIATx Measures23 NIATx Measures: Summary  Simple measures  Direct indicators of the process or problem being addressed  Collected automatically or with minimal burden  Monitor easy processes to begin  Expand measures with experience  Limit the number of key measures

March 21, 2008NIATx Measures24 Acknowledgements  Preparation of this presentation was supported through awards from Robert Wood Johnson Foundation: & The Center for Substance Abuse Treatment: SAMHSA SC The National Institute on Drug Abuse: R01 DA  The Network for the Improvement of Addiction Treatment provided data included in the presentation.

March 21, 2008NIATx Measures25 Acknowledgements (continued)  Thanks to NIATx colleagues Victor Capoccia, Elaine Cassidy, Frances Cotter, Jay Ford, David Gustafson, Todd Molfenter, Betta Owens  Special thanks to the NIATx Evaluation Team: Luke Bergmann, Eldon Edmundson, Marie Elwood, Carla Green, Kim Hoffman, Traci Rieckmann, Katie Riley, Marie Shea, and Jennifer Wisdom

March 21, 2008NIATx Measures26 Citations  Capoccia, et al Making Stone Soup: Improvements in Clinic Access and Retention in Addiction Treatment. Joint Commission Journal on Quality and Patient Safety, 22 (2), 95 – 103.  McCarty, et al The Network for the Improvement of Addiction Treatment (NIATx): Enhancing access and retention. Drug and Alcohol Dependence, 88, 138 – 145.