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.