1. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net David Gustafson PhD NIATx Director, University of Wisconsin-Madison Reduce Waiting & No-Shows  Increase Admissions & Continuation

2. www.NIATx.net The Network for the Improvement of Addiction Treatment (NIATx): a partnership of The Center for Substance Abuse Treatment Strengthening Treatment Access and Retention and The Robert Wood Johnson Foundation Paths to Recovery

3. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Also NCI’s TECC Center of Excellence in Cancer Communications Research

4. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net NIATx Presence

5. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Key Points M/SU  Fantastic!!! Process Improvement can speed adoption of evidence based practices States: key to diffusing Process Improvement Redesign should involve technology to be customer centered.

6. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net

7. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Between patient and caring help lies a canyon of paperwork and burdensome processes A chronic disease where timing is everything Poorly designed processes keep patients & staff apart And they waste money Processes CAN be improved!

8. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Our focus: Nine Processes. First contact Intake and assessment Transition thru levels of care Paperwork Scheduling Engagement Social supports Outreach Maximizing revenue

9. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Clear, precise aims Reduce Waiting Times Reduce No-Shows Increase Admissions Increase Continuation Rates

10. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Five Evidence Based Principles Help the CEO sleep Rapid improvement Ideas & “pressure” from outside. Influential change leader Understand/involve customersUnderstand/involve customers

11. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Results so Far. Waiting Times: 51% (n=37) Reduce No-Shows: 41% (n=28) Increaase admissions: 56% (n=23) Improve continuation : 39% (n=39) *Change cycle data

12. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Lessons from Acadia Hospital (Mental Illness + Addiction Treatment) Lynn M. Madden, MPA, CHE Acadia Hospital Bangor, Maine

13. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Open Access to IOP Clients fitting clinical profile (phone or ED) offered evaluation @ 7:30 next AM. Evaluated clients start treatment same day

14. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net IOP Access Results Continued growth in admissions (project implemented in March 2003)

15. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net IOP Operating Results Serve more clients & operate more efficiently

16. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Physical Restraints (CMS/JCAHO) Inpatients more complex w less restrictive care. Too many restraints. Rapid Response Team –Medical Dir. Clinical Sup. & RN mgr. –Meet w/in 24hrs of any mechanical restraint –Make rapid changes to treatment plan to reduce need for further restraints

17. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Restraint reduction 41% Physical; 32% Mechanical Restraints per 1000 bed days

18. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net NIATx State Pilot Project States play a key role in promoting adoption of process improvements Delaware Iowa North Carolina Oklahoma Texas

19. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net NIATx State State processesIncentives Tx Agency Processes

20. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Lessons from Oklahoma Terry Cline, PhD Oklahoma Department of Mental Health and Substance Abuse Services

21. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Oklahoma Project #1 Eliminate eligibility determination requirement for those seeking treatment Preliminary results: –Data being collected –Anecdote: one outpatient provider reduced time from 1 st contact to admission from 30+ to 3 days

22. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Oklahoma Project #2 Reduce paperwork in state treatment rules. Cut duplication in clinical documentation that evolved over many years. Results : –Residential providers reduced admission time from 8 to 2 hours. –Outpatient providers reduced admission time from 4 to 3 hours

23. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Technology Technology can improve treatment of mental illness & addiction. Electronic Medical Records are key AND...

24. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Virtual Reality Simulations

25. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Mobile Social Software (MoSoSo)

26. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Smart Phones

27. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Wearables: (pulse, blood pressure, sweating, etc)

28. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Biofeedback

29. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net RFID (chip w medical record) http://www.wired.com/wired/archive/8.02/warwick.html

30. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Information/decision help (chess.chsra.wisc.edu/bc)chess.chsra.wisc.edu/bc

31. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Video Conferencing on a PC

32. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Diagnosis & Treatment Planning

33. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Computer-based Discussion Groups

34. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Affective Computing

35. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Technology can help now! Patients Families Treatment providers Primary care and Emergency Child welfare and criminal justice.

36. Increasing lifestyle imbalance & desire for gratification Withdrawal symptoms Fear Overwhelm Anger Depressed Hopeless Rationalize & deny Hi-risk situation No coping response Reduced efficacy Temporal discountng Initial lapse Monitor w surveys & physiology. Immediate rewards w increasing payments. Social support. Rehearse relapse Remove symptoms Know warning sign Ways to avoid & cope ID high-risk people Set up plan Remov craving causes Lower symptoms Show relapse effects Break into sub-tasks See as gaining skills Stress mgmt, Relaxation training, Social norm  Environment  See as mistake Remind how to cope w lapse. Contract: no more Analyze the situation & options MoSoSo Discussion Groups Ask Expert EMR Reminders Wearables GPS Anti-drugs Bio- feedback VR CBT VR Problem knowledge couplers. EMR Video conferencing RFID Video conf Action planning Online stress mgt Reminders Video conf Decision analysis Vaccines CHESS VR training Journaling Note: Smart phone will be key communication device. VR Affective computing Prepare to quit w trial quit attempts. Train SOs

37. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Key Points M/SU  Fantastic!!! Process Improvement can speed adoption of evidence based practices States: key to diffusing Process Improvement Redesign should involve technology to be customer centered.