#154 Translating Ideas into Practice: Implementation of a Process ImprovementRandomized Control Trial for 200 Drug Treatment Agencies The Network for the

Improvement of Addiction Treatment 200

AbstractAuthorsJ. H. Ford1, A. Quanbeck1, A. Pulvermacher1, D.H. Gustafson1, D. McCarty2,K. Hoffman2, J. McConnell2

Institutions1. University of Wisconsin – Madison, WI, USA.2. Oregon Health & Science University, Portland, OR, USA.

AimsThis study presents the protocol for a five-year randomized control trial designed to evaluate the cost-effectiveness of combinations of four process improvement (PI) interventions designed to improve client access to and retention in treatment across 200 agencies in five U.S. states. Research questions were:

(1) What challenges arose when transforming research into practicefor each intervention?

(2) How were intervention arms modified to ensure study integrity?

MethodsThe initial protocol outlined four process improvement interventions – learning sessions, interest circle calls, coaching, and a web site. Using an anthropological framework for action research, the evolution of each intervention was tracked to examine key changes over time.

ResultsLearning sessions and interest circle calls employ process improvement coaches to teach participating agencies to use customer experiences to identify key intake issues, to select an area for change, and to pick a promising practice forimplementation. Coaches use a one-day site visit and bimonthly calls to teachprocess improvement tools and change ideas for improving client access to andretention in treatment. The web site provides step-by-step instructions forimplementing key promising practices designed to improve client access to and retention in treatment. Preliminary learning session results show an averageattendance of 41 persons. Learning session evaluations support the hypothesis (=0.05) that no differences exist across the evaluation scores for 56 out of 63 possible comparisons.

ConclusionsThis study provides a snapshot of the randomized control trial designed to test the cost-effectiveness of process improvement techniques in 200 drug treatmentagencies. It highlights the importance of listening and reviewing the study design while developing study interventions for clinical trials involving real-worldorganizations.

SupportThis project is funded by the National Institute on Drug Abuse (5 R01 DA020832-02).

J. H. Ford, A. Quanbeck, A. Pulvermacher, D.H. Gustafson, D. McCarty, K. Hoffman, J. McConnell

What is NIATx?NIATx is a pioneering improvement collaborative that works withsubstance abuse and behavioral health organizations across the

country. We teach organizations to use a simple process improvement modeldeveloped by industrial engineers at the University of Wisconsin – Madison.

NIATx helps behavioral health providers improve access to and retention intreatment for all of their clients. We do this primarily by helping treatmentproviders use process improvement methods to achieve the four NIATx aims:

Over the last four years, agencies working with NIATx have realized significantimprovements in the reduction of waiting times and no-shows and in the increase of admissions and treatment continuation. Since its inception, NIATx has worked with over 400 treatment agencies to help them improve access to and retentionin treatment.

What is NIATx 200?NIATx 200 is a five-year, randomized trial designed to evaluate the

cost-effectiveness of field-tested process improvement strategies foraddiction treatment providers. The study aims to help determine whichcombinations of collaborative services produce the greatest improvement for the economic investment.

Providers in the NIATx 200 study commit to an 18-month engagement in which theyparticipate in the services provided to their randomly assigned study group. At the same time, they test promising practices, collect and report their data, and provide staff responses to questionnaires and surveys.

The participating treatment providers, with support from their single state agency (SSA), focus their efforts in three areas—providing same day therapeutic services,increasing client participation, and increasing admissions.

NIATx 200 is a partnership between NIATx, the National Institute on Drug Abuse, and more than 200 treatment providers and state agencies in Massachusetts, Michigan, New York, Oregon, and Washington.

Intervention Timeline

Evolution of the Treatment ArmsStudy Interventions1. Low-level coaching (one site visit + monthly one-hour calls)

2. High-level coaching (three site visits + monthly one-hour calls)

3. Learning sessions

4. Interest circle calls

5. Web site

Grant Application Before Recruitment During Recruitment

Six Study Arms1) Learning Sessions +

Interest Circle Calls +High-level Coaching + Web site

2) Learning Sessions +Interest Circle Calls + Web site

3) Interest Circle Calls + Web site

4) High-level Coaching +Interest Circle Calls + Web site

5) Low-level Coaching +Interest Circle Calls + Web site

Five Study Arms1) Interest Circle Calls + Web site

2) Learning Sessions + Web site

3) Coaching + Web site

4) Interest Circle Calls +Learning Sessions + Coaching + Web site

5) Web only (Control Group)

Four Study Arms1) Interest Circle Calls

2) Learning Sessions

3) Coaching

4) Interest Circle Calls +Learning Sessions +Coaching

All study arms have accessto the NIATx 200 web site.

Available Study Conditions

Learning Objective Road Map Framework

Activities Objectives Competencies

Beginning and LearningFirst Six Months

Using and MasteringSecond Six Months

Strengthening and SustainingThird Six Months

NIATx fundamentals

Review the walk-through baseline data

Review and deepen understanding of NIATx fundamentals

Present Change Projects and what has worked, barriers, and successes

Build the NIATx fundamentals into the fabric of the organization

Spreading excitement about process improvementand NIATx

Learn the NIATx way

Share findings and compare to the baseline data

Move toward NIATx as a way of doing business

Master rapid-cycle change projects (PDSAs)

Make the business case part of the strategic andleadership culture of the organization

Understand the need for refreshment and excitement in process improvement

Learn the basics of PDSA cycles and the NIATx way

Learn how to conduct the walk-through and recognize the emotional and leadership aspects of the walk-through

Demonstrate understanding of and an ability to produce the business case

Produce two strong examples of PDSAs conducted in the organization and displayexamples in storyboards

Identify and effectively use strategies for building NIATx in organizationalinfrastructure and culture

Demonstrate continuous use of refreshment and excitement strategies

AcknowledgmentsNIATx 200 is funded by the National Institute on Drug Abuse (5 R01 DA020832-02).

We’d like to thank the five single state agencies and more than 200 addictiontreatment providers in the states of Michigan, Massachusetts, New York, Oregon and Washington, as well as the NIATx 200 team and consultants.

CPDD Transl Ideas Poster.indd 1 5/22/08 8:45:40 AM