Replication and sustainability of improved access and retention within the Network for the Improvement of Addiction Treatment

Abstract

The Network for the Improvement of Addiction Treatment (NIATx) applies process improvement strategies to enhance the quality of care for the treatment of alcohol and drug disorders. A prior analysis reported significant reductions in days to treatment and significant increases in retention in care [McCarty, D., Gustafson, D. H., Wisdom, J. P., Ford, J., Choi, D., Molfenter, T., Capoccia, V., Cotter, F. 2007. The Network for the Improvement of Addiction Treatment (NIATx): enhancing access and retention. Drug Alcohol Depend. 88, 138-145]. A second cohort of outpatient (n=10) and intensive outpatient (n=4) treatment centers tested the replicability of the NIATx model. An additional 20 months of data from the original cohort (7 outpatient, 4 intensive outpatient, and 4 residential treatment centers) assessed long-term sustainability. The replication analysis found a 38% reduction in days to treatment (30.7 to 19.4 days) during an 18-month intervention. Retention in care improved 13% from the first to second session of care (from 75.4% to 85.0%), 12% between the first and third session of care (69.2-77.7%), and 18% between the first and fourth session of care (57.1-67.5%). The sustainability analysis suggested that treatment centers maintained the reductions in days to treatment and the enhanced retention in care. Replication of the NIATx improvements in a second cohort of treatment centers increases confidence in the application of process improvements to treatment for alcohol and drug disorders. The ability to sustain the gains after project awards were exhausted suggests that participating programs institutionalized the organizational changes that led to the enhanced performance.

A Literature Review of Learning Collaboratives in Mental Health Care: Used but Untested

“…The study’s use of individual site coaching is somewhat unique. One-to-one coaching was described in some studies of the NIATx model (35, 36), but most papers did not specify the use of coaching.…”

Improving client engagement and retention in treatment: The Los Angeles County experience

“…Participating agencies demonstrated significant reductions in days to admission and early dropouts and increases in treatment retention (McCarty et al, 2007). The Evaluation Team subsequently analyzed data from a second cohort of outpatient and intensive outpatient programs and found comparable positive improvements in treatment waiting times and retention (Hoffman, Ford, Choi, Gustafson, & McCarty, 2008). These quantitative data were supplemented by qualitative information, revealing that agency leaders were successful in implementing the NIATx model when they valued data-driven decision making, provided the necessary staff training and material resources, supported data collection, and shared project findings with agency staff (Wisdom et al, 2006).…”

Priorities for policy research on treatments for alcohol and drug use disorders

“…The Network for the Improvement of Addiction Treatment (NIATx) works at the treatment program level to support the implementation of process improvements that enhance proximal outcomes assumed to reflect better quality of care (e.g., reducing days to admission, increasing retention in care). NIATx participants have reduced waiting periods for treatment, increased treatment retention, reduced no shows, and increased their capacity to treat more individuals (Capoccia et al, 2007;Hoffman, Ford, Choi, Gustafson, & McCarty, 2008;McCarty et al, 2007). Inequities and disparities in access and the outcomes of care, however, suggest that much remains to be accomplished in policy efforts to reduce health care disparities among racial and ethnic populations (Schmidt, Greenfield, & Mulia, 2006).…”