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de Beurs E, Rademacher C, Blankers M, Peen J, Dekker J, Goudriaan A. Alcohol use disorder treatment via video conferencing compared with in-person therapy during COVID-19 social distancing : A non-inferiority comparison of three cohorts. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2208-2217. [PMID: 38226749 DOI: 10.1111/acer.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Social distancing measures during the COVID-19 pandemic forced an abrupt transformation of treatment delivery for mental health care. In mid-March 2020, nearly all in-person contact was replaced with video conferencing. The pandemic thus offered a natural experiment and a unique opportunity to conduct an observational study of whether alcohol use disorder treatment through video conferencing is non-inferior to in-person treatment. METHODS In a large urban substance use disorder treatment center in the Netherlands, treatment evaluation is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pre-test and post-test data on alcohol use (Measurements in the Addictions for Triage and Evaluation), psychopathology (Depression Anxiety Stress Scales), and quality of life (Manchester Short Assessment of Quality of Life) were used to compare outcomes of cognitive behavioral therapy treatment for three cohorts: patients who received treatment for a primary alcohol use disorder performed prior to (n = 628), partially during (n = 557), and entirely during (n = 653) the COVID-19 lockdown. RESULTS Outcome was similar across the three cohorts: No inferior outcomes were found for treatments that were conducted predominantly through video conferencing during lockdown or treatments that started in-person, but were continued through video conferencing, compared to in-person treatments that were conducted prior to COVID-19. The number of drop-outs were also similar between cohorts. However, there was a difference in average treatment intensity between cohorts, with treatment partially or fully conducted during the COVID-19 pandemic lasting longer. CONCLUSIONS Treatment for a primary alcohol use disorder, provided partially or predominantly through video conferencing during the COVID-19 pandemic resulted in abstinence rates and secondary outcomes similar to traditional in-person care, in spite of the potentially negative effects of the COVID-related lockdown measures themselves. These results from everyday clinical practice corroborate findings of randomized controlled studies and meta-analyses in which video conferencing appeared non-inferior to in-person care in clinical effectiveness.
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Affiliation(s)
- Edwin de Beurs
- Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands
- Arkin GGZ, Amsterdam, The Netherlands
| | - Clara Rademacher
- Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands
| | - Matthijs Blankers
- Arkin GGZ, Amsterdam, The Netherlands
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
| | - Jaap Peen
- Arkin GGZ, Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin GGZ, Amsterdam, The Netherlands
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anneke Goudriaan
- Arkin GGZ, Amsterdam, The Netherlands
- Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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2
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Schmidt EM, Gupta S, Bowe T, Ellerbe LS, Phelps TE, Finney JW, Asch SM, Humphreys K, Trafton J, Vanneman M, Harris AHS. Predictive validity of a quality measure for intensive substance use disorder treatment. Subst Abus 2016; 38:317-323. [PMID: 27435754 DOI: 10.1080/08897077.2016.1212779] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Measures of substance use disorder (SUD) treatment quality are essential tools for performance improvement. The Veterans Health Administration (VHA) developed a measure of access to and engagement in intensive outpatient programs (IOPs) for SUD. However, predictive validity, or associations between this measure and treatment outcomes, has not been examined. METHODS Data on veterans with SUD came from 3 samples: the Outcomes Monitoring Project (N = 5436), a national evaluation of VHA mental health services (N = 339,887), and patients receiving detoxification services (N = 23,572). Propensity score-weighted mixed-effects regressions modeled associations between receiving at least 1 week of IOP treatment and patient outcomes, controlling for facility-level performance and a random effect for facility. RESULTS Propensity score weighting reduced or eliminated observable baseline differences between patient groups. Patients who accessed IOPs versus those who did not reported significantly reduced alcohol- and drug-related symptom severity, with significantly fewer past-month days drinking alcohol (b = 1.83, P < .001) and fewer past-month days intoxicated (b = 1.55, P < .001). Patients who received IOP after detoxification services had higher 6-month utilization of SUD outpatient visits (b = 2.09, P < .001), more subsequent detoxification episodes (b = 0.25, P < .001), and lower odds of 2-year mortality (odds ratio [OR] = 0.68, 95% confidence interval [CI]: 0.61-0.75; P < .001). CONCLUSIONS Receiving at least 1 week of SUD treatment in an IOP was associated with higher follow-up utilization, improved health outcomes, and reduced mortality. These associations lend support to the predictive validity of VHA's IOP quality measure. Future research should focus on measure feasibility and validity outside of VHA, and whether predictive validity is maintained once this quality measure is tied to performance incentives.
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Affiliation(s)
- Eric M Schmidt
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.,b Center for Health Policy/Primary Care and Outcomes Research (CHP/PCOR) and the Division of General Medical Disciplines , Stanford , California , USA
| | - Shalini Gupta
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Thomas Bowe
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Laura S Ellerbe
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Tyler E Phelps
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - John W Finney
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Steven M Asch
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Keith Humphreys
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Jodie Trafton
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.,c Program Evaluation and Resource Center , Office of Mental Health Operations, VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Megan Vanneman
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.,b Center for Health Policy/Primary Care and Outcomes Research (CHP/PCOR) and the Division of General Medical Disciplines , Stanford , California , USA
| | - Alex H S Harris
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
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3
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Savic M, Fomiatti R. Producing “Progress” Through the Implementation of Outcome Monitoring in Alcohol and Other Drug Treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/0091450916641979] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Outcome monitoring—a process in which clinicians use standardized tools to routinely measure client “progress” on predefined outcomes of interest over time—is increasingly being implemented in alcohol and other drug (AOD) treatment services as a way of demonstrating quality of care. However, relatively little is known about the implications and unintended consequences of implementing outcome monitoring in clinical and social practices. In this paper we draw on qualitative data emerging from focus groups with clinicians who piloted an outcome monitoring tool in Melbourne, Australia, using conceptual tools drawn from science and technology studies. Rather than acting as a stable empirical object, we argue that realities of progress are enacted multiply in relation to preexisting treatment discourses and policy, organizational practices of data collection and management, reporting tools, and clinician attitudes and practices. In particular, we trace how the tool orders the “problem” of drugs differently to the qualitative mode of ordering; how different modes of ordering progress hang together and the tensions and coordination strategies that are involved. And finally, we highlight an unintended consequence of the outcome monitoring process—the enactment of vulnerability and its distribution across the clinical relationship. We suggest that researchers, policy makers, and clinicians need to think reflectively and critically about the ways in which we and our tools and interventions are influential in producing AOD problems, what constitutes progress, and ultimately what the focus of treatment should be.
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Affiliation(s)
- Michael Savic
- Turning Point, Eastern Health, Fitzroy, Australia
- Faculty of Medicine, Nursing & Health Sciences, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Renae Fomiatti
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Australia
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4
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Im JJ, Shachter RD, Finney JW, Trafton JA. Toward cost-effective staffing mixes for Veterans Affairs substance use disorder treatment programs. BMC Health Serv Res 2015; 15:515. [PMID: 26596421 PMCID: PMC4656190 DOI: 10.1186/s12913-015-1175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 11/18/2015] [Indexed: 11/25/2022] Open
Abstract
Background In fiscal year (FY) 2008, 133,658 patients were provided services within substance use disorders treatment programs (SUDTPs) in the U.S. Department of Veterans Affairs (VA) health care system. To improve the effectiveness and cost-effectiveness of SUDTPs, we analyze the impacts of staffing mix on the benefits and costs of specialty SUD services. This study demonstrates how cost-effective staffing mixes for each type of VA SUDTPs can be defined empirically. Methods We used a stepwise method to derive prediction functions for benefits and costs based on patients’ treatment outcomes at VA SUDTPs nationally from 2001 to 2003, and used them to formulate optimization problems to determine recommended staffing mixes that maximize net benefits per patient for four types of SUDTPs by using the solver function with the Generalized Reduced Gradient algorithm in Microsoft Excel 2010 while conforming to limits of current practice. We conducted sensitivity analyses by varying the baseline severity of addiction problems between lower (2.5 %) and higher (97.5 %) values derived from bootstrapping. Results and conclusions Compared to the actual staffing mixes in FY01-FY03, the recommended staffing mixes would lower treatment costs while improving patients’ outcomes, and improved net benefits are estimated from $1472 to $17,743 per patient.
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Affiliation(s)
- Jinwoo J Im
- Management of Innovation Program, Daegu Gyeongbuk Institute of Science and Technology, Daegu, 711-873, South Korea. .,Department of Management Science and Engineering, Stanford University, Stanford, CA, 94305, USA. .,Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park, CA, 94025, USA.
| | - Ross D Shachter
- Department of Management Science and Engineering, Stanford University, Stanford, CA, 94305, USA.
| | - John W Finney
- Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park, CA, 94025, USA.
| | - Jodie A Trafton
- Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park, CA, 94025, USA. .,Department of Psychiatry and Behavioral Sciences and Center for Health Policy, Stanford University School of Medicine, 795 Willow Road (152-MPD), Stanford, CA, 94305, USA.
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5
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Deane FP, Kelly PJ, Crowe TP, Lyons GCB, Cridland EK. The feasibility of telephone follow-up interviews for monitoring treatment outcomes of Australian residential drug and alcohol treatment programs. Subst Abus 2015; 35:21-9. [PMID: 24588289 DOI: 10.1080/08897077.2013.789815] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Telephone follow-up interviewing is one method of monitoring treatment outcomes of individuals involved in drug and alcohol treatment programs. The present study is the first to examine the feasibility and generalizability of data obtained from telephone follow-up interviews after drug and alcohol treatment in Australia. METHODS Participants attended 1 of 8 Salvation Army Recovery Service Centres where staff administered outcome measures at intake. Three-month postdischarge telephone follow-up interviews were conducted by researchers from the Illawarra Institute for Mental Health, University of Wollongong. RESULTS A sample of 700 clients was obtained for follow-up (582 males; 118 females). A 51% follow-up rate was achieved at a cost of US$82 per completed interview. No significant differences in baseline characteristics between responding and nonresponding participants were found. CONCLUSIONS Overall, the telephone methodology was shown to be feasible and relatively inexpensive. However, the introduction of outcome measures at the service level in parallel with follow-up data collection procedures complicated the collection of response data. The burden of introducing outcome measures in residential services may be reduced by utilizing a phased implementation strategy.
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Affiliation(s)
- Frank P Deane
- a Illawarra Institute for Mental Health, University of Wollongong , North Wollongong , Australia
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6
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Synergistic Effects of Lifetime Psychiatric Disorders on Suicidal Ideation Among Blacks in the USA. J Racial Ethn Health Disparities 2014. [DOI: 10.1007/s40615-014-0034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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7
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Nelson KG, Young K, Chapman H. Examining the performance of the brief addiction monitor. J Subst Abuse Treat 2014; 46:472-81. [DOI: 10.1016/j.jsat.2013.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 10/25/2022]
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8
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Lennox RD, Sternquist MA, Paredes A. A simplified method for routine outcome monitoring after drug abuse treatment. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2013; 7:155-69. [PMID: 24092985 PMCID: PMC3782393 DOI: 10.4137/sart.s12691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The routine collection of drug treatment outcomes to manage quality of care, improve patient satisfaction, and allocate treatment resources is currently hampered by two key difficulties: (1) problems locating clients once they leave treatment; and (2) the prohibitive cost of obtaining meaningful and reliable post-treatment data. This pilot describes precise methods for an economical staff-based routine outcome monitoring (ROM) system using an 18-item core measure telephone survey. As implemented at Narconon™ of Oklahoma, a behavioral and social skills based, residential drug rehabilitation program, the system was psychometrically adequate for aggregate reporting while providing clinically useful information. Standardized procedures for staff training, collecting client contact information, structuring exit interviews and maintaining post-treatment telephone contact produced follow-up rates that improved from 57.6% to 100% over the course of the project. Aggregate data was used to improve program delivery and thereby post-treatment substance use and social outcomes. These methods and use of data may contribute to the discussion on how to best monitor outcomes.
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Affiliation(s)
- Richard D Lennox
- Chestnut Health Systems, 2404 Western Park Lane, Hillsborough, NC 27278, USA
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9
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Tiet QQ, Schutte KK, Leyva YE. Diagnostic accuracy of brief PTSD screening instruments in military veterans. J Subst Abuse Treat 2013; 45:134-42. [DOI: 10.1016/j.jsat.2013.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 12/20/2012] [Accepted: 01/28/2013] [Indexed: 11/30/2022]
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10
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Cacciola JS, Alterman AI, Dephilippis D, Drapkin ML, Valadez C, Fala NC, Oslin D, McKay JR. Development and initial evaluation of the Brief Addiction Monitor (BAM). J Subst Abuse Treat 2013; 44:256-63. [PMID: 22898042 PMCID: PMC3602977 DOI: 10.1016/j.jsat.2012.07.013] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 07/06/2012] [Accepted: 07/10/2012] [Indexed: 12/31/2022]
Abstract
This project developed and tested a 17-item monitoring instrument covering important substance use related behaviors to support measurement-based care and outcomes assessment. The study consisted of two phases, an instrument development phase and an initial study to examine its psychometric properties. Participants were 175 patients entering VA outpatient substance abuse treatment. The findings revealed that this Brief Addiction Monitor (BAM) exhibited acceptable characteristics. Exploratory factor analysis yielded three summary factors; recovery protection, physical and psychological problems, and substance use and risk. The root mean square error of approximation estimate was acceptable and the factors had alpha values exceeding or approaching 0.70. All three factors were sensitive to change and had excellent test-retest reliability. Predictive validity was demonstrated for two factors; recovery protection, and substance use and risk. At the item level, there was little indication of inappropriate response patterns. Change over time was significant for most items, and test-retest reliability was acceptable for nearly all items. Additional research is warranted to further establish the BAM's reliability, validity and usefulness.
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Affiliation(s)
- John S Cacciola
- Treatment Research Institute, Philadelphia, PA19106–3414, USA.
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11
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Manning V, Gomez B, Koh PK, Ng A, Guo S, Kandasami G, Wong KE. Treatment outcome and its predictors among Asian problem drinkers. Drug Alcohol Rev 2012; 32:178-86. [PMID: 23043535 DOI: 10.1111/j.1465-3362.2012.00518.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 08/31/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Evidence of treatment effectiveness for alcohol use disorders (AUD) have emerged predominantly from Western studies, using highly controlled trials that may not reflect real-world settings. This paper examines treatment outcome and its predictors among Asian problem drinkers participating in a treatment outcome monitoring program at an addiction treatment centre in Singapore. DESIGN AND METHODS Data were collected at intake and 3, 6 and 12 months, although the focus of this paper is on reliable change at 3 months among the 70% who were followed up. Five hundred and forty-one AUD-diagnosed outpatients presenting for treatment, over a 2-year period, were assessed on drinking behaviours and administered the Addiction Severity Index-Lite, Personal Wellbeing Index (PWI) and Treatment Perceptions Questionnaire. RESULTS At 3 months, drinking days, alcohol units and alcohol use severity had more than halved and 69% were either abstinent or had reliably reduced their drinking days. Baseline drinking days and treatment satisfaction predicted 3-month drinking frequency but not severity. Positive alcohol outcomes observed at 3 months were sustained among those followed up until 12 months. Mean PWI score improved significantly and fell within the 'normal' range. Treatment satisfaction also emerged as the only significant predictor of reliable positive change in both drinking days and PWI score. DISCUSSION AND CONCLUSIONS Significant reductions in drinking frequency and severity are possible for Asian problem drinkers after 12 weeks of outpatient treatment. The identified predictors suggest that more frequent drinkers and patients with past/current psychiatric comorbidities may require a more intensive treatment approach to optimise treatment outcomes.
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Affiliation(s)
- Victoria Manning
- National Addictions Management Service, Institute of Mental Health, Singapore.
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12
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Humphreys K, McLellan AT. A policy-oriented review of strategies for improving the outcomes of services for substance use disorder patients. Addiction 2011; 106:2058-66. [PMID: 21631620 DOI: 10.1111/j.1360-0443.2011.03464.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To inform policy makers on available options for improving the effectiveness of treatments for substance use disorders and to stimulate debate about treatment improvement strategies among public officials, clinical providers, care managers, service users, families and researchers. METHODS We draw on the scientific literature and our public policy experiences in two countries (the United Kingdom and the United States) to give an overview of policies which may improve care for individuals with substance use disorders. We divide such policies into 'process-focused quality improvement strategies' that attempt to change some aspect of treatment (e.g. increased retention, greater use of evidence-based practices) and 'patient-focused strategies' that attempt to reward outcomes directly (e.g. contingency management for patients, payment by results for providers). FINDINGS Many policies of both types are poorly developed, have shown poor results, or both. The evidence is clear that process-focused quality improvement strategies can change what providers do and how treatment programs work, but such changes have thus far demonstrated only minimal impact on patient outcomes. Patient-focused strategies face challenges including treatment providers avoiding hard-to-treat patients or spending inordinate time relocating patients after treatment to assess outcome. However, policies that reward in-treatment outcomes and policies that allow the patient to purchase desired recovery support services show more promise. As policy makers go forward in this endeavor, they can do an enormous service to their countries and the field by embedding careful evaluation studies alongside new treatment outcome improvement initiatives.
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Affiliation(s)
- Keith Humphreys
- Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA, USA.
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13
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Crits-Christoph P, Ring-Kurtz S, Hamilton JL, Lambert MJ, Gallop R, McClure B, Kulaga A, Rotrosen J. A preliminary study of the effects of individual patient-level feedback in outpatient substance abuse treatment programs. J Subst Abuse Treat 2011; 42:301-9. [PMID: 22036697 DOI: 10.1016/j.jsat.2011.09.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/03/2011] [Accepted: 09/14/2011] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to examine the effects of feedback provided to counselors on the outcomes of patients treated at community-based substance abuse treatment programs. A version of the Outcome Questionnaire (OQ-45), adapted to include drug and alcohol use, was administered to patients (N = 304) in 3 substance abuse treatment clinics. Phase I of the study consisted only of administration of the assessment instruments. Phase II consisted of providing feedback reports to counselors based on the adapted OQ-45 at every treatment session up to Session 12. Patients who were found to not be progressing at an expectable rate (i.e., "offtrack") were administered a questionnaire that was used as a second feedback report for counselors. For offtrack patients, feedback compared with no feedback led to significant linear reductions in alcohol use throughout treatment and also in OQ-45 total scores and drug use from the point of the second feedback instrument to Session 12. The effect for improving mental health functioning was evident at only 1 of the 3 clinics. These results suggest that a feedback system adapted to the treatment of substance use problems is a promising approach that should be tested in a larger randomized trial.
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Affiliation(s)
- Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
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14
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Longer Length of Stay Is Not Associated with Better Outcomes in VHA’s Substance Abuse Residential Rehabilitation Treatment Programs. J Behav Health Serv Res 2011; 39:68-79. [DOI: 10.1007/s11414-011-9250-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Glass JE, Ilgen MA, Winters JJ, Murray RL, Perron BE, Chermack ST. Inpatient hospitalization in addiction treatment for patients with a history of suicide attempt: a case of support for treatment performance measures. J Psychoactive Drugs 2010; 42:315-25. [PMID: 21053754 DOI: 10.1080/02791072.2010.10400694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study attempts to validate substance use disorder (SUD) treatment performance measures (PM) in a naturalistic treatment setting. Despite its significance in healthcare systems and in SUD populations, suicidality is one patient characteristic that remains unexplored in the context of SUD PMs. The current study focused on the extent to which the care processes encouraged by SUD PMs were associated with improved outcomes in patients with a prior suicide attempt as compared to those without. We abstracted Addiction Severity Index and health services data from the VA medical record for 381 veterans who initiated outpatient SUD treatment and completed baseline intake measures at a Midwestern VA hospital. Cox proportional hazard regressions examined how baseline characteristics, prior suicide attempts, and PM status predicted the time until hospitalization for psychiatric or substance use problems. Prior suicide attempts significantly interacted with treatment engagement, and hospitalization risk was significantly higher among individuals with a prior suicide attempt who did not meet PMs. This study provides initial observational evidence that past suicide attempts may be a factor that should be considered when defining performance standards that influence the processes of SUD treatment. Future research on PMs should take into account the differences on indicators of high risk and poor treatment outcomes.
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Affiliation(s)
- Joseph E Glass
- George Warren Brown School of Social Work, Washington University, St. Louis, Missouri, USA.
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16
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Harris AHS, Humphreys K, Bowe T, Tiet Q, Finney JW. Does meeting the HEDIS substance abuse treatment engagement criterion predict patient outcomes? J Behav Health Serv Res 2010; 37:25-39. [PMID: 18770044 DOI: 10.1007/s11414-008-9142-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examines the patient-level associations between the Health Plan Employer Data and Information Set (HEDIS) substance use disorder (SUD) treatment engagement quality indicator and improvements in clinical outcomes. Administrative and survey data from 2,789 US Department of Veterans Affairs SUD patients were used to estimate the effects of meeting the HEDIS engagement criterion on improvements in Addiction Severity Index Alcohol, Drug, and Legal composite scores. Patients meeting the engagement indicator improved significantly more in all domains than patients who did not engage, and the relationship was stronger for alcohol and legal outcomes for patients seen in outpatient settings. The benefit accrued by those who engaged was statistically significant but clinically modest. These results add to the literature documenting the clinical benefits of treatment entry and engagement. Although these findings only indirectly support the use of the HEDIS engagement measure for its intended purpose-discriminating quality at the facility or system level-they confirm that the processes of care captured by the measure are associated with important patient outcomes.
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Affiliation(s)
- Alex H S Harris
- Center for Health Care Evaluation, Department of Veterans Affairs, Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, CA 94025, USA.
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17
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A randomized controlled study of a web-based performance improvement system for substance abuse treatment providers. J Subst Abuse Treat 2010; 38:251-62. [PMID: 20116964 DOI: 10.1016/j.jsat.2010.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 11/30/2009] [Accepted: 01/04/2010] [Indexed: 11/22/2022]
Abstract
We report here the results of a randomized, controlled trial evaluating the efficacy of a semiautomated performance improvement system ("patient feedback") that enables real-time monitoring of patient outcomes in outpatient substance abuse treatment clinics. The study involved 118 clinicians working at 20 community-based outpatient substance abuse treatment clinics in the northeast United States. Ten clinics received 12 weeks of the patient feedback performance improvement intervention, and 10 clinics received no intervention during the 12 weeks. More than 1,500 patients provided anonymous ratings of therapeutic alliance, treatment satisfaction, and drug/alcohol use. There was no evidence of an intervention effect on the primary drug and alcohol use scales. There was also no evidence of an intervention effect on secondary measures of therapeutic alliance. Clinician-rated measures of organizational functioning and job satisfaction also showed no intervention effect. Possible insights from these findings and alternative methods of utilizing feedback reports to enhance clinical outcomes are proposed.
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Harris AHS, Finney JW, Moos RH. Baseline Abstinence May Moderate Substance Use Disorder Intrvention Effects. JOURNAL OF DRUG ISSUES 2010. [DOI: 10.1177/002204261004000108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In many evaluations of care for patients with substance use disorders (SUD), a substantial proportion of patients are abstinent from substances prior to their baseline assessment. For researchers evaluating the effect of treatments or patterns of care on follow-up abstinence, especially with non-randomized designs, this raises important conceptual and statistical questions. We discuss several ways researchers might address baseline heterogeneity in abstinence either through design or statistical approaches. For illustration, we estimate the effect of continuing care duration on follow-up abstinence in a sample of 3,181 SUD outpatients treated in 54 Veterans Health Affairs (VHA) facilities. We show that failure to separately examine individuals who are and are not abstinent at baseline overestimates the “treatment effect” on substance use outcomes for those abstinent at baseline and underestimates the treatment effect for those not abstinent at baseline. We also describe comparable findings for the effect of attendance in 12-step self-help groups.
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Developing and validating process measures of health care quality: an application to alcohol use disorder treatment. Med Care 2009; 47:1244-50. [PMID: 19786908 DOI: 10.1097/mlr.0b013e3181b58882] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Health care process quality measures usually are designed by expert panels attempting to synthesize nuanced clinical evidence and subsequently operationalized using administrative data. Many quality measures are then adopted without directly validating their presumed links with outcomes. Later efforts to validate process measures often yield negative results, leaving policy makers without a defensible means of measuring quality. This article presents an alternative strategy for developing and validating process quality measures. The development of an alcohol use disorder (AUD) treatment quality measure is used as an example. METHODS An expert panel generated a range of candidate process quality measures of AUD treatment derivable from administrative data that were then tested to determine which had the strongest associations with facility- and patient-level outcomes. Outcome and process data were from 2701 US Veterans Health Administration patients starting a new episode of care at 54 VA facilities. RESULTS Several of the candidate process-of-care quality measures predicted facility- and patient-level outcomes. Having at least 3 visits during the first month of specialty AUD treatment was correlated with improvement on the Addiction Severity Index Alcohol composite at the facility level, r = 0.41 (95% Confidence Interval 0.16-0.61), and at the patient level, r = 0.07 (CI: 0.03-0.11). CONCLUSIONS These "prevalidated" quality measures can now be judged for the extent they map onto the extant clinical literature and other design requirements. The development and validation strategy we describe should aid in efficiently producing quality measures in other areas of health care.
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Monitoring and Evaluation of Substance Abuse Services in South Africa: Implications for Policy and Practice. Int J Ment Health Addict 2009. [DOI: 10.1007/s11469-009-9232-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Humphreys K, Harris AHS, Kivlahan DR. Performance Monitoring of Substance Use Disorder Interventions in the Veterans Health Administration. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 35:123-7. [DOI: 10.1080/00952990802707042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Oudejans SCC, Schippers GM, Merkx MJM, Schramade MH, Koeter MWJ, van den Brink W. Feasibility and validity of low-budget telephonic follow-up interviews in routine outcome monitoring of substance abuse treatment. Addiction 2009; 104:1138-46. [PMID: 19563559 DOI: 10.1111/j.1360-0443.2009.02593.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Routine outcome monitoring (ROM) is receiving growing attention. However, follow-up interviews are time-consuming and costly. This study examines the feasibility and validity of low-budget telephonic follow-up interviews for ROM in a substance abuse treatment centre (SATC). DESIGN Observational study using data collected for routine outcome monitoring. SETTING The study was performed in a SATC in an urban area in the Netherlands. Participants Feasibility and validity were assessed on data of 2325 patients. MEASUREMENTS Data on pre-treatment socio-demographic and clinical characteristics were collected using electronic patient records (EPRs) and the European version of the Addiction Severity Index (EuropASI). Data on intensity of treatment were also collected through the EPRs. Telephonic follow-up interviews were conducted between 9 and 10 months after intake. FINDINGS A 53% follow-up rate was achieved; 35% of the patients could not be contacted, 3% explicitly refused and in 8% other reasons accounted for non-participation. About 50% of the interviews took place in the intended time-frame. Costs were Euro 40 (57 US dollars) per completed interview. There were indications of selection bias, because patients with cocaine as their primary problem and patients with polysubstance abuse were under-represented in the follow-up sample; the presence of these disorders is associated with negative treatment outcome. CONCLUSIONS Implementing telephonic low-budget follow-up interviews for ROM is feasible, but selection bias threatens internal validity of data, limiting generalization to the total treatment population. Increased efforts to track patients for follow-up may improve generalization.
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Affiliation(s)
- Suzan C C Oudejans
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands.
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Harris AH, Humphreys K, Bowe T, Kivlahan DR, Finney JW. Measuring the quality of substance use disorder treatment: Evaluating the validity of the Department of Veterans Affairs continuity of care performance measure. J Subst Abuse Treat 2009; 36:294-305. [DOI: 10.1016/j.jsat.2008.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 04/09/2008] [Accepted: 05/05/2008] [Indexed: 10/21/2022]
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Evans E, Grella CE, Murphy DA, Hser YI. Using administrative data for longitudinal substance abuse research. J Behav Health Serv Res 2008; 37:252-71. [PMID: 18679805 DOI: 10.1007/s11414-008-9125-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 04/26/2008] [Indexed: 10/21/2022]
Abstract
The utilization of administrative data in substance abuse research has become more widespread than ever. This selective review synthesizes recent extant research from 31 articles to consider what has been learned from using administrative data to conduct longitudinal substance abuse research in four overlapping areas: (1) service access and utilization, (2) underrepresented populations, (3) treatment outcomes, and (4) cost analysis. Despite several notable limitations, administrative data contribute valuable information, particularly in the investigation of service system interactions and outcomes among substance abusers as they unfold and influence each other over the long term. This critical assessment of the advantages and disadvantages of using existing administrative data within a longitudinal framework should stimulate innovative thinking regarding future applications of administrative data for longitudinal substance abuse research purposes.
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Affiliation(s)
- Elizabeth Evans
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90025, USA.
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Stetler CB, Mittman BS, Francis J. Overview of the VA Quality Enhancement Research Initiative (QUERI) and QUERI theme articles: QUERI Series. Implement Sci 2008; 3:8. [PMID: 18279503 PMCID: PMC2289837 DOI: 10.1186/1748-5908-3-8] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 02/15/2008] [Indexed: 11/25/2022] Open
Abstract
Background Continuing challenges to timely adoption of evidence-based clinical practices in healthcare have generated intense interest in the development and application of new implementation methods and frameworks. These challenges led the United States (U.S.) Department of Veterans Affairs (VA) to create the Quality Enhancement Research Initiative (QUERI) in the late 1990s. QUERI's purpose was to harness VA's health services research expertise and resources in an ongoing system-wide effort to improve the performance of the VA healthcare system and, thus, quality of care for veterans. QUERI in turn created a systematic means of involving VA researchers both in enhancing VA healthcare quality, by implementing evidence-based practices, and in contributing to the continuing development of implementation science. The efforts of VA researchers to improve healthcare delivery practices through QUERI and related initiatives are documented in a growing body of literature. The scientific frameworks and methodological approaches developed and employed by QUERI are less well described. A QUERI Series of articles in Implementation Science will illustrate many of these QUERI tools. This Overview article introduces both QUERI and the Series. Methods The Overview briefly explains the purpose and context of the QUERI Program. It then describes the following: the key operational structure of QUERI Centers, guiding frameworks designed to enhance implementation and related research, QUERI's progress and promise to date, and the Series' general content. QUERI's frameworks include a core set of steps for diagnosing and closing quality gaps and, simultaneously, advancing implementation science. Throughout the paper, the envisioned involvement and activities of VA researchers within QUERI Centers also are highlighted. The Series is then described, illustrating the use of QUERI frameworks and other tools designed to respond to implementation challenges. Conclusion QUERI's simultaneous pursuit of improvement and research goals within a large healthcare system may be unique. However, descriptions of this still-evolving effort, including its conceptual frameworks, methodological approaches, and enabling processes, should have applicability to implementation researchers in a range of health care settings. Thus, the Series is offered as a resource for other implementation research programs and researchers pursuing common goals in improving care and developing the field of implementation science.
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Ilgen MA, Harris AHS, Moos RH, Tiet QQ. Predictors of a suicide attempt one year after entry into substance use disorder treatment. Alcohol Clin Exp Res 2007; 31:635-42. [PMID: 17374043 DOI: 10.1111/j.1530-0277.2007.00348.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The present study examined the patient intake and treatment-related risk factors associated with a suicide attempt in the 30 days before a 1-year posttreatment assessment. METHODS A national sample of 8,807 patients presenting for treatment of substance use disorders (SUDs) in the Department of Veterans Affairs healthcare system were assessed at treatment intake and follow-up. Using the MacArthur Model, the risk and protective factors for suicide attempt were identified at baseline and during treatment. RESULTS At follow-up, 4% (314/8,807) of the patients reported a suicide attempt within the past 30 days. Baseline predictors of a suicide attempt before follow-up included elevated suicidal/psychiatric symptoms, more recent problematic alcohol use, and longer duration of cocaine use. Contact with the criminal justice system was a protective factor that reduced the likelihood of a future suicide attempt. Greater engagement in SUD treatment was also associated with a reduction in suicide risk. CONCLUSIONS More involvement in SUD treatment reduced the likelihood of a future suicide attempt in high-risk patients. Substance use disorder treatment providers interested in reducing future suicidal behavior may want to concentrate their efforts on identifying at-risk individuals and actively engaging these patients in longer treatment episodes.
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Affiliation(s)
- Mark A Ilgen
- Department of Veterans Affairs, Center for Health Care Evaluation, Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, California 94025, USA.
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Harris AHS, Humphreys K, Finney JW. Veterans Affairs facility performance on Washington Circle indicators and casemix-adjusted effectiveness. J Subst Abuse Treat 2007; 33:333-9. [PMID: 17400416 DOI: 10.1016/j.jsat.2006.12.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 12/18/2006] [Accepted: 12/25/2006] [Indexed: 11/21/2022]
Abstract
Self-administered Addiction Severity Index (ASI) data were collected on 5,723 patients who received substance abuse treatment in 1 of 110 programs located at 73 Veterans Affairs facilities. The associations between each of three Washington Circle (WC) performance indicator scores (identification, initiation, and engagement) and their casemix-adjusted facility-level improvement in ASI drug and alcohol composites 7 months after intake were estimated. Higher initiation rates were not associated with facility-level improvement in ASI alcohol composite scores but were modestly associated with greater improvements in ASI drug composite scores. Identification and engagement rates were unrelated to 7-month outcomes. WC indicators focused on the early stages of treatment may tap necessary but insufficient processes for patients with substance use disorder to achieve good posttreatment outcomes. Ideally, the WC indicators would be supplemented with other measures of treatment quality.
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Affiliation(s)
- Alex H S Harris
- Center for Health Care Evaluation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA.
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Tiet QQ, Ilgen MA, Byrnes HF, Harris AHS, Finney JW. Treatment setting and baseline substance use severity interact to predict patients' outcomes. Addiction 2007; 102:432-40. [PMID: 17298651 DOI: 10.1111/j.1360-0443.2006.01717.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS This study tested the hypothesis that patients with more severe substance use disorders (SUDs) at intake respond better when treated in more structured and intensive settings (i.e. in-patient/residential versus out-patient), whereas patients with less severe SUD problems have similar outcomes regardless of treatment setting. DESIGN, SETTING AND PARTICIPANTS Up to 50 new patients were selected randomly from each of a random and representative sample of 50 Department of Veterans Affairs (VA) SUD treatment programs (total n = 1917 patients), and were followed-up an average of 6.7 months later (n = 1277). MEASURES Patients completed a brief self-report version of the Addiction Severity Index (ASI) at baseline and at follow-up. FINDINGS In mixed-model regression analyses, baseline substance use severity predicted follow-up substance use severity and there were no main effects of treatment setting. However, interaction effects were found, such that more severe patients experienced better alcohol and drug outcomes following in-patient/residential treatment versus out-patient treatment; on the other hand, patients with lower baseline ASI drug severity had better drug outcomes following out-patient treatment than in-patient treatment. Treatment setting was unrelated to alcohol outcomes in patients with less severe ASI alcohol scores. CONCLUSIONS Results provide some support to the matching hypothesis that for patients who have higher levels of substance use severity at intake, treatment in in-patient/residential treatment settings is associated with better outcomes than out-patient treatment. More research needs to be conducted before in-patient/residential settings are further reduced as a part of the SUD continuum of care in the United States.
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Affiliation(s)
- Quyen Q Tiet
- Center for Health Care Evaluation, Department of Veterans Affairs, Palo Alto Health Care System, Menlo Park, CA 94025, USA.
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