Improving M/SU Treatment Effectiveness & Efficiency
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Improving M/SU Treatment Effectiveness & Efficiency . David Gustafson PhD NIATx Director, University of Wisconsin-Madison. Reduce Waiting & No-Shows  Increase Admissions & Continuation. The Network for the Improvement of Addiction Treatment (NIATx): a partnership of.

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David Gustafson PhD NIATx Director, University of Wisconsin-Madison

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Improving M/SU Treatment Effectiveness & Efficiency

David Gustafson PhD

NIATx Director, University of Wisconsin-Madison

Reduce Waiting & No-Shows  Increase Admissions & Continuation


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


Also NCI’s TECC Center of Excellence in Cancer Communications Research


NIATx Presence


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.


Process Improvement

Admission


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!


Our focus: Nine Processes.

  • First contact

  • Intake and assessment

  • Transition thru levels of care

  • Paperwork

  • Scheduling

  • Engagement

  • Social supports

  • Outreach

  • Maximizing revenue


Clear, precise aims

Reduce Waiting Times

Reduce No-Shows

Increase Admissions

Increase Continuation Rates


Five Evidence Based Principles

  • Help the CEO sleep

  • Rapid improvement

  • Ideas & “pressure” from outside.

  • Influential change leader

  • Understand/involve customers


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


Lessons from Acadia Hospital(Mental Illness + Addiction Treatment)

Lynn M. Madden, MPA, CHE

Acadia Hospital

Bangor, Maine


Open Access to IOP

Clients fitting clinical profile (phone or ED) offered evaluation @ 7:30 next AM.

Evaluated clients start treatment same day


IOP Access Results

Continued growth in admissions(project implemented in March 2003)


IOP Operating Results

Serve more clients & operate more efficiently


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


Restraint reduction 41% Physical; 32% Mechanical

Restraints per 1000 bed days


NIATx State Pilot Project States play a key role in promoting adoption of process improvements

Delaware

Iowa

North Carolina

Oklahoma

Texas


Tx Agency Processes

State processes

Incentives

State

NIATx


Lessons from Oklahoma

Terry Cline, PhD

Oklahoma Department of Mental Health and Substance Abuse Services


Oklahoma Project #1

  • Eliminate eligibility determination requirement for those seeking treatment

  • Preliminary results:

    • Data being collected

    • Anecdote: one outpatient provider reduced time from 1st contact to admission from 30+ to 3 days


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


Technology

Technology can improve treatment of mental illness & addiction.

Electronic Medical Records are key AND . . .


Virtual Reality Simulations


Mobile Social Software (MoSoSo)


Smart Phones


Wearables: (pulse, blood pressure, sweating, etc)


Biofeedback


RFID (chip w medical record)

http://www.wired.com/wired/archive/8.02/warwick.html


Information/decision help(chess.chsra.wisc.edu/bc)


Video Conferencing on a PC


Diagnosis & Treatment Planning


Computer-based Discussion Groups


Affective Computing


Technology can help now!

  • Patients

  • Families

  • Treatment providers

  • Primary care and Emergency

  • Child welfare and criminal justice.


EMR

Reminders

Wearables

GPS

MoSoSo

Discussion Groups

Ask Expert

Vaccines

CHESS

VR training

Journaling

VR

Affective computing

Monitor w surveys & physiology. Immediate rewards w increasing payments. Social support.

Withdrawal symptoms

Fear

Overwhelm

Anger

Depressed

Hopeless

Reduced efficacy

Temporal discountng

Increasing lifestyle imbalance & desire for gratification

Hi-risk situation

No coping response

Prepare to quit w trial quit attempts. Train SOs

Rationalize

& deny

Initial lapse

Rehearse relapse

Analyze the situation & options

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

ID high-risk people

Set up plan

Remov craving causes

Lower symptoms

Remove symptoms Know warning sign

Ways to avoid & cope

VR

Decision analysis

Reminders

Video conf

Anti-drugs

Bio-feedback

VR

CBT

Video conf

Action planning

Online stress mgt

Problem knowledge couplers.

EMR

Video conferencing

RFID

Note: Smart phone will be key communication device.


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.


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