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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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 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



NIATx Presence Communications Research


Key points
Key Points Communications Research

  • 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 Communications Research

Admission


Between patient and caring help lies a canyon of paperwork and burdensome processes
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
Our focus: Nine Processes. paperwork and burdensome processes

  • First contact

  • Intake and assessment

  • Transition thru levels of care

  • Paperwork

  • Scheduling

  • Engagement

  • Social supports

  • Outreach

  • Maximizing revenue


Clear, precise aims paperwork and burdensome processes

Reduce Waiting Times

Reduce No-Shows

Increase Admissions

Increase Continuation Rates


Five evidence based principles
Five Evidence Based Principles paperwork and burdensome processes

  • Help the CEO sleep

  • Rapid improvement

  • Ideas & “pressure” from outside.

  • Influential change leader

  • Understand/involve customers


Results so far
Results so Far paperwork and burdensome processes.

  • 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

Lessons from Acadia Hospital paperwork and burdensome processes(Mental Illness + Addiction Treatment)

Lynn M. Madden, MPA, CHE

Acadia Hospital

Bangor, Maine


Open access to iop
Open Access to IOP paperwork and burdensome processes

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

Evaluated clients start treatment same day


Iop access results
IOP Access Results paperwork and burdensome processes

Continued growth in admissions(project implemented in March 2003)


Iop operating results
IOP Operating Results paperwork and burdensome processes

Serve more clients & operate more efficiently


Physical restraints cms jcaho
Physical Restraints paperwork and burdensome processes(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
Restraint reduction paperwork and burdensome processes41% Physical; 32% Mechanical

Restraints per 1000 bed days


Niatx state pilot project states play a key role in promoting adoption of process improvements
NIATx State Pilot Project paperwork and burdensome processes States play a key role in promoting adoption of process improvements

Delaware

Iowa

North Carolina

Oklahoma

Texas


Tx Agency Processes paperwork and burdensome processes

State processes

Incentives

State

NIATx


Lessons from oklahoma

Lessons from Oklahoma paperwork and burdensome processes

Terry Cline, PhD

Oklahoma Department of Mental Health and Substance Abuse Services


Oklahoma project 1
Oklahoma Project #1 paperwork and burdensome processes

  • 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
Oklahoma Project #2 paperwork and burdensome processes

  • 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 paperwork and burdensome processes

Technology can improve treatment of mental illness & addiction.

Electronic Medical Records are key AND . . .


Virtual reality simulations
Virtual Reality Simulations paperwork and burdensome processes


Mobile social software mososo
Mobile Social Software (MoSoSo) paperwork and burdensome processes


Smart phones
Smart Phones paperwork and burdensome processes


Wearables pulse blood pressure sweating etc
Wearables: paperwork and burdensome processes(pulse, blood pressure, sweating, etc)


Biofeedback
Biofeedback paperwork and burdensome processes


Rfid chip w medical record
RFID (chip w medical record) paperwork and burdensome processes

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


Information decision help chess chsra wisc edu bc
Information/decision help paperwork and burdensome processes(chess.chsra.wisc.edu/bc)


Video conferencing on a pc
Video Conferencing on a PC paperwork and burdensome processes


Diagnosis treatment planning
Diagnosis & Treatment Planning paperwork and burdensome processes


Computer based discussion groups
Computer-based Discussion Groups paperwork and burdensome processes


Affective computing
Affective Computing paperwork and burdensome processes


Technology can help now
Technology can help now! paperwork and burdensome processes

  • Patients

  • Families

  • Treatment providers

  • Primary care and Emergency

  • Child welfare and criminal justice.


EMR paperwork and burdensome processes

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 points1
Key Points paperwork and burdensome processes

  • 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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