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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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slide1

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

key points
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.
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.
  • First contact
  • Intake and assessment
  • Transition thru levels of care
  • Paperwork
  • Scheduling
  • Engagement
  • Social supports
  • Outreach
  • Maximizing revenue
slide9

Clear, precise aims

Reduce Waiting Times

Reduce No-Shows

Increase Admissions

Increase Continuation Rates

five evidence based principles
Five Evidence Based Principles
  • Help the CEO sleep
  • Rapid improvement
  • Ideas & “pressure” from outside.
  • Influential change leader
  • Understand/involve customers
results so far
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

Lessons from Acadia Hospital(Mental Illness + Addiction Treatment)

Lynn M. Madden, MPA, CHE

Acadia Hospital

Bangor, Maine

open access to iop
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
IOP Access Results

Continued growth in admissions(project implemented in March 2003)

iop operating results
IOP Operating Results

Serve more clients & operate more efficiently

physical restraints cms jcaho
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
niatx state pilot project states play a key role in promoting adoption of process improvements
NIATx State Pilot Project States play a key role in promoting adoption of process improvements

Delaware

Iowa

North Carolina

Oklahoma

Texas

slide19

Tx Agency Processes

State processes

Incentives

State

NIATx

lessons from oklahoma

Lessons from Oklahoma

Terry Cline, PhD

Oklahoma Department of Mental Health and Substance Abuse Services

oklahoma project 1
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
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

Technology can improve treatment of mental illness & addiction.

Electronic Medical Records are key AND . . .

rfid chip w medical record
RFID (chip w medical record)

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

technology can help now
Technology can help now!
  • Patients
  • Families
  • Treatment providers
  • Primary care and Emergency
  • Child welfare and criminal justice.
slide36

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 points1
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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