Trial Outcomes & Findings for Evaluating Improvement Strategies in Addiction Treatment (NCT NCT00934141)
NCT ID: NCT00934141
Last Updated: 2013-08-12
Results Overview
The average length of time in days it takes from when a patient first calls for help to the time a patient was able to meet a clinician. In this quality improvement study, changes in this measure over time are reported. Estimates of improvement show the average days of improvement per month based on a best linear unbiased predictor estimate for each site. Note: this study has three primary outcomes. The number of participants analyzed varies for each outcome. The (higher) number of clinics shown in the flow diagram results because clinics may have been analyzed on a subset of the three primary outcomes (e.g., analyzed for waiting time and continuation, but not for annual number of new patients). To be considered "analyzed" in the flow diagram, a clinic must have been included in at least one primary outcomes analysis.
Recruitment status
COMPLETED
Study phase
PHASE3
Target enrollment
201 participants
Primary outcome timeframe
Baseline and 15 months
Results posted on
2013-08-12
Participant Flow
Participant milestones
| Measure |
Interest Circle Call + Website
Interest Circles are monthly teleconferences where agency change leaders discuss change-related issues and progress. Circles address how to improve timeliness, continuation, admissions, dropouts and transitions. They also address specialty topics (e.g., programs for women, adolescents). Participants discuss successes, failures, and challenges, and get advice and assignments for their improvement plans. Meeting summaries appear on the Web site. Interest Circles are inexpensive, but are they are sufficient? Should Interest Circles prove effective, they would provide a low-cost, convenient diffusion approach.
|
Coaching + Website
Coaching assigns an expert in process improvement to work with an agency to make, sustain, and spread process improvement efforts. Consultations focus on executive directors, change leaders and improvement teams. Coaches help agencies address key issues, but also broker relationships with other agencies, offer process improvement training, and promote the innovations to make and how to make them. Coaching takes place during site visits, monthly phone conferences, and via email.
|
Full: LS, Coaching, ICC, Website
Learning Session, Coaching, Interest Circle Calls, Website, see descriptions above
|
Learning Session + Website
Learning Sessions occur bi-annually as change teams convene to learn and gather support from each other and outside experts who offer advice on how best to adopt the innovations and learn about new directions for the collaborative (e.g., the need to create business cases for improvements). Learning Sessions and Interest Circles (see below) have similar objectives-to help agencies learn and gather support from each other and from outside experts.
|
|---|---|---|---|---|
|
Overall Study
STARTED
|
49
|
50
|
48
|
54
|
|
Overall Study
COMPLETED
|
45
|
47
|
48
|
51
|
|
Overall Study
NOT COMPLETED
|
4
|
3
|
0
|
3
|
Reasons for withdrawal
Withdrawal data not reported
Baseline Characteristics
Evaluating Improvement Strategies in Addiction Treatment
Baseline characteristics by cohort
| Measure |
Interest Circle Call + Website
n=49 Participants
Interest Circles are monthly teleconferences where agency change leaders discuss change-related issues and progress. Circles address how to improve timeliness, continuation, admissions, dropouts and transitions. They also address specialty topics (e.g., programs for women, adolescents). Participants discuss successes, failures, and challenges, and get advice and assignments for their improvement plans. Meeting summaries appear on the Web site. Interest Circles are inexpensive, but are they are sufficient? Should Interest Circles prove effective, they would provide a low-cost, convenient diffusion approach.
|
Coaching + Website
n=50 Participants
Coaching assigns an expert in process improvement to work with an agency to make, sustain, and spread process improvement efforts. Consultations focus on executive directors, change leaders and improvement teams. Coaches help agencies address key issues, but also broker relationships with other agencies, offer process improvement training, and promote the innovations to make and how to make them. Coaching takes place during site visits, monthly phone conferences, and via email.
|
Full: LS, Coaching, ICC, Website
n=48 Participants
Learning Session, Coaching, Interest Circle Calls, Website, see descriptions above
|
Learning Session + Website
n=54 Participants
Learning Sessions occur bi-annually as change teams convene to learn and gather support from each other and outside experts who offer advice on how best to adopt the innovations and learn about new directions for the collaborative (e.g., the need to create business cases for improvements). Learning Sessions and Interest Circles (see below) have similar objectives-to help agencies learn and gather support from each other and from outside experts.
|
Total
n=201 Participants
Total of all reporting groups
|
|---|---|---|---|---|---|
|
Race/Ethnicity, Customized
Native Hawaiian or Other Pacific Islander
|
0 Non-white or Hispanic participants
n=93 Participants
|
0 Non-white or Hispanic participants
n=4 Participants
|
0 Non-white or Hispanic participants
n=27 Participants
|
0 Non-white or Hispanic participants
n=483 Participants
|
0 Non-white or Hispanic participants
n=36 Participants
|
|
Age Continuous
|
33.36 years
STANDARD_DEVIATION 11.81 • n=93 Participants
|
31.89 years
STANDARD_DEVIATION 12.02 • n=4 Participants
|
32.71 years
STANDARD_DEVIATION 11.81 • n=27 Participants
|
32.08 years
STANDARD_DEVIATION 12.19 • n=483 Participants
|
32.53 years
STANDARD_DEVIATION 11.96 • n=36 Participants
|
|
Sex: Female, Male
Female
|
16 Participants
n=93 Participants
|
17 Participants
n=4 Participants
|
16 Participants
n=27 Participants
|
17 Participants
n=483 Participants
|
66 Participants
n=36 Participants
|
|
Sex: Female, Male
Male
|
33 Participants
n=93 Participants
|
33 Participants
n=4 Participants
|
32 Participants
n=27 Participants
|
37 Participants
n=483 Participants
|
135 Participants
n=36 Participants
|
|
Race/Ethnicity, Customized
American Indian or Alaska Native
|
0 Non-white or Hispanic participants
n=93 Participants
|
0 Non-white or Hispanic participants
n=4 Participants
|
0 Non-white or Hispanic participants
n=27 Participants
|
0 Non-white or Hispanic participants
n=483 Participants
|
0 Non-white or Hispanic participants
n=36 Participants
|
|
Race/Ethnicity, Customized
Asian
|
0 Non-white or Hispanic participants
n=93 Participants
|
0 Non-white or Hispanic participants
n=4 Participants
|
0 Non-white or Hispanic participants
n=27 Participants
|
0 Non-white or Hispanic participants
n=483 Participants
|
0 Non-white or Hispanic participants
n=36 Participants
|
|
Race/Ethnicity, Customized
Black or African American
|
0 Non-white or Hispanic participants
n=93 Participants
|
0 Non-white or Hispanic participants
n=4 Participants
|
0 Non-white or Hispanic participants
n=27 Participants
|
0 Non-white or Hispanic participants
n=483 Participants
|
0 Non-white or Hispanic participants
n=36 Participants
|
|
Race/Ethnicity, Customized
White
|
0 Non-white or Hispanic participants
n=93 Participants
|
0 Non-white or Hispanic participants
n=4 Participants
|
0 Non-white or Hispanic participants
n=27 Participants
|
0 Non-white or Hispanic participants
n=483 Participants
|
0 Non-white or Hispanic participants
n=36 Participants
|
|
Race/Ethnicity, Customized
More than one race
|
0 Non-white or Hispanic participants
n=93 Participants
|
0 Non-white or Hispanic participants
n=4 Participants
|
0 Non-white or Hispanic participants
n=27 Participants
|
0 Non-white or Hispanic participants
n=483 Participants
|
0 Non-white or Hispanic participants
n=36 Participants
|
|
Race/Ethnicity, Customized
Unknown or Not Reported
|
49 Non-white or Hispanic participants
n=93 Participants
|
50 Non-white or Hispanic participants
n=4 Participants
|
48 Non-white or Hispanic participants
n=27 Participants
|
54 Non-white or Hispanic participants
n=483 Participants
|
201 Non-white or Hispanic participants
n=36 Participants
|
|
Region of Enrollment
United States
|
49 participants
n=93 Participants
|
50 participants
n=4 Participants
|
48 participants
n=27 Participants
|
54 participants
n=483 Participants
|
201 participants
n=36 Participants
|
|
Organizational structure
Private for-profit
|
0 participants
n=93 Participants
|
0 participants
n=4 Participants
|
0 participants
n=27 Participants
|
3 participants
n=483 Participants
|
3 participants
n=36 Participants
|
|
Organizational structure
Private not-for-profit
|
37 participants
n=93 Participants
|
41 participants
n=4 Participants
|
41 participants
n=27 Participants
|
43 participants
n=483 Participants
|
162 participants
n=36 Participants
|
|
Organizational structure
Unit of state government
|
4 participants
n=93 Participants
|
1 participants
n=4 Participants
|
4 participants
n=27 Participants
|
3 participants
n=483 Participants
|
12 participants
n=36 Participants
|
|
Organizational structure
Unit of tribal government
|
1 participants
n=93 Participants
|
2 participants
n=4 Participants
|
2 participants
n=27 Participants
|
2 participants
n=483 Participants
|
7 participants
n=36 Participants
|
|
Organizational structure
Unit of other government
|
7 participants
n=93 Participants
|
6 participants
n=4 Participants
|
1 participants
n=27 Participants
|
3 participants
n=483 Participants
|
17 participants
n=36 Participants
|
|
Primary setting
Hospital/Health Center (including primary setting)
|
4 participants
n=93 Participants
|
6 participants
n=4 Participants
|
5 participants
n=27 Participants
|
3 participants
n=483 Participants
|
18 participants
n=36 Participants
|
|
Primary setting
Community mental health clinic
|
7 participants
n=93 Participants
|
13 participants
n=4 Participants
|
5 participants
n=27 Participants
|
10 participants
n=483 Participants
|
35 participants
n=36 Participants
|
|
Primary setting
Free-standing alcohol or drug treatment clinic
|
26 participants
n=93 Participants
|
25 participants
n=4 Participants
|
26 participants
n=27 Participants
|
32 participants
n=483 Participants
|
109 participants
n=36 Participants
|
|
Primary setting
Family or children's service agency
|
3 participants
n=93 Participants
|
2 participants
n=4 Participants
|
1 participants
n=27 Participants
|
2 participants
n=483 Participants
|
8 participants
n=36 Participants
|
|
Primary setting
Social services agency
|
1 participants
n=93 Participants
|
2 participants
n=4 Participants
|
3 participants
n=27 Participants
|
2 participants
n=483 Participants
|
8 participants
n=36 Participants
|
|
Primary setting
Corrections
|
3 participants
n=93 Participants
|
0 participants
n=4 Participants
|
1 participants
n=27 Participants
|
1 participants
n=483 Participants
|
5 participants
n=36 Participants
|
|
Primary setting
Other or unreported
|
5 participants
n=93 Participants
|
2 participants
n=4 Participants
|
7 participants
n=27 Participants
|
4 participants
n=483 Participants
|
18 participants
n=36 Participants
|
|
Clinics' annual number of patient admissions per year
|
500 Patients per year
STANDARD_DEVIATION 485 • n=93 Participants
|
578 Patients per year
STANDARD_DEVIATION 684 • n=4 Participants
|
488 Patients per year
STANDARD_DEVIATION 437 • n=27 Participants
|
671 Patients per year
STANDARD_DEVIATION 1031 • n=483 Participants
|
559.25 Patients per year
STANDARD_DEVIATION 659.25 • n=36 Participants
|
|
Rating of management quality
|
3.02 Units on a scale between 1 and 5
STANDARD_DEVIATION 0.54 • n=93 Participants
|
2.97 Units on a scale between 1 and 5
STANDARD_DEVIATION 0.64 • n=4 Participants
|
2.99 Units on a scale between 1 and 5
STANDARD_DEVIATION 0.57 • n=27 Participants
|
2.95 Units on a scale between 1 and 5
STANDARD_DEVIATION 0.73 • n=483 Participants
|
2.98 Units on a scale between 1 and 5
STANDARD_DEVIATION 0.62 • n=36 Participants
|
PRIMARY outcome
Timeframe: Baseline and 15 monthsThe average length of time in days it takes from when a patient first calls for help to the time a patient was able to meet a clinician. In this quality improvement study, changes in this measure over time are reported. Estimates of improvement show the average days of improvement per month based on a best linear unbiased predictor estimate for each site. Note: this study has three primary outcomes. The number of participants analyzed varies for each outcome. The (higher) number of clinics shown in the flow diagram results because clinics may have been analyzed on a subset of the three primary outcomes (e.g., analyzed for waiting time and continuation, but not for annual number of new patients). To be considered "analyzed" in the flow diagram, a clinic must have been included in at least one primary outcomes analysis.
Outcome measures
| Measure |
Learning Session + Website
n=44 Participants
Learning Sessions occur bi-annually as change teams convene to learn and gather support from each other and outside experts who offer advice on how best to adopt the innovations and learn about new directions for the collaborative (e.g., the need to create business cases for improvements). Learning Sessions and Interest Circles (see below) have similar objectives-to help agencies learn and gather support from each other and from outside experts.
|
Interest Circle Call + Website
n=36 Participants
Interest Circles are monthly teleconferences where agency change leaders discuss change-related issues and progress. Circles address how to improve timeliness, continuation, admissions, dropouts and transitions. They also address specialty topics (e.g., programs for women, adolescents). Participants discuss successes, failures, and challenges, and get advice and assignments for their improvement plans. Meeting summaries appear on the Web site. Interest Circles are inexpensive, but are they are sufficient? Should Interest Circles prove effective, they would provide a low-cost, convenient diffusion approach.
|
Coaching + Website
n=42 Participants
Coaching assigns an expert in process improvement to work with an agency to make, sustain, and spread process improvement efforts. Consultations focus on executive directors, change leaders and improvement teams. Coaches help agencies address key issues, but also broker relationships with other agencies, offer process improvement training, and promote the innovations to make and how to make them. Coaching takes place during site visits, monthly phone conferences, and via email.
|
Learning Session + Website
n=41 Participants
Learning Sessions occur bi-annually as change teams convene to learn and gather support from each other and outside experts who offer advice on how best to adopt the innovations and learn about new directions for the collaborative (e.g., the need to create business cases for improvements). Learning Sessions and Interest Circles (see below) have similar objectives-to help agencies learn and gather support from each other and from outside experts.
|
|---|---|---|---|---|
|
Change in Average Waiting Time From First Contact to Treatment
|
3.520 Change in days
Standard Error 1.407
|
.253 Change in days
Standard Error 1.514
|
4.610 Change in days
Standard Error 1.414
|
4.723 Change in days
Standard Error 1.421
|
PRIMARY outcome
Timeframe: 48 months (2 year baseline period and 2 year post-intervention period)We aimed to increase clinics' treatment capacity in this quality improvement study. Capacity was measured by counting clinics' annual number of patient admissions. We monitored changes in admission counts, per clinic, in a pre-post analysis. Changes in the natural logarithm of annual admissions are presented, which approximates the average percentage change (year-to-year) in the number of new patient admissions per clinic. Note: this study has three primary outcomes. The number of participants analyzed varies for each outcome. The (higher) number of clinics shown in the flow diagram results because clinics may have been analyzed on a subset of the three primary outcomes (e.g., analyzed for waiting time and continuation, but not for annual number of new patients). To be considered "analyzed" in the flow diagram, a clinic must have been included in at least one primary outcomes analysis.
Outcome measures
| Measure |
Learning Session + Website
n=33 Participants
Learning Sessions occur bi-annually as change teams convene to learn and gather support from each other and outside experts who offer advice on how best to adopt the innovations and learn about new directions for the collaborative (e.g., the need to create business cases for improvements). Learning Sessions and Interest Circles (see below) have similar objectives-to help agencies learn and gather support from each other and from outside experts.
|
Interest Circle Call + Website
n=41 Participants
Interest Circles are monthly teleconferences where agency change leaders discuss change-related issues and progress. Circles address how to improve timeliness, continuation, admissions, dropouts and transitions. They also address specialty topics (e.g., programs for women, adolescents). Participants discuss successes, failures, and challenges, and get advice and assignments for their improvement plans. Meeting summaries appear on the Web site. Interest Circles are inexpensive, but are they are sufficient? Should Interest Circles prove effective, they would provide a low-cost, convenient diffusion approach.
|
Coaching + Website
n=40 Participants
Coaching assigns an expert in process improvement to work with an agency to make, sustain, and spread process improvement efforts. Consultations focus on executive directors, change leaders and improvement teams. Coaches help agencies address key issues, but also broker relationships with other agencies, offer process improvement training, and promote the innovations to make and how to make them. Coaching takes place during site visits, monthly phone conferences, and via email.
|
Learning Session + Website
n=38 Participants
Learning Sessions occur bi-annually as change teams convene to learn and gather support from each other and outside experts who offer advice on how best to adopt the innovations and learn about new directions for the collaborative (e.g., the need to create business cases for improvements). Learning Sessions and Interest Circles (see below) have similar objectives-to help agencies learn and gather support from each other and from outside experts.
|
|---|---|---|---|---|
|
Change in Annual Number of Patient Admissions
|
8.9 Percent change (approx.)
95% Confidence Interval .041 • Interval 0.8 to 17.0
|
-3.6 Percent change (approx.)
95% Confidence Interval .040 • Interval -11.7 to 4.4
|
19.5 Percent change (approx.)
95% Confidence Interval .089 • Interval 1.7 to 37.3
|
0.0 Percent change (approx.)
95% Confidence Interval .065 • Interval -13.2 to 12.9
|
PRIMARY outcome
Timeframe: Baseline and 21 monthsThis outcome represents change in the rate at which a clinic's patients continue in treatment. Continuation rate is defined as the percentage of patients that make at least 4 visits to the clinic, on different days, before being discharged. Estimates of improvement show the average percentage points of improvement per month based on a best linear unbiased predictor estimate for each site. Note: this study has three primary outcomes. The number of participants analyzed varies for each outcome. The (higher) number of clinics shown in the flow diagram results because clinics may have been analyzed on a subset of the three primary outcomes (e.g., analyzed for waiting time and continuation, but not for annual number of new patients). To be considered "analyzed" in the flow diagram, a clinic must have been included in at least one primary outcomes analysis.
Outcome measures
| Measure |
Learning Session + Website
n=42 Participants
Learning Sessions occur bi-annually as change teams convene to learn and gather support from each other and outside experts who offer advice on how best to adopt the innovations and learn about new directions for the collaborative (e.g., the need to create business cases for improvements). Learning Sessions and Interest Circles (see below) have similar objectives-to help agencies learn and gather support from each other and from outside experts.
|
Interest Circle Call + Website
n=35 Participants
Interest Circles are monthly teleconferences where agency change leaders discuss change-related issues and progress. Circles address how to improve timeliness, continuation, admissions, dropouts and transitions. They also address specialty topics (e.g., programs for women, adolescents). Participants discuss successes, failures, and challenges, and get advice and assignments for their improvement plans. Meeting summaries appear on the Web site. Interest Circles are inexpensive, but are they are sufficient? Should Interest Circles prove effective, they would provide a low-cost, convenient diffusion approach.
|
Coaching + Website
n=41 Participants
Coaching assigns an expert in process improvement to work with an agency to make, sustain, and spread process improvement efforts. Consultations focus on executive directors, change leaders and improvement teams. Coaches help agencies address key issues, but also broker relationships with other agencies, offer process improvement training, and promote the innovations to make and how to make them. Coaching takes place during site visits, monthly phone conferences, and via email.
|
Learning Session + Website
n=43 Participants
Learning Sessions occur bi-annually as change teams convene to learn and gather support from each other and outside experts who offer advice on how best to adopt the innovations and learn about new directions for the collaborative (e.g., the need to create business cases for improvements). Learning Sessions and Interest Circles (see below) have similar objectives-to help agencies learn and gather support from each other and from outside experts.
|
|---|---|---|---|---|
|
Change in Average Continuation Rate Through the Fourth Treatment Session
|
.013 Change in continuation rate
Standard Error .018
|
-.019 Change in continuation rate
Standard Error .021
|
-.02 Change in continuation rate
Standard Error .016
|
-.004 Change in continuation rate
Standard Error .017
|
SECONDARY outcome
Timeframe: Baseline and 18 monthsThe goal of the economic analysis was to estimate costs of each group for governmental authorities who might organize improvement collaboratives. We collected the cost of personnel (state employees, NIATx employees, coaches and consultants), data management, buildings and facilities, lodging, travel, telephone calls and miscellaneous costs. Costs were categorized as group specific (such as hotel costs for the learning sessions group) or non-group-specific, which included state-incurred costs for outreach, data management and infrastructure, encouraging participation and administration. Cost data were collected three times during the study period and aggregated to create a total cost estimate. Figures reported below represent costs at the arm/group level (costs were not assessed at the organizational level). Measure type is "Number."
Outcome measures
| Measure |
Learning Session + Website
n=51 Participants
Learning Sessions occur bi-annually as change teams convene to learn and gather support from each other and outside experts who offer advice on how best to adopt the innovations and learn about new directions for the collaborative (e.g., the need to create business cases for improvements). Learning Sessions and Interest Circles (see below) have similar objectives-to help agencies learn and gather support from each other and from outside experts.
|
Interest Circle Call + Website
n=45 Participants
Interest Circles are monthly teleconferences where agency change leaders discuss change-related issues and progress. Circles address how to improve timeliness, continuation, admissions, dropouts and transitions. They also address specialty topics (e.g., programs for women, adolescents). Participants discuss successes, failures, and challenges, and get advice and assignments for their improvement plans. Meeting summaries appear on the Web site. Interest Circles are inexpensive, but are they are sufficient? Should Interest Circles prove effective, they would provide a low-cost, convenient diffusion approach.
|
Coaching + Website
n=47 Participants
Coaching assigns an expert in process improvement to work with an agency to make, sustain, and spread process improvement efforts. Consultations focus on executive directors, change leaders and improvement teams. Coaches help agencies address key issues, but also broker relationships with other agencies, offer process improvement training, and promote the innovations to make and how to make them. Coaching takes place during site visits, monthly phone conferences, and via email.
|
Learning Session + Website
n=48 Participants
Learning Sessions occur bi-annually as change teams convene to learn and gather support from each other and outside experts who offer advice on how best to adopt the innovations and learn about new directions for the collaborative (e.g., the need to create business cases for improvements). Learning Sessions and Interest Circles (see below) have similar objectives-to help agencies learn and gather support from each other and from outside experts.
|
|---|---|---|---|---|
|
Cost of Group
|
229229 USD ($)
|
59790 USD ($)
|
135244 USD ($)
|
380652 USD ($)
|
Adverse Events
Interest Circle Call + Website
Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths
Coaching + Website
Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths
Full: LS, Coaching, ICC, Website
Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths
Learning Session + Website
Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths
Serious adverse events
Adverse event data not reported
Other adverse events
Adverse event data not reported
Additional Information
Dr. David H Gustafson
University of Wisconsin - Madison
Phone: 608-890-1436
Email: [email protected]
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place