David Gustafson PhD

1
Improving M/SU Treatment Effectiveness
Efficiency
David Gustafson PhD NIATx Director, University of
Wisconsin-Madison
Reduce Waiting  No-Shows ? Increase Admissions 
Continuation
2
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

3
Also NCIs TECC Center of Excellence in Cancer
Communications Research
4
NIATx Presence
5
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.

6

Process Improvement
Admission
7
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!

8
Our focus Nine Processes.

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

9
Clear, precise aims

• Reduce Waiting Times
• Reduce No-Shows
• Increase Admissions
• Increase Continuation Rates

10
Five Evidence Based Principles

• Help the CEO sleep
• Rapid improvement
• Ideas pressure from outside.
• Influential change leader
• Understand/involve customers

11
Results so Far.

• Waiting Times 51 (n37)
• Reduce No-Shows 41 (n28)
• Increaase admissions 56 (n23)
• Improve continuation 39 (n39)

Change cycle data
12
Lessons from Acadia Hospital(Mental Illness
Addiction Treatment)

• Lynn M. Madden, MPA, CHE
• Acadia Hospital
• Bangor, Maine

13
Open Access to IOP

• Clients fitting clinical profile (phone or ED)
  offered evaluation _at_ 730 next AM.
• Evaluated clients start treatment same day

14
IOP Access Results

• Continued growth in admissions (project
  implemented in March 2003)

15
IOP Operating Results

• Serve more clients operate more efficiently

16
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

17
Restraint reduction 41 Physical 32 Mechanical
Restraints per 1000 bed days
18
NIATx State Pilot Project States play a key role
in promoting adoption of process improvements

• Delaware
• Iowa
• North Carolina
• Oklahoma
• Texas

19
Tx Agency Processes
State processes
Incentives
State
NIATx
20
Lessons from Oklahoma

• Terry Cline, PhD
• Oklahoma Department of Mental Health and
  Substance Abuse Services

21
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

22
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

23
Technology

• Technology can improve treatment of mental
  illness addiction.
• Electronic Medical Records are key AND . . .

24
Virtual Reality Simulations
25
Mobile Social Software (MoSoSo)
26
Smart Phones
27
Wearables (pulse, blood pressure, sweating, etc)

28
Biofeedback
29
RFID (chip w medical record)
30
Information/decision help(chess.chsra.wisc.edu/bc
)
31
Video Conferencing on a PC
32
Diagnosis Treatment Planning
33
Computer-based Discussion Groups
34
Affective Computing

35
Technology can help now!

• Patients
• Families
• Treatment providers
• Primary care and Emergency
• Child welfare and criminal justice.

36
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
Rationalize deny
Hi-risk situation
No coping response
Initial lapse
Prepare to quit w trial quit attempts. Train SOs
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
Remove symptoms Know warning sign Ways to avoid
cope
ID high-risk people Set up plan Remov craving
causes Lower symptoms
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.
37
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.