David Gustafson PhD NIATx Director, University of Wisconsin-Madison

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 NCI’s 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% (n=37) • Reduce No-Shows: 41% (n=28) • Increaase admissions: 56% (n=23) • Improve continuation : 39% (n=39) *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 @ 7:30 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) http://www.wired.com/wired/archive/8.02/warwick.html

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 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.

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.