Management Practices in Addiction Treatment Programs

1. Management Practices in Addiction Treatment Programs K. John McConnell, PhD Oregon Health & Science University Supported by a grant from NIDA 1R01DA020832

2. Two research threads • Substance Abuse: • A call for research on the “business” of addiction treatment (Kimberly & McLellan, JSAT 2006) • Economics: • Typically treat “management quality” as a fixed effect • New research to measure management practice (Bloom & Van Reenen, QJE 2007) • Innovative telephone survey to “score” management practice • Strongly correlated with firm performance (>700 firms in 4 countries)

3. Study Objective • Adapt management practice survey tool to addiction treatment programs • Are better management practices associated with better client treatment?

4. Study Sample • Programs from the NIATx 200 project • NIDA 1R01DA020832 • Approximately 200 agencies in 5 States (MA, MI, NY, OR, WA) randomized to different levels of support (coaching, interest circles, learning sessions, and combinations of all 3) • We use data on 147 surveys by 3 interviewers • ~20 programs not interviewed because they were part of a multi-site agency • Excluded 5 programs with different interviewers • Excluded 5 with interview scored as “not reliable” • Excluded 20 with missing data

5. Steps to measure management practices • Developing management practice scoring • Adapted scorecard for 14 questions on 4 areas: • Client intake and retention • Quality improvement & data monitoring • Program targets • Incentives & employee management • 60 minute phone interview of program executive sponsors • Obtaining unbiased responses • Interviews run by 3 MPH level research assistants • “Double-blind”: • Interviewers do not know program performance • Interviewees are not informed (in advance) they are scored • “Open-ended” question format

7. Analysis • Negative binomial, clustered std. err. • Outcome: Time to treatment • Days from first phone call to first appointment • Pseudo-patient phone calls by NIATx researcher • Caller identified herself as NIATx researcher • Average of 7 calls made to each program • Independent variables • Average z-score of management practices across 14 questions • z-score removes scaling issues between questions • Employee FTE • State & interviewer fixed effects • Day of week for pseudo-patient phone call • Month of survey

8. Results

9. Distribution of management practice scores for 147 addiction treatment programs

10. Double-scored interviews(N = 14)

11. Model results • Main analysis: • Time-to-treatment • 1081 observations on 147 programs • Management score significantly associated with time-to-treatment (P <0.01) • Sub-analyses • 7 of 14 management practices were correlated with better time to treatment • Of the 4 areas, 3 were associated with better time-to-treatment • Client intake and retention • Quality improvement & data monitoring • Program targets • One was not • Incentives & employee management • ?

12. Limitations • Endogeneity • Double scoring vs. test-retest • Programs selected from NIATx 200 project

13. Concluding thoughts • Management practices can be measured and are associated with client treatment • Are they associated with financial outcomes? • Do employee incentives matter or are substance abuse treatment programs “different”? • NIATx aims for process improvement; can we design interventions to improve management practices?

14. University of Wisconsin David Gustafson, PI Andy Quanbeck Alice Pulvermacher Jay Ford Anna Wheelock Renee Hill Oregon Health & Science University Dennis McCarty Kim Hoffman Marie Shea Gretchen Luhr Susan Rosenkranz Traci Rieckmann Stanford University Nick Bloom Thank you Research supported by NIDA R01DA020832