NIATx200: Study Description and Lessons Learned

The first session presentation about the NIATx 200 randomized controlled trial will provide background information on the study, including a detailed overview of the study design and commentary on managing a project of this scope. NIATx 200 is, to our knowledge, the largest randomized trial of organizational change ever conducted in addiction treatment and among the largest ever conducted in healthcare. NIATx 200 evaluated the costs and effectiveness of different approaches to quality improvement by randomizing 201 addiction-treatment agencies across five states to four interventions. Each intervention used a web-based learning kit plus (1) monthly phone calls, (2) coaching, (3) face-to-face meetings, or (4) the combination of all three. Using their assigned intervention, participating organizations made changes aimed at improving treatment access and retention. Effectiveness was defined as reducing the days between first contact and treatment, increasing program admissions, and increasing continuation in treatment. Opportunity costs were estimated for the resources associated with providing the services.

Quality improvement collaboratives are widely used to address quality problems in healthcare. Randomized controlled trials of quality improvement are rare, and the few that have been implemented provide little clear direction about effective methods of disseminating improvement. The project management team offers seven recommendations for conducting a large-scale randomized controlled trials of organizations based on their experience: (1) provide valuable services, (2) have aims that are clear and important, (3) seek powerful allies, (4) understand the recruiting challenge, (5) cultivate commitment, (6) address turnover, and (7) encourage rigor and flexibility.