246758 NIATx200: Study Description and Lessons Learned

Tuesday, November 1, 2011: 12:35 PM

Andrew Quanbeck, MSIE , Center for Health Enhancement Systems Studies, University of Wisconsin - Madison, Madison, WI
David Gustafson, PhD , Center for Health Systems Research and Analysis (CHSRA), University of Wisconsin - Madison, Madison, WI
James Ford II, PhD , Center for Health Enhancement Systems Studies, University of Wisconsin - Madison, Madison, WI
Alice Pulvermacher, MS , Center for Health Enhancement Systems Studies, University of Wisconsin - Madison, Madison, WI
Michael French, PhD , Departments of Sociology, Epidemiology and Public Health, Economics, University of Miami, Coral Gables, FL
Kenneth McConnell, PhD , Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
Dennis McCarty, PhD , Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR
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.

Learning Areas:
Administration, management, leadership
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Describe the study design of the NIATx 200 randomized controlled trial, a study of quality improvement in addiction treatment Describe the NIATx 200 study in historical context through a review of the literature on randomized trials of organizational change in healthcare Discuss the challenges in applying the principles of randomized controlled trials at the organizational level and to highlight a series of lessons learned by the study management team

Keywords: Quality Improvement, Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an associate researcher and doctoral candidate in the Industrial & Systems Engineering program at the University of Wisconsin. I contributed to the design of the NIATx 200 study and was responsible for implementation of the protocol.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
NIATx Foundation Quality Improvement Consultant

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.