NIATx200: Impact of the Study Interventions on Access and Retention

The second session reports the main outcomes of the NIATx200 study. We worked with five states (MA, MI, NY, OR, and WA) to recruit addiction treatment providers to participate in an 18-month improvement collaborative. Organizations offering outpatient or intensive outpatient addiction services with at least 60 annual admissions were eligible to participate in the trial. A total of 201 programs enrolled in the study. Sites were assigned to interest circle calls (n=49), coaching (n=50), learning sessions (n=54), and the combination of all services (n=48). Main outcomes included significant reductions in waiting time in the coaching and combination arms (p < .05). Significant increases in annual program admissions were observed in the coaching and combination arms as well. While improvement rates were similar between the coaching and combination arm, the combination arm exhibited less variation in improvement than the coaching arm. Differences in improvement rates between the coaching and combination arms were statistically significant when compared to improvement rates in the interest circle calls arm. Coaching was common to both arms, suggesting that coaching is the element of the collaborative that is key to improvement. While slight increases in continuation were observed in the coaching, learning sessions, and combination arms, the increases did not reach statistical significance. Across all arms, staff turnover and revenue instability affected organizations' ability to improve. NIATx 200, as one of the few organizational studies to employ a randomized design, provides some of the strongest evidence to date on the effectiveness of quality improvement in healthcare.