Innovation Adoption in Substance Abuse Treatment: Exposure, Trialability, and the Clinical Trials Network

Institute for Behavioral Research, University of Georgia, Athens, GA 30602-2401, USA.
Journal of Substance Abuse Treatment (Impact Factor: 3.14). 07/2007; 32(4):321-9. DOI: 10.1016/j.jsat.2006.05.021
Source: PubMed


Researchers and policymakers are increasingly focusing on factors that facilitate or impede the diffusion of evidence-based treatment techniques into routine clinical practice. One potentially fruitful avenue of research is the influence of involvement in research networks as a predictor of organizational innovation. The Clinical Trials Network (CTN) is examining a number of behavioral and pharmacological treatment techniques in controlled multisite studies. Using data from participating CTN treatment programs and large samples of programs outside the CTN, these analyses examine the influence of exposure to clinical trials on the subsequent adoption of buprenorphine and voucher-based motivational incentives. The analyses show that, controlling for a variety of organizational characteristics, direct exposure to buprenorphine clinical trials in the CTN significantly increased the odds of subsequent adoption. By contrast, the adoption of motivational incentives was entirely explained by organizational characteristics. The findings suggest that adoption of treatment innovations is a function of exposure, organizational resources, nature of innovations, and stage of the diffusion process.

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    • "Larger addiction treatment centers were reported by some to be more likely to implement QI (Knudsen, Ducharme, & Roman, 2007; Knudsen, & Roman, 2004), while an analysis of programs participating in a national research network found a negative relationship between size and QI (Ducharme, Knudsen, Roman, & Johnson, 2007). Corporate structure (forprofit versus not-for-profit) also has inconsistent relationships with the use of QI (Ducharme et al., 2007; Knudsen et al., 2007; Knudsen & Roman, 2004). Roman and colleagues observed a strong need for leadership on implementation to counteract the tendency of clinics to discontinue evidence-based practices after adopting them (Roman et al., 2010). "
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    ABSTRACT: Healthcare providers have increased the use of quality improvement (QI) techniques, but organizational variables that affect QI uptake and implementation warrant further exploration. This study investigates organizational characteristics associated with clinics that enroll and participate over time in QI. The Network for the Improvement of Addiction Treatment (NIATx) conducted a large cluster-randomized trial of outpatient addiction treatment clinics, called NIATx 200, which randomized clinics to one of four QI implementation strategies: (1) interest circle calls, (2) coaching, (3) learning sessions, and (4) the combination of all three components. Data on organizational culture and structure were collected before, after randomization, and during the 18-month intervention. Using univariate descriptive analyses and regression techniques, the study identified two significant differences between clinics that enrolled in the QI study (n = 201) versus those that did not (n = 447). Larger programs were more likely to enroll and clinics serving more African Americans were less likely to enroll. Once enrolled, higher rates of QI participation were associated with clinics' not having a hospital affiliation, being privately owned, and having staff who perceived management support for QI. The study discusses lessons for the field and future research needs.
    Journal for Healthcare Quality 01/2014; 37(6). DOI:10.1111/jhq.12064 · 1.40 Impact Factor
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    • "This difficulty is especially visible within the U.S. substance abuse treatment system. For example, Ducharme and colleagues found that exposure to training and positive feedback from peer organizations regarding CM did not persuade clinics to use incentives such as motivational vouchers (Ducharme et al. 2007). Instead, clinical structural factors such as revenue sources, accreditation, and type of clinical programming had a more pronounced negative influence on the use of CM. "

    01/2013; 1(1):7. DOI:10.1186/2194-7899-1-7
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    • "Social architecture, or how staff is organized to provide services, is often clustered around particular services or clientele. In identified literature, the presence of methadone services predicts adoption whereas presence of detox services is an inverse predictor (Bride et al., 2011; Ducharme et al., 2007). With respect to client subgroups, greater adoption occurs in publicly-funded programs serving adolescents or drug-court referrals (Bride et al., 2011). "
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