Article

Innovation adoption in substance abuse treatment: Exposure, trialability and the Clinical Trials Network. Journal of Substance Abuse Treatment, 32, 321-329

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

ABSTRACT 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.

Download full-text

Full-text

Available from: Paul Michael Roman, Aug 28, 2015
0 Followers
 · 
145 Views
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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; DOI:10.1111/jhq.12064
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Extant literature on contingency management (CM) transportability, or its transition from academia to community practice, is reviewed. The Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) guides the examination of this material. PsychInfo and Medline database searches identified 27 publications, with reviewed reference lists garnering 22 others. These 49 sources were examined according to CFIR domains of the intervention, outer setting, inner setting, clinicians, and implementation processes. Intervention characteristics were focal in 59% of the identified literature, with less frequent focus on clinicians (34%), inner setting (32%), implementation processes (18%), and outer setting (8%). As intervention characteristics, adaptability and trialability most facilitate transportability whereas non-clinical origin, perceived inefficacy or disadvantages, and costs are impediments. Clinicians with a managerial focus and greater clinic tenure and CM experience are candidates to curry organizational readiness for implementation, and combat staff disinterest or philosophical objection. A clinic's technology comfort, staff continuity, and leadership advocacy are inner setting characteristics that prompt effective implementation. Implementation processes in successful demonstration projects include careful fiscal/logistical planning, role-specific staff engagement, practical adaptation in execution, and evaluation via fidelity-monitoring and cost-effectiveness analyses. Outer setting characteristics-like economic policies and inter-agency networking or competition-are salient, often unrecognized influences. As most implementation constructs are still moving targets, CM transportability is in its infancy and warrants further scientific attention. More effective dissemination may necessitate that future research weight emphasis on external validity, and utilize models of implementation science.
    Drug and alcohol dependence 12/2011; 122(1-2):1-10. DOI:10.1016/j.drugalcdep.2011.11.011 · 3.28 Impact Factor
  • Source
    • "Client population characteristics, like the proportion that are adolescent or courtreferred , are also systemic indices linked to favorable CM attitudes of staff (Bride et al., 2011). Systemic variables linked to negative CM attitudes include clinic accreditation (Ducharme et al., 2007) and provision of detoxification services (Fuller et al., 2007). Extant literature concerning idiographic staff attributes as predictors of CM attitudes is more equivocal. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Adoption of contingency management (CM) by the addiction treatment community is limited to date despite much evidence for its efficacy. This study examined systemic and idiographic staff predictors of CM adoption attitudes via archival data collected from treatment organizations affiliated with the National Drug Abuse Treatment Clinical Trials Network. Multilevel modeling analyses evaluated potential predictors from organizational, treatment unit, and workforce surveys. Among these were individual and shared perceptions of staff concerning aspects of their clinic culture and climate. Modeling analyses identified three systemic predictors (clinic provision of opiate agonist services, national accreditation, and lesser shared perception of workplace stress) and five idiographic predictors (staff with a graduate degree, longer service tenure, managerial position, e-communication facility, and openness to change in clinical procedures). Findings are discussed as they relate to extant literature on CM attitudes and established implementation science constructs, and their practical implications are discussed.
    Journal of substance abuse treatment 12/2011; 42(2):213-21. DOI:10.1016/j.jsat.2011.10.012 · 2.90 Impact Factor
Show more