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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    • "One consequence of this organizational distance is that most SAT agencies are underresourced, have few slack resources to invest in technological improvements, rely on paraprofessional rather than professional staff to provide treatment, and commonly focus on helping clients initiate the twelve steps to the exclusion of pharmacotherapy and other evidence-based practices (D'Aunno 2006). At the other end of the spectrum, a minority of SAT programs are fiscally, technologically, and strategically sophisticated; affiliated with mainstream health care institutions and investigators (Ducharme et al. 2007); striving to implement quality improvement processes and evidence-based practices (Hoffman et al. 2011; Quanbeck et al. 2011); and likely positioning themselves in anticipation of health reform. Conceptual Approach We argue that a critical first step toward the integration of substance abuse treatment with primary care and other mainstream health care providers is the formal inclusion of SAT organizations in ACOs (Buck 2011). "
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    ABSTRACT: To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation's fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors' perceptions of market competition, organizational ownership, and geographic location are significantly related to SAT involvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system. Copyright © 2015 by Duke University Press.
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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.
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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. "

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