Research across the health care industry has shown that measuring patient outcomes and using that information to guide care can improve care quality and overall treatment outcomes. Although addiction treatment has lagged in implementing outcomes measurement, there is growing interest in adopting this approach.
In response to this growing interest, I recently moderated a webinar that described how outcome measurement can be used to improve the quality of addiction treatment. During the webinar, we heard from three practitioners who are currently collecting and using outcome measures to improve the quality of their addiction treatment services.
I kicked off the webinar by reviewing the evidence that measurement-based care and provider feedback improves outcomes, in general and specifically for addiction treatment. Scott Luetgenau, Medication-Assisted Treatment Director of SouthLight Healthcare, discussed the use of an application, ACORN, that collects patient-centered measures to benchmark the performance of clinicians. Dr. Katherine Fitzgerald, Medical Director of a treatment center in Massachusetts, has been using a mobile phone application to improve client engagement by allowing patients to input simple mood data that can be easily shared with care providers and transferred to an electronic health record HER. Finally, Karin Haberlin, Behavioral Health Program Manager for the Connecticut Department of Mental Health and Addiction Services, has implemented provider performance reports that allows addiction treatment programs to track their outcomes relative to benchmarks and their peers.
In addition to sharing best practices and lessons learned from measurement-based care applications, each speaker also had the opportunity to answer questions from attendees. Below, we’ve reprinted some of the top questions and responses from the Q&A session.
Question: I’m struggling to identify particular measures that I like for treatment outcomes. Can you reiterate the outcomes you’re capturing?
Scott: A lot of literature has shown that therapeutic alliance is critical. We’re also measuring substance abuse—if a client is able to abstain or reduce substance use to management levels. We’re also looking at global distress. The outcomes give us a lot of information around mental illness symptomology in addition to substance use.
Question: How can measurement-based care encourage engagement?
Katherine: A lot of people in early recovery are afraid to leave the safety and privacy of their home, especially given the stigma associated with addiction and early recovery. That’s one reason why going for treatment with their primary care doctor is a little easier than going to a standalone addiction center—people will just think you’re going to the doctor, so that’s a little easier. But it’s still hard to go to a group for the first time. It’s hard to get treatment and ask for help. It’s easier to reach out for help through an application, especially for the younger generation. If you can get them to reach out through an app, they’re more willing to do that. They still have to come to group, and they have to come see me, but this is an added avenue for them to reach out to their provider, a nurse, and their peers, to prevent isolation. Usually they’ll warm up and realize that it’s a safe place and begin to trust everyone. It’s another tool in the toolbelt to make them feel they’re part of a community, which is crucial.
Question: Can you talk a little about the feedback from providers on the performance reports?
Karin: We’ve gotten a lot of positive feedback, but it took a number of years. It’s 2019 now, and we started back in 2013-2014. We have done a lot of education around these provider quality reports. We have bimonthly provider quality conference calls where we talk about data quality issues, share news, talk about the development of the report cards, etc. We also have forums a couple times a year. These are opportunities for us to talk about issues, hash out any problems that people have, and ask questions. We also encourage people to email or call us with questions. Early on in the process, we definitely got a lot of feedback and spent a lot of time ensuring that the data was accurate. Sometimes we would find that, for example, it was that a provider was using a discharge reason that wasn’t accurate, while other times we might have had a calculation problem. We kept a log for the first couple of years with all the questions and comments that people made, and we would go through this log religiously on a weekly basis. Nowadays, we don’t get much feedback—people review their provider quality reports and they’re good to go.
Question: Can you share the biggest challenge you faced in optimizing your outcome measurement system, and how you’ve overcome it?
Katherine: The biggest challenge would be participation. Not everyone utilizes the app like I want them to. I have about 50% of them that do it regularly and are very good about it, and the other 50% only use it when they are in crisis. That obviously skews data. I can assume that the other 50% of the time, things are rosy. We’re trying to work with patients to be more consistent and participate more in the group aspect, but at the end of the day, the end goal is that they’re doing better in their recovery. As far as research, it does skew my data a little bit.
Scott: Our biggest challenge was getting the buy-in of the clinicians, to allow us to kind of open the curtain and see what’s going on in those sessions. What’s the value? How are we going to use the information? Is this going to be a part of their evaluation process? Clearly, that wasn’t going to be the case. We had the founder of the organization, ACORN, do an informational webinar with our staff, which helped a lot to get the buy-in there. Just making this part of the experience for your clients, so they know they’re going to fill out this questionnaire when they come in. It only takes about a minute—it’s really quick. Now a lot of clients look forward to filling them out. They think about how they might answer those questions in between sessions. I think the proof is in the pudding—our clinicians are starting to see the value there. Sometimes folks will disclose things in their survey that they may not feel comfortable verbally expressing in a session. We see a lot of remarkable strides being made with our therapeutic alliance with clientele and clinicians buy-in. Once they were on board, we felt really good about the data and how it was being handled.
When properly implemented, measurement-based care can improve early detection of risk factors for relapse, detect patients who are not progressing with treatment as expected, improve patient engagement and self-management, improve patient-clinician communication and joint decision making, and communicate value to payers and other stakeholders. By working with clinicians and clients to demonstrate the value in collecting these measures and by sharing our trials and errors with others in the community, we can continue to improve implementation of this evidence-based practice.
To learn more about the webinar, download the slides, and view a recording of the presentation, visit the webinar event page.