Transcript Reduce Waiting & No-Shows

David Gustafson PhD
NIATx Director, University of Wisconsin-Madison
Reduce Waiting & No-Shows  Increase Admissions & Continuation
www.NIATx.net
Reduce Waiting & No-Shows  Increase Admissions & Continuation
The Network for the Improvement of Addiction
Treatment (NIATx): a partnership of
The Center for Substance Abuse Treatment
Strengthening Treatment Access and Retention
and
The Robert Wood Johnson Foundation
Paths to Recovery
www.NIATx.net
Reduce Waiting & No-Shows  Increase Admissions & Continuation
Also NCI’s TECC Center of Excellence
in Cancer Communications Research
www.NIATx.net
Reduce Waiting & No-Shows  Increase Admissions & Continuation
NIATx Presence
www.NIATx.net
Reduce Waiting & No-Shows  Increase Admissions & Continuation
Key Points
• M/SU  Fantastic!!!
• Process Improvement can speed adoption
of evidence based practices
• States: key to diffusing Process
Improvement
• Redesign should involve technology to be
customer centered.
www.NIATx.net
Reduce Waiting & No-Shows  Increase Admissions & Continuation
www.NIATx.net
Reduce Waiting & No-Shows  Increase Admissions & Continuation
Between patient and caring help
lies a canyon of paperwork and
burdensome processes
• A chronic disease where
timing is everything
• Poorly designed processes
keep patients & staff apart
• And they waste money
• Processes CAN be
improved!
www.NIATx.net
Reduce Waiting & No-Shows  Increase Admissions & Continuation
Our focus: Nine Processes.
•
•
•
•
•
•
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•
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First contact
Intake and assessment
Transition thru levels of care
Paperwork
Scheduling
Engagement
Social supports
Outreach
Maximizing revenue
Reduce Waiting & No-Shows  Increase Admissions & Continuation
Clear, precise aims
Reduce Waiting Times
Reduce No-Shows
Increase Admissions
Increase Continuation Rates
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Five Evidence Based Principles
• Help the CEO sleep
• Rapid improvement
• Ideas & “pressure” from outside.
• Influential change leader
• Understand/involve customers
16
14
12
10
8
6
4
2
0
Customer
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Problem
Change
agent
Look
outside
Quality
Reduce Waiting & No-Shows  Increase Admissions & Continuation
Results so Far.
 Waiting Times: 51% (n=37)
 Reduce No-Shows: 41% (n=28)
 Increaase admissions: 56% (n=23)
 Improve continuation : 39% (n=39)
*Change cycle data
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Lessons from Acadia Hospital
(Mental Illness + Addiction Treatment)
Lynn M. Madden, MPA, CHE
Acadia Hospital
Bangor, Maine
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Open Access to IOP
Clients fitting clinical profile (phone or ED) offered
evaluation @ 7:30 next AM.
Evaluated clients start treatment same day
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
IOP Access Results
Continued growth in admissions
(project implemented in March 2003)
70
67/mth
60
50
40
43/mth
30
28/mth
20
10
16/mth
0
FY02
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FY03
FY04
FY05 YTD
(through 5/05)
Reduce Waiting & No-Shows  Increase Admissions & Continuation
IOP Operating Results
Serve more clients & operate more efficiently
$300,000
Persons Served in IOP
$208,639
$225,000
1000
$150,000
800
804
600
$0
516
400
-$75,000
336
200
192
0
FY02
$75,000
-$150,000
FY03
FY04
FY05 (annual ized
from 5/05)
-$225,000
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FY02
FY03
FY04
-$139,346
-$202,611
Outpatient Substance Abuse Services Net Profit or Loss
Reduce Waiting & No-Shows  Increase Admissions & Continuation
Physical Restraints
(CMS/JCAHO)
• Inpatients more complex w less restrictive care.
• Too many restraints.
• Rapid Response Team
– Medical Dir. Clinical Sup. & RN mgr.
– Meet w/in 24hrs of any mechanical restraint
– Make rapid changes to treatment plan to reduce need
for further restraints
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Restraint reduction
41% Physical; 32% Mechanical
25
20
15
Before
After
10
5
0
Mechanical
Physicial
Restraints per 1000 bed days
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
NIATx State Pilot Project
States play a key role in promoting adoption
of process improvements
Delaware
Iowa
North Carolina
Oklahoma
Texas
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Tx Agency
Processes
State processes
Incentives
State
NIATx
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Lessons from Oklahoma
Terry Cline, PhD
Oklahoma Department of Mental Health and Substance Abuse
Services
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Oklahoma Project #1
• Eliminate eligibility determination
requirement for those seeking treatment
• Preliminary results:
– Data being collected
– Anecdote: one outpatient provider reduced time
from 1st contact to admission from 30+ to 3 days
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Oklahoma Project #2
• Reduce paperwork in state treatment rules.
Cut duplication in clinical documentation
that evolved over many years.
• Results:
– Residential providers reduced admission time
from 8 to 2 hours.
– Outpatient providers reduced admission time
from 4 to 3 hours
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Technology
Technology can improve treatment
of mental illness & addiction.
Electronic Medical Records are
key AND . . .
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Virtual Reality Simulations
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Mobile Social Software (MoSoSo)
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Smart Phones
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Wearables:
(pulse, blood pressure, sweating, etc)
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Biofeedback
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
RFID (chip w medical record)
http://www.wired.com/wired/archive/8.02/warwick.html
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Information/decision help
(chess.chsra.wisc.edu/bc)
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Video Conferencing on a PC
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Diagnosis & Treatment Planning
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Computer-based Discussion Groups
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Affective Computing
•
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Technology can help now!
• Patients
• Families
• Treatment providers
• Primary care and Emergency
• Child welfare and criminal justice.
www.NIATx.net
Reduce Waiting & No-Shows  Increase Admissions & Continuation
EMR
Reminders
Wearables
GPS
Vaccines
CHESS
VR
training
Journaling
Monitor w surveys & physiology.
Prepare to
quit w trial
quit
attempts.
Train SOs
Increasing
lifestyle
imbalance
& desire for
gratification
ID high-risk people
Set up plan
Remov craving causes
Lower symptoms
Problem knowledge
couplers.
EMR
Video conferencing
RFID
Withdrawal
symptoms
Fear
Overwhelm
Anger
Depressed
Hopeless
Remove symptoms
Know warning sign
Ways to avoid &
cope
Anti-drugs
Biofeedback
VR
CBT
MoSoSo
Discussion Groups
Ask Expert
VR
Affective
computing
Immediate rewards w increasing payments.
Rationalize
& deny
Rehearse
relapse
Hi-risk
situation
Analyze the
situation &
options
VR
Decision
analysis
Social support.
No coping
response
Reduced
efficacy
Temporal
discountng
Show relapse effects
Break into sub-tasks
See as gaining skills
Stress mgmt,
Relaxation training,
Social norm 
Environment 
Video conf
Action planning
Online stress
mgt
Note: Smart phone will be key communication device.
Initial
lapse
See as mistake
Remind how to
cope w lapse.
Contract: no more
Reminders
Video conf
Key Points
• M/SU  Fantastic!!!
• Process Improvement can speed adoption
of evidence based practices
• States: key to diffusing Process
Improvement
• Redesign should involve technology to be
customer centered.
www.NIATx.net
Reduce Waiting & No-Shows  Increase Admissions & Continuation