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Article Title

Improving Engagement in Addiction Treatment: Translating Addiction Research Into Evidence-Based Practice

Publication Date

4-30-2015

Keywords

addiction treatment, patient engagement

Abstract

Background/Aims: Patient engagement is critical for the success of addiction treatment. We sought to evaluate the effectiveness of an innovative patient engagement enhancement system, Enhanced Engagement in Chemical Dependency (EECD), for improving patient engagement in addiction treatment.

Methods: The EECD system promotes motivational interviewing/motivational enhancement therapy (MI/MET) and service matching approaches, an evidence-based practice that can improve engagement. It includes two components: 1) staff training in MI/MET, and 2) a standardized Web-based engagement assessment with real-time clinical and personalized patient reports and program-level management reports. We will roll out a staggered implementation in 12 outpatient addiction treatment programs at Kaiser Permanente Southern California, where about 8,000 new intakes were conducted per year. The analysis employs a stepped wedge design, in which all adults who have completed an intake in the 6 months prior to implementation will serve as internal baseline controls, while all adults who have completed an intake in the sites that have not yet implemented the system will serve as external controls for the implementation sites. We will evaluate the effectiveness of the EECD system on: 1) improving treatment engagement (attendance at two sessions within 30 days after the initial treatment visit); 2) authentic participation in outpatient treatment; 3) clinical outcomes (addiction severity index); 4) reducing treatment reentry within 6 months following the end of a treatment episode; 5) matching services to patient needs; and 6) sustained effectiveness in improving engagement. Generalized estimating equations will be used to test for significant differences in proportion of patients with favorable outcomes on binary variables. Linear mixed models will be used for continuous outcome variables.

Results: Staff training and a staggered implementation of the EECD system will be rolled out in 12 sites during October 2014–April 2015, with two initial sites in phase I, five sites in phase II and five sites in Phase III. The results are forthcoming.

Discussion: This systemic intervention project represents an important example of translating research into improving patient care in addiction treatment, through a multidisciplinary collaboration between researchers, providers and operational leaders. The findings from this project will facilitate adoption of evidence-based practices and innovative technologies in addiction treatment.

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