Testing of a patient-centered e-health implementation model in addiction treatment

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Project Summary/Abstract A team of researchers from the Center for Health Enhancement Systems Studies (the Center) at University of Wisconsin–Madison College of Engineering and the Iowa Department of Public Health will test the effectiveness of the Network for the Improvement of Addiction Treatment-Technology Implementation (NIATx- TI) framework in implementing the ACHESS substance use disorder (SUD) treatment and recovery app. ACHESS uses smartphone technology to provide continual access to SUD care and has improved treatment outcomes in a randomized trial as well as in real-world SUD treatment settings with patients with opioid and alcohol use disorders. Despite its evidence base and 74% of SUD treatment patients possessing a smartphone, ACHESS is currently used in <1% of settings that provide SUD treatment. ACHESS is not unique in this regard; health care, in general, has low patient-centered technology adoption rates. This low adoption highlights yet another implementation gap and the need for the dissemination and implementation field to develop approaches to facilitate adoption of the growing list of evidence-based e-health technologies. The two strategies to be tested in increasing ACHESS use are the NIATx-TI framework and product training, followed by ongoing technical support. The NIATx-TI framework developed by our Center builds on our experience in applying the NIATx organizational change model in more than 3,300 organizations. NIATx-TI combines the systems engineering principles embedded in the NIATx organizational model with validated technology adoption techniques. NIATx-TI was piloted successfully in our Center's 7-state project, “Promoting the Use of Technology to Improve Treatment and Recovery Learning Collaborative,” and led to a 2-fold increase in clients receiving distance treatment during the pilot study. The RE-AIM framework will be used to measure the impact of the 2 interventions in n=16 SUD organizations in Iowa (with n=8 organizations per each arm). A qualitative and cost analysis will be used to develop a better understanding of the implementation process. Iowa was selected as a research setting because of its diverse population of service providers, high participation rates in other national projects, strong data reporting systems, and because the Iowa Consortium for Substance Abuse Research & Evaluation will provide strong local support for the study. SUD treatment providers in Iowa and across the country need the effective treatment supports that evidence-based mobile technologies can provide when successfully implemented. ACHESS and other promising evidence-based patient-centered technologies are positioned to alter SUD treatment and its outcomes. Through testing the NIATx-TI framework and typical product training, this trial will yield a deeper understanding of how to successfully implement ACHESS and other promising evidence-based technologies.